Ignace Hanoulle - Academia.edu (original) (raw)

Papers by Ignace Hanoulle

Research paper thumbnail of Improving quality of life in patients with chronic kidney disease: influence of acceptance and personality

Nephrology Dialysis Transplantation, Jul 20, 2012

Background. A low health-related quality of life (HQL) is associated with the evolution of chroni... more Background. A low health-related quality of life (HQL) is associated with the evolution of chronic kidney disease (CKD) and mortality in patients in end-stage of the disease. Therefore research on psychological determinants of HQL is emerging. We investigate whether acceptance of the disease contributes to a better physical and mental health-related quality of life (PHQL and MHQL). We also examine the impact of personality characteristics on acceptance, PHQL and MHQL. Methods. In this cross-sectional study, patients from an outpatient clinic of nephrology completed self-report questionnaires on quality of life, acceptance and personality characteristics. We performed correlations, regression analyses and a path analysis. Results. Our sample of 99 patients had a mean duration of CKD of 10.81 years and a mean estimated Glomerular Filtration Rate (eGFR) by Modification of Diet in Renal Disease (MDRD)-formula of 34.49 ml/min (SD 21.66). Regression analyses revealed that acceptance had a significant positive contribution to the prediction of PHQL and MHQL. Neuroticism was negatively associated with acceptance and MHQL. Path analysis showed that 37% of the total effect of neuroticism on MHQL was mediated by acceptance. Conclusions. Acceptance is an important positive variable in accounting for HQL, however, clinicians must be aware that if patients have a high level of neuroticism they are likely to have more difficulties with this coping strategy. These results provide a better understanding of psychological determinants of HQL in CKD, which can initiate another approach of these patients by nephrologists, specific psychological interventions, or other supporting public health services.

Research paper thumbnail of Therapeutic compliance and the impact on symptomatic outcome in patients with chronic fatigue and chronic fatigue syndrome

Journal of Sleep Research, 2016

Research paper thumbnail of Correlations of use of antidepressants, hypnotics and anti-histaminics with occurrence of clinically significant periodic limb movement in polysomnographically assessed abnormal fatigue and insomnia

Journal of Sleep Research, 2018

Research paper thumbnail of Personality Traits in Chronic Pain Patients Are Associated with Low Acceptance and Catastrophizing About Pain

Acta Clinica Belgica, 2011

Objective: Pain acceptance is considered important for mental well-being with better functional o... more Objective: Pain acceptance is considered important for mental well-being with better functional outcomes for chronic pain patients. The present study explored whether pain-related variables (pain severity, pain interference, pain duration, and pain catastrophizing) and non-pain-related variables (personality traits) influence acceptance and additionally examined the interrelationship between the influencing variables and acceptance. Methods: One hundred patients with chronic pain from a multidisciplinary pain centre completed selfreport questionnaires on acceptance, pain severity, interference of life, pain duration, pain catastrophizing, and personality. Results: Pain severity, pain interference, and pain duration had no significant correlations with acceptance. Pain catastrophizing and most personality traits were significantly and negatively related to acceptance. Regression analyses revealed that of all personality traits, the avoidant personality trait explains most variance of...

Research paper thumbnail of Subjective sleep quality, fatigue and depressive symptoms during and after pregnancy

Journal of Sleep Research, 2018

Research paper thumbnail of Therapeutic compliance and the impact on symptomatic outcome in patients with chronic fatigue and chronic fatigue syndrome

Journal of Sleep Research, 2016

Research paper thumbnail of Retrospective Analysis of Risk Factors for Periodic Limb Movements in a Large Cohort of Insomnia and Chronic Fatigue Patients

Pharmacopsychiatry, 2019

Introduction Although the pathophysiology of periodic limb movements in sleep (PLMS) is not well ... more Introduction Although the pathophysiology of periodic limb movements in sleep (PLMS) is not well understood, there is increasing belief that management of PLMS can modulate humans’ general health. The aim of this study is to investigate the associations between risk factors including the use of antidepressants, hypnotics, and antihistamines as well as of caffeine, alcohol, and nicotine and the occurrence of PLMS and periodic limb movement disorder (PLMD). Methods Patients with either chronic fatigue or insomnia who underwent polysomnography as standardized clinical assessment were included in a retrospective study. Associations were calculated between substance use and sleep variables. Results Tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitor (SNRI) are significantly associated with higher rates of PLMS. Additionally, SNRI is significantly positive associated with PLMD, as also seen for selective serotonin reuptake inhibitors (SSRI). The most frequently u...

Research paper thumbnail of Comparison of subjective sleep and fatigue in breast- and bottle-feeding mothers

Midwifery, 2017

Formula supplementation remains a popular practice in spite of the well documented and indisputab... more Formula supplementation remains a popular practice in spite of the well documented and indisputable advantages of breastfeeding for both mother and child. However, the association between maternal sleep, fatigue and feeding method is understudied and remains unclear. The aim of this study is to investigate whether perceived sleep and fatigue differ between breastand bottle-feeding postpartum women. In addition, the relationship between subjective sleep characteristics and fatigue is examined. Methods: Postpartum women (four to 16 weeks) filled out a socio-demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) and the Checklist Individual Strength (CIS). Results: Sixty-one within the past week exclusively breast-and 44 exclusively bottle-feeding mothers were included. The first group showed better subjective sleep quality, but lower habitual sleep efficiency as measured by the PSQI. Global PSQI, as well as subjective fatigue and global CIS, did not differ between the two groups. Significant positive correlations were found between global CIS and the number of night feeds and global PSQI. However, only global PSQI significantly predicted global CIS in relation to the number of night feeds. Conclusions: Within a general pattern of deteriorated sleep quality, breastfeeding women showed better subjective sleep quality, but lower habitual sleep efficiency, between four and fourteen weeks after childbirth. However, the PSQI component scores compensated for each other, resulting in absence of any difference in global PSQI sleep quality between the two groups. Global PSQI significantly predicted global CIS, resulting in an absence of any difference in postpartum fatigue according to feeding method.

Research paper thumbnail of Factors determining fatigue in the chronic fatigue syndrome: a path analysis

Acta Clinica Belgica, 2016

Objectives: To explore the interrelationship of different dimensions (fatigue, neuroticism, sleep... more Objectives: To explore the interrelationship of different dimensions (fatigue, neuroticism, sleep quality, global mental and physical health) in patients with chronic fatigue syndrome (CFS). Methods: Patients meeting the Fukuda criteria of CFS filled out two independent fatigue scales (Fatigue Questionnaire, FQ and Checklist Individual Strength, CIS), NEO-Five Factor Inventory (NEO-FFI), Pittsburgh Sleep Quality Index (PSQI) and Medical Outcomes Study 36-item Short Form Health Survey (SF36). Exploratory and confirmatory path analyses were performed. Results: Out of 226 eligible patients, 167 subjects were included (mean age 39.13 years, SD 10.14, 92% female). In a first exploratory path analysis, using FQ for assessment of fatigue, night-time PSQI sleep quality had a direct effect on SF36 physical quality of life (PQoL) and no effect on FQ fatigue. This was confirmed by a subsequent path analysis with CIS fatigue and by confirmatory path analyses in 81 patients. These unexpected results raised the question whether FQ or CIS fatigue sufficiently operationalizes fatigue in CFS patients. Conclusions: Poor sleep quality seems to directly impact on mental quality of life (MQoL) and PQoL without mediation of fatigue assessed with FQ and CIS. A more cohesive framework needs to be developed with more comprehensive clinical tools for the different dimensions in the construct of CFS.

Research paper thumbnail of Polysomnographic and multiple sleep latency testing data in a large sample of patients with chronic fatigue syndrome and their relationship with subjective scores

Fatigue: Biomedicine, Health & Behavior, 2015

ABSTRACT Background: Despite the majority of patients with chronic fatigue syndrome (CFS) complai... more ABSTRACT Background: Despite the majority of patients with chronic fatigue syndrome (CFS) complaining about sleep disturbances and/or non-refreshing sleep, abnormalities in objective sleep parameters have not consistently been identified in this population. Purpose: To assess objective parameters of sleep and sleepiness in a large sample of patients with CFS and their relationship with the subjective dimensions of mental and physical health, sleep quality, daytime sleepiness and fatigue. Methods: Objective sleep parameters were derived from polysomnography (PSG) and multiple sleep latency testing (MSLT). Subjective scores for mental and physical health, sleep quality, daytime sleepiness and fatigue were based on validated, self-report questionnaires. Hierarchical multiple regression analysis was performed to predict sleepiness, global quality of sleep and fatigue. Results: PSG in 184 CFS patients indicated decreased total sleep time and sleep efficiency as well as increased sleep latency and waking after sleep onset. Only a few modest but significant correlations (r’s < .30) were found between objective parameters of sleep and sleepiness and subjective scores for health, sleep quality and fatigue. Conclusions: Objective sleep parameters indicated poor sleep in CFS, suggesting an insomnia phenotype, but with only modest associations to subjective scores of mental and physical health, sleep quality, daytime sleepiness and fatigue.

Research paper thumbnail of Mutual perception of communication between general practitioners and hospital-based specialists

Acta Clinica Belgica, 2015

Communication between general practitioners (GPs) and specialists is an important aspect of quali... more Communication between general practitioners (GPs) and specialists is an important aspect of qualitative care. Efficient communication exchange is essential and key in guaranteeing continuity of care. Inefficient communication is related to several negative outcomes, including patient harm. This study aimed to investigate the perception of GPs and hospital-based specialists in Belgium of the quality of their mutual communication. A cross-sectional study was conducted among GPs and specialists. Participants were asked to complete a validated questionnaire on several aspects of their mutual communication. Response rates of 17.9% (343/1.912) for GPs and 17.3% (392/2.263) for specialists were obtained. Both specialists and GPs qualify their mutual telephone accessibility as suboptimal. Specialists think poorly of the GP referral letter, in contrast to GP perception. Eighty per cent of the GPs feel that specialists address their questions appropriately; specialists have a similar perception of their own performance. According to 16.7% of the specialists, GPs not always follow their recommendations. Contrarily, GPs rate their compliance much higher (90.7%). Less than half of the GPs feel that the specialists&amp;amp;amp;amp;amp;amp;#39; letter arrives on time, whereas specialists have a different and a more positive perception. GPs and specialists disagree on several aspects of their mutual communication. These include the perception of accessibility, in both directions, and of the timeliness of written communication. Feedback is positively appreciated, again in both directions. Nevertheless, specialists feel that uptake of their recommendations is insufficient. Hence, there may remain significant room for improvement, which could contribute significantly to continuity of care and patient safety.

Research paper thumbnail of Sleep in the chronic fatigue syndrome

Sleep Medicine Reviews, 2013

Chronic fatigue syndrome (CFS) is a disabling condition characterized by severe fatigue lasting f... more Chronic fatigue syndrome (CFS) is a disabling condition characterized by severe fatigue lasting for more than six months and the presence of at least four out of eight minor criteria. Sleep disturbance presenting as unrefreshing or nonrestorative sleep is one of these criteria and is very common in CFS patients. Biologically disturbed sleep is a known cause of fatigue and could play a role in the pathogenesis of CFS. However, the nature of presumed sleep impairment in CFS remains unclear. Whilst complaints of NRS persist over time, there is no demonstrable neurophysiological correlate to substantiate a basic deficit in sleep function in CFS. Polysomnographic findings have not shown to be significantly different between subjects with CFS and normal controls. Discrepancies between subjectively poor and objectively normal sleep suggest a role for psychosocial factors negatively affecting perception of sleep quality. Primary sleep disorders are often detected in patients who otherwise qualify for a CFS diagnosis. These disorders could contribute to the presence of daytime dysfunctioning. There is currently insufficient evidence to indicate that treatment of primary sleep disorders sufficiently improves the fatigue associated with CFS. Therefore, primary sleep disorders may be a comorbid rather than an exclusionary condition with respect to CFS.

Research paper thumbnail of Polysomnographic and MSLT data in a large sample of patients with unexplained chronic fatigue: comparison with a reference sample and relation with subjective scores

Research paper thumbnail of Interrelationship of sleep quality with fatigue, neuroticism and global health in unexplained chronic fatigue

Sleep Medicine, 2013

Introduction The interrelationship of different dimensions (fatigue, neuroticism, sleep quality, ... more Introduction The interrelationship of different dimensions (fatigue, neuroticism, sleep quality, global mental and physical health) in patients with unexplained chronic fatigue, referred with presumed chronic fatigue syndrome (CFS), was explored. Materials and methods Patients with unexplained chronic fatigue filled out two independent fatigue scales (Fatigue Questionnaire, FQ and Checklist Individual Strength, CIS), NEO-Five Factor Inventory (NEO-FFI), Pittsburgh Sleep Quality Index (PSQI) and Medical Outcomes Study 36-item Short Form Health Survey (SF36). Path and regression analyses were performed. Results Out of 296 eligible patients, 203 subjects were included (mean age 39.0 years, SD 10.37, 89% female). In a first path analysis, using FQ for assessment of fatigue, night-time PSQI sleep quality had a direct effect on SF36 physical health quality of life (PHQL) and no effect on FQ fatigue. This was confirmed by a subsequent path analysis with CIS fatigue and by regression analyses. These unexpected results raised the question whether FQ or CIS fatigue sufficiently reflects fatigue. For both scales, the introduction of a latent variable into the model resulted in a significant improvement of fit, with an indirect effect of PSQI sleep quality on SF36 PHQL through this latent variable. Furthermore, this variable had a direct effect on FQ or CIS fatigue, respectively, and on the two SF36 variables. Conclusion A latent variable was introduced as missing link in the relationship between different subjective complaints of patients with presumed CFS and outcome measures of quality of life. Hence, this finding holds promise for a more cohesive framework of the different dimensions in the construct of chronic fatigue and CFS and needs to be developed as a clinical tool.

Research paper thumbnail of Mental quality of life in chronic fatigue is associated with an accommodative coping style and neuroticism: a path analysis

Quality of Life Research, 2011

Purpose An accommodative coping style (e.g. acceptance) is related to a better mental health-rela... more Purpose An accommodative coping style (e.g. acceptance) is related to a better mental health-related quality of life (MHQL) in patients with chronic fatigue syndrome (CFS). We want to explore whether neuroticism is predictive for this coping style and MHQL. Secondly we want to explore the relation between acceptance and physical health-related quality of life (PHQL) and expect that illness-related variables such as fatigue severity and duration are related to PHQL. Method In this cross-sectional study, 117 patients with chronic fatigue syndrome from an outpatient internal medicine clinic completed self-report questionnaires on quality of life (SF-36), acceptance (ICQ), personality traits (NEO-FFI) and fatigue severity (CIS). Results Regression analyses showed that neuroticism and acceptance are predictors of MHQL (38% of the variance was explained). The path analysis showed that acceptance mediates between neuroticism and MHQL and that PHQL is related to MHQL. PHQL is related to fatigue severity and duration, but not to neuroticism and acceptance. Conclusion Stimulating an 'accepting accommodative coping style' within the treatment for CFS is important in improving mental quality of life. Our results suggest that neuroticism may be negatively related to acceptance and MHQL. This findings support the idea that a psychological diagnostic workout with special attention to personality traits in relation to their coping style is recommended in order to choose the most appropriate therapeutic approach in this population.

Research paper thumbnail of Improving quality of life in patients with chronic kidney disease: influence of acceptance and personality

Nephrology Dialysis Transplantation, 2012

Background. A low health-related quality of life (HQL) is associated with the evolution of chroni... more Background. A low health-related quality of life (HQL) is associated with the evolution of chronic kidney disease (CKD) and mortality in patients in end-stage of the disease. Therefore research on psychological determinants of HQL is emerging. We investigate whether acceptance of the disease contributes to a better physical and mental health-related quality of life (PHQL and MHQL). We also examine the impact of personality characteristics on acceptance, PHQL and MHQL. Methods. In this cross-sectional study, patients from an outpatient clinic of nephrology completed self-report questionnaires on quality of life, acceptance and personality characteristics. We performed correlations, regression analyses and a path analysis. Results. Our sample of 99 patients had a mean duration of CKD of 10.81 years and a mean estimated Glomerular Filtration Rate (eGFR) by Modification of Diet in Renal Disease (MDRD)-formula of 34.49 ml/min (SD 21.66). Regression analyses revealed that acceptance had a significant positive contribution to the prediction of PHQL and MHQL. Neuroticism was negatively associated with acceptance and MHQL. Path analysis showed that 37% of the total effect of neuroticism on MHQL was mediated by acceptance. Conclusions. Acceptance is an important positive variable in accounting for HQL, however, clinicians must be aware that if patients have a high level of neuroticism they are likely to have more difficulties with this coping strategy. These results provide a better understanding of psychological determinants of HQL in CKD, which can initiate another approach of these patients by nephrologists, specific psychological interventions, or other supporting public health services.

Research paper thumbnail of Validation of the three-factor model of the PSQI in a large sample of chronic fatigue syndrome (CFS) patients

Journal of Psychosomatic Research, 2012

To evaluate whether a 3-factor model of the Pittsburgh Sleep Quality Index (PSQI) scale would fit... more To evaluate whether a 3-factor model of the Pittsburgh Sleep Quality Index (PSQI) scale would fit the constellation of sleep disturbances in patients with a diagnosis of chronic fatigue syndrome (CFS). Methods: Consecutive CFS patients filled out the PSQI. Scores from this self-report questionnaire were examined with exploratory and confirmatory factor analysis (CFA). Results: 413 CFS patients were included for analysis in this study. CFA showed that the 7 PSQI component scores clustered into the 3 factors reported by Cole et al. (2006), i.e. Sleep Efficiency, Perceived Sleep Quality and Daily Disturbances. In contrast with the single-factor and all 2-factor models, all factor loadings were significant, and all goodness-of-fit values were acceptable. Conclusion: In CFS, the PSQI operates as a 3-factor scoring model as initially seen in healthy and depressed older adults. The separation into 3 discrete factors suggests the limited usefulness of the global PSQI as a single factor for the assessment of subjective sleep quality, as also evidenced by a low Cronbach's alpha (0.64) in this patient sample.

Research paper thumbnail of Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome

Journal of Psychosomatic Research, 2013

To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with ... more To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS). Methods: Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography + multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders. Results: Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8 years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder. Conclusions: A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.

Research paper thumbnail of Representation and segmentation of shape based on curvature singularities (Poster)

Perception, 1993

Associatie KULeuven. ...

Research paper thumbnail of Are curvature singularities sufficient to represent shape?

Investigative ophthalmology & visual science, 1994

Associatie KULeuven. ...

Research paper thumbnail of Improving quality of life in patients with chronic kidney disease: influence of acceptance and personality

Nephrology Dialysis Transplantation, Jul 20, 2012

Background. A low health-related quality of life (HQL) is associated with the evolution of chroni... more Background. A low health-related quality of life (HQL) is associated with the evolution of chronic kidney disease (CKD) and mortality in patients in end-stage of the disease. Therefore research on psychological determinants of HQL is emerging. We investigate whether acceptance of the disease contributes to a better physical and mental health-related quality of life (PHQL and MHQL). We also examine the impact of personality characteristics on acceptance, PHQL and MHQL. Methods. In this cross-sectional study, patients from an outpatient clinic of nephrology completed self-report questionnaires on quality of life, acceptance and personality characteristics. We performed correlations, regression analyses and a path analysis. Results. Our sample of 99 patients had a mean duration of CKD of 10.81 years and a mean estimated Glomerular Filtration Rate (eGFR) by Modification of Diet in Renal Disease (MDRD)-formula of 34.49 ml/min (SD 21.66). Regression analyses revealed that acceptance had a significant positive contribution to the prediction of PHQL and MHQL. Neuroticism was negatively associated with acceptance and MHQL. Path analysis showed that 37% of the total effect of neuroticism on MHQL was mediated by acceptance. Conclusions. Acceptance is an important positive variable in accounting for HQL, however, clinicians must be aware that if patients have a high level of neuroticism they are likely to have more difficulties with this coping strategy. These results provide a better understanding of psychological determinants of HQL in CKD, which can initiate another approach of these patients by nephrologists, specific psychological interventions, or other supporting public health services.

Research paper thumbnail of Therapeutic compliance and the impact on symptomatic outcome in patients with chronic fatigue and chronic fatigue syndrome

Journal of Sleep Research, 2016

Research paper thumbnail of Correlations of use of antidepressants, hypnotics and anti-histaminics with occurrence of clinically significant periodic limb movement in polysomnographically assessed abnormal fatigue and insomnia

Journal of Sleep Research, 2018

Research paper thumbnail of Personality Traits in Chronic Pain Patients Are Associated with Low Acceptance and Catastrophizing About Pain

Acta Clinica Belgica, 2011

Objective: Pain acceptance is considered important for mental well-being with better functional o... more Objective: Pain acceptance is considered important for mental well-being with better functional outcomes for chronic pain patients. The present study explored whether pain-related variables (pain severity, pain interference, pain duration, and pain catastrophizing) and non-pain-related variables (personality traits) influence acceptance and additionally examined the interrelationship between the influencing variables and acceptance. Methods: One hundred patients with chronic pain from a multidisciplinary pain centre completed selfreport questionnaires on acceptance, pain severity, interference of life, pain duration, pain catastrophizing, and personality. Results: Pain severity, pain interference, and pain duration had no significant correlations with acceptance. Pain catastrophizing and most personality traits were significantly and negatively related to acceptance. Regression analyses revealed that of all personality traits, the avoidant personality trait explains most variance of...

Research paper thumbnail of Subjective sleep quality, fatigue and depressive symptoms during and after pregnancy

Journal of Sleep Research, 2018

Research paper thumbnail of Therapeutic compliance and the impact on symptomatic outcome in patients with chronic fatigue and chronic fatigue syndrome

Journal of Sleep Research, 2016

Research paper thumbnail of Retrospective Analysis of Risk Factors for Periodic Limb Movements in a Large Cohort of Insomnia and Chronic Fatigue Patients

Pharmacopsychiatry, 2019

Introduction Although the pathophysiology of periodic limb movements in sleep (PLMS) is not well ... more Introduction Although the pathophysiology of periodic limb movements in sleep (PLMS) is not well understood, there is increasing belief that management of PLMS can modulate humans’ general health. The aim of this study is to investigate the associations between risk factors including the use of antidepressants, hypnotics, and antihistamines as well as of caffeine, alcohol, and nicotine and the occurrence of PLMS and periodic limb movement disorder (PLMD). Methods Patients with either chronic fatigue or insomnia who underwent polysomnography as standardized clinical assessment were included in a retrospective study. Associations were calculated between substance use and sleep variables. Results Tricyclic antidepressants and serotonin and norepinephrine reuptake inhibitor (SNRI) are significantly associated with higher rates of PLMS. Additionally, SNRI is significantly positive associated with PLMD, as also seen for selective serotonin reuptake inhibitors (SSRI). The most frequently u...

Research paper thumbnail of Comparison of subjective sleep and fatigue in breast- and bottle-feeding mothers

Midwifery, 2017

Formula supplementation remains a popular practice in spite of the well documented and indisputab... more Formula supplementation remains a popular practice in spite of the well documented and indisputable advantages of breastfeeding for both mother and child. However, the association between maternal sleep, fatigue and feeding method is understudied and remains unclear. The aim of this study is to investigate whether perceived sleep and fatigue differ between breastand bottle-feeding postpartum women. In addition, the relationship between subjective sleep characteristics and fatigue is examined. Methods: Postpartum women (four to 16 weeks) filled out a socio-demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI) and the Checklist Individual Strength (CIS). Results: Sixty-one within the past week exclusively breast-and 44 exclusively bottle-feeding mothers were included. The first group showed better subjective sleep quality, but lower habitual sleep efficiency as measured by the PSQI. Global PSQI, as well as subjective fatigue and global CIS, did not differ between the two groups. Significant positive correlations were found between global CIS and the number of night feeds and global PSQI. However, only global PSQI significantly predicted global CIS in relation to the number of night feeds. Conclusions: Within a general pattern of deteriorated sleep quality, breastfeeding women showed better subjective sleep quality, but lower habitual sleep efficiency, between four and fourteen weeks after childbirth. However, the PSQI component scores compensated for each other, resulting in absence of any difference in global PSQI sleep quality between the two groups. Global PSQI significantly predicted global CIS, resulting in an absence of any difference in postpartum fatigue according to feeding method.

Research paper thumbnail of Factors determining fatigue in the chronic fatigue syndrome: a path analysis

Acta Clinica Belgica, 2016

Objectives: To explore the interrelationship of different dimensions (fatigue, neuroticism, sleep... more Objectives: To explore the interrelationship of different dimensions (fatigue, neuroticism, sleep quality, global mental and physical health) in patients with chronic fatigue syndrome (CFS). Methods: Patients meeting the Fukuda criteria of CFS filled out two independent fatigue scales (Fatigue Questionnaire, FQ and Checklist Individual Strength, CIS), NEO-Five Factor Inventory (NEO-FFI), Pittsburgh Sleep Quality Index (PSQI) and Medical Outcomes Study 36-item Short Form Health Survey (SF36). Exploratory and confirmatory path analyses were performed. Results: Out of 226 eligible patients, 167 subjects were included (mean age 39.13 years, SD 10.14, 92% female). In a first exploratory path analysis, using FQ for assessment of fatigue, night-time PSQI sleep quality had a direct effect on SF36 physical quality of life (PQoL) and no effect on FQ fatigue. This was confirmed by a subsequent path analysis with CIS fatigue and by confirmatory path analyses in 81 patients. These unexpected results raised the question whether FQ or CIS fatigue sufficiently operationalizes fatigue in CFS patients. Conclusions: Poor sleep quality seems to directly impact on mental quality of life (MQoL) and PQoL without mediation of fatigue assessed with FQ and CIS. A more cohesive framework needs to be developed with more comprehensive clinical tools for the different dimensions in the construct of CFS.

Research paper thumbnail of Polysomnographic and multiple sleep latency testing data in a large sample of patients with chronic fatigue syndrome and their relationship with subjective scores

Fatigue: Biomedicine, Health & Behavior, 2015

ABSTRACT Background: Despite the majority of patients with chronic fatigue syndrome (CFS) complai... more ABSTRACT Background: Despite the majority of patients with chronic fatigue syndrome (CFS) complaining about sleep disturbances and/or non-refreshing sleep, abnormalities in objective sleep parameters have not consistently been identified in this population. Purpose: To assess objective parameters of sleep and sleepiness in a large sample of patients with CFS and their relationship with the subjective dimensions of mental and physical health, sleep quality, daytime sleepiness and fatigue. Methods: Objective sleep parameters were derived from polysomnography (PSG) and multiple sleep latency testing (MSLT). Subjective scores for mental and physical health, sleep quality, daytime sleepiness and fatigue were based on validated, self-report questionnaires. Hierarchical multiple regression analysis was performed to predict sleepiness, global quality of sleep and fatigue. Results: PSG in 184 CFS patients indicated decreased total sleep time and sleep efficiency as well as increased sleep latency and waking after sleep onset. Only a few modest but significant correlations (r’s < .30) were found between objective parameters of sleep and sleepiness and subjective scores for health, sleep quality and fatigue. Conclusions: Objective sleep parameters indicated poor sleep in CFS, suggesting an insomnia phenotype, but with only modest associations to subjective scores of mental and physical health, sleep quality, daytime sleepiness and fatigue.

Research paper thumbnail of Mutual perception of communication between general practitioners and hospital-based specialists

Acta Clinica Belgica, 2015

Communication between general practitioners (GPs) and specialists is an important aspect of quali... more Communication between general practitioners (GPs) and specialists is an important aspect of qualitative care. Efficient communication exchange is essential and key in guaranteeing continuity of care. Inefficient communication is related to several negative outcomes, including patient harm. This study aimed to investigate the perception of GPs and hospital-based specialists in Belgium of the quality of their mutual communication. A cross-sectional study was conducted among GPs and specialists. Participants were asked to complete a validated questionnaire on several aspects of their mutual communication. Response rates of 17.9% (343/1.912) for GPs and 17.3% (392/2.263) for specialists were obtained. Both specialists and GPs qualify their mutual telephone accessibility as suboptimal. Specialists think poorly of the GP referral letter, in contrast to GP perception. Eighty per cent of the GPs feel that specialists address their questions appropriately; specialists have a similar perception of their own performance. According to 16.7% of the specialists, GPs not always follow their recommendations. Contrarily, GPs rate their compliance much higher (90.7%). Less than half of the GPs feel that the specialists&amp;amp;amp;amp;amp;amp;#39; letter arrives on time, whereas specialists have a different and a more positive perception. GPs and specialists disagree on several aspects of their mutual communication. These include the perception of accessibility, in both directions, and of the timeliness of written communication. Feedback is positively appreciated, again in both directions. Nevertheless, specialists feel that uptake of their recommendations is insufficient. Hence, there may remain significant room for improvement, which could contribute significantly to continuity of care and patient safety.

Research paper thumbnail of Sleep in the chronic fatigue syndrome

Sleep Medicine Reviews, 2013

Chronic fatigue syndrome (CFS) is a disabling condition characterized by severe fatigue lasting f... more Chronic fatigue syndrome (CFS) is a disabling condition characterized by severe fatigue lasting for more than six months and the presence of at least four out of eight minor criteria. Sleep disturbance presenting as unrefreshing or nonrestorative sleep is one of these criteria and is very common in CFS patients. Biologically disturbed sleep is a known cause of fatigue and could play a role in the pathogenesis of CFS. However, the nature of presumed sleep impairment in CFS remains unclear. Whilst complaints of NRS persist over time, there is no demonstrable neurophysiological correlate to substantiate a basic deficit in sleep function in CFS. Polysomnographic findings have not shown to be significantly different between subjects with CFS and normal controls. Discrepancies between subjectively poor and objectively normal sleep suggest a role for psychosocial factors negatively affecting perception of sleep quality. Primary sleep disorders are often detected in patients who otherwise qualify for a CFS diagnosis. These disorders could contribute to the presence of daytime dysfunctioning. There is currently insufficient evidence to indicate that treatment of primary sleep disorders sufficiently improves the fatigue associated with CFS. Therefore, primary sleep disorders may be a comorbid rather than an exclusionary condition with respect to CFS.

Research paper thumbnail of Polysomnographic and MSLT data in a large sample of patients with unexplained chronic fatigue: comparison with a reference sample and relation with subjective scores

Research paper thumbnail of Interrelationship of sleep quality with fatigue, neuroticism and global health in unexplained chronic fatigue

Sleep Medicine, 2013

Introduction The interrelationship of different dimensions (fatigue, neuroticism, sleep quality, ... more Introduction The interrelationship of different dimensions (fatigue, neuroticism, sleep quality, global mental and physical health) in patients with unexplained chronic fatigue, referred with presumed chronic fatigue syndrome (CFS), was explored. Materials and methods Patients with unexplained chronic fatigue filled out two independent fatigue scales (Fatigue Questionnaire, FQ and Checklist Individual Strength, CIS), NEO-Five Factor Inventory (NEO-FFI), Pittsburgh Sleep Quality Index (PSQI) and Medical Outcomes Study 36-item Short Form Health Survey (SF36). Path and regression analyses were performed. Results Out of 296 eligible patients, 203 subjects were included (mean age 39.0 years, SD 10.37, 89% female). In a first path analysis, using FQ for assessment of fatigue, night-time PSQI sleep quality had a direct effect on SF36 physical health quality of life (PHQL) and no effect on FQ fatigue. This was confirmed by a subsequent path analysis with CIS fatigue and by regression analyses. These unexpected results raised the question whether FQ or CIS fatigue sufficiently reflects fatigue. For both scales, the introduction of a latent variable into the model resulted in a significant improvement of fit, with an indirect effect of PSQI sleep quality on SF36 PHQL through this latent variable. Furthermore, this variable had a direct effect on FQ or CIS fatigue, respectively, and on the two SF36 variables. Conclusion A latent variable was introduced as missing link in the relationship between different subjective complaints of patients with presumed CFS and outcome measures of quality of life. Hence, this finding holds promise for a more cohesive framework of the different dimensions in the construct of chronic fatigue and CFS and needs to be developed as a clinical tool.

Research paper thumbnail of Mental quality of life in chronic fatigue is associated with an accommodative coping style and neuroticism: a path analysis

Quality of Life Research, 2011

Purpose An accommodative coping style (e.g. acceptance) is related to a better mental health-rela... more Purpose An accommodative coping style (e.g. acceptance) is related to a better mental health-related quality of life (MHQL) in patients with chronic fatigue syndrome (CFS). We want to explore whether neuroticism is predictive for this coping style and MHQL. Secondly we want to explore the relation between acceptance and physical health-related quality of life (PHQL) and expect that illness-related variables such as fatigue severity and duration are related to PHQL. Method In this cross-sectional study, 117 patients with chronic fatigue syndrome from an outpatient internal medicine clinic completed self-report questionnaires on quality of life (SF-36), acceptance (ICQ), personality traits (NEO-FFI) and fatigue severity (CIS). Results Regression analyses showed that neuroticism and acceptance are predictors of MHQL (38% of the variance was explained). The path analysis showed that acceptance mediates between neuroticism and MHQL and that PHQL is related to MHQL. PHQL is related to fatigue severity and duration, but not to neuroticism and acceptance. Conclusion Stimulating an 'accepting accommodative coping style' within the treatment for CFS is important in improving mental quality of life. Our results suggest that neuroticism may be negatively related to acceptance and MHQL. This findings support the idea that a psychological diagnostic workout with special attention to personality traits in relation to their coping style is recommended in order to choose the most appropriate therapeutic approach in this population.

Research paper thumbnail of Improving quality of life in patients with chronic kidney disease: influence of acceptance and personality

Nephrology Dialysis Transplantation, 2012

Background. A low health-related quality of life (HQL) is associated with the evolution of chroni... more Background. A low health-related quality of life (HQL) is associated with the evolution of chronic kidney disease (CKD) and mortality in patients in end-stage of the disease. Therefore research on psychological determinants of HQL is emerging. We investigate whether acceptance of the disease contributes to a better physical and mental health-related quality of life (PHQL and MHQL). We also examine the impact of personality characteristics on acceptance, PHQL and MHQL. Methods. In this cross-sectional study, patients from an outpatient clinic of nephrology completed self-report questionnaires on quality of life, acceptance and personality characteristics. We performed correlations, regression analyses and a path analysis. Results. Our sample of 99 patients had a mean duration of CKD of 10.81 years and a mean estimated Glomerular Filtration Rate (eGFR) by Modification of Diet in Renal Disease (MDRD)-formula of 34.49 ml/min (SD 21.66). Regression analyses revealed that acceptance had a significant positive contribution to the prediction of PHQL and MHQL. Neuroticism was negatively associated with acceptance and MHQL. Path analysis showed that 37% of the total effect of neuroticism on MHQL was mediated by acceptance. Conclusions. Acceptance is an important positive variable in accounting for HQL, however, clinicians must be aware that if patients have a high level of neuroticism they are likely to have more difficulties with this coping strategy. These results provide a better understanding of psychological determinants of HQL in CKD, which can initiate another approach of these patients by nephrologists, specific psychological interventions, or other supporting public health services.

Research paper thumbnail of Validation of the three-factor model of the PSQI in a large sample of chronic fatigue syndrome (CFS) patients

Journal of Psychosomatic Research, 2012

To evaluate whether a 3-factor model of the Pittsburgh Sleep Quality Index (PSQI) scale would fit... more To evaluate whether a 3-factor model of the Pittsburgh Sleep Quality Index (PSQI) scale would fit the constellation of sleep disturbances in patients with a diagnosis of chronic fatigue syndrome (CFS). Methods: Consecutive CFS patients filled out the PSQI. Scores from this self-report questionnaire were examined with exploratory and confirmatory factor analysis (CFA). Results: 413 CFS patients were included for analysis in this study. CFA showed that the 7 PSQI component scores clustered into the 3 factors reported by Cole et al. (2006), i.e. Sleep Efficiency, Perceived Sleep Quality and Daily Disturbances. In contrast with the single-factor and all 2-factor models, all factor loadings were significant, and all goodness-of-fit values were acceptable. Conclusion: In CFS, the PSQI operates as a 3-factor scoring model as initially seen in healthy and depressed older adults. The separation into 3 discrete factors suggests the limited usefulness of the global PSQI as a single factor for the assessment of subjective sleep quality, as also evidenced by a low Cronbach's alpha (0.64) in this patient sample.

Research paper thumbnail of Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome

Journal of Psychosomatic Research, 2013

To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with ... more To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS). Methods: Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography + multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders. Results: Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8 years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder. Conclusions: A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.

Research paper thumbnail of Representation and segmentation of shape based on curvature singularities (Poster)

Perception, 1993

Associatie KULeuven. ...

Research paper thumbnail of Are curvature singularities sufficient to represent shape?

Investigative ophthalmology & visual science, 1994

Associatie KULeuven. ...