51
|
Jahrami H, BaHammam AS, Bragazzi NL, Saif Z, Faris M, Vitiello MV. Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med 2021; 17:299-313. [PMID: 33108269 PMCID: PMC7853219 DOI: 10.5664/jcsm.8930] [Citation(s) in RCA: 382] [Impact Index Per Article: 127.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 12/23/2022]
Abstract
STUDY OBJECTIVES No systematic review or meta-analysis has yet been conducted to examine the impact of the pandemic on the prevalence of sleep problems among the general population, health care workers, or patients with COVID-19. Therefore, this systematic review was conducted to assess the impact and prevalence of sleep problems among those categories. METHODS American Psychological Association PsycINFO, Cochrane, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCOhost, EMBASE, Google Scholar, MEDLINE, ProQuest Medical, ScienceDirect, Scopus, and Web of Science from November 1, 2019 to July 5, 2020 were used. Additionally, 5 preprints servers (medRxiv.org; preprints.org; psyarxiv.com; arXiv.org; biorxiv.org) were also searched for papers accepted after peer review but not yet published and indexed. There was no language restriction. The random-effect models meta-analysis model was used with the DerSimonian and Laird methodology. RESULTS Forty-four papers, involving a total of 54,231 participants from 13 countries, were judged relevant and contributed to the systematic review and meta-analysis of sleep problems during COVID-19. The global pooled prevalence rate of sleep problems among all populations was 35.7% (95% confidence interval, 29.4-42.4%). Patients with COVID-19 appeared to be the most affected group, with a pooled rate of 74.8% (95% confidence interval, 28.7-95.6%). Health care workers and the general population had comparative rates of sleep problems, with rates of 36.0% (95% confidence interval, 21.1-54.2%) and 32.3% (95% confidence interval, 25.3-40.2%), respectively. CONCLUSIONS The prevalence of sleep problems during the COVID-19 pandemic is high and affects approximately 40% of people from the general and health care populations. Patients with active COVID-19 appeared to have a higher prevalence rates of sleep problems.
Collapse
|
52
|
Lu Q, Zhang X, Wang Y, Li J, Xu Y, Song X, Su S, Zhu X, Vitiello MV, Shi J, Bao Y, Lu L. Sleep disturbances during pregnancy and adverse maternal and fetal outcomes: A systematic review and meta-analysis. Sleep Med Rev 2021; 58:101436. [PMID: 33571887 DOI: 10.1016/j.smrv.2021.101436] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
Sleep disturbances are highly prevalent in pregnancy and are frequently overlooked as a potential cause of significant morbidity. The association between sleep disturbances and pregnancy outcomes remains largely controversial and needs to be clarified to guide management. To evaluate the association between sleep disturbances and maternal complications and adverse fetal outcomes, we performed a systematic search of PubMed, Embase and Web of Science for English-language articles published from inception to March 6, 2020, including observational studies of pregnant women with and without sleep disturbances assessing the risk of obstetric complications in the antenatal, intrapartum or postnatal period, and neonatal complications. Data extraction was completed independently by two reviewers. We utilized the Newcastle-Ottawa Scales to assess the methodological quality of included studies and random-effect models to pool the associations. A total of 120 studies with 58,123,250 pregnant women were included. Sleep disturbances were assessed, including poor sleep quality, extreme sleep duration, insomnia symptoms, restless legs syndrome, subjective sleep-disordered breathing and diagnosed obstructive sleep apnea. Significant associations were found between sleep disturbances in pregnancy and a variety of maternal complications and adverse fetal outcomes. Overall sleep disturbances were significantly associated with pre-eclampsia (odds ratio = 2.80, 95% confidence interval: 2.38-3.30), gestational hypertension (1.74, 1.54-1.97), gestational diabetes mellitus (1.59, 1.45-1.76), cesarean section (1.47, 1.31-1.64), preterm birth (1.38, 1.26-1.51), large for gestational age (1.40, 1.11-1.77), and stillbirth (1.25, 1.08-1.45), but not small for gestational age (1.03, 0.92-1.16), or low birth weight (1.27, 0.98-1.64). Sleep disturbances were related to higher morbidities in pregnant women who are 30 y or older and overweight before pregnancy. The findings indicate that sleep disturbances, which are easily ignored and treatable for both pregnant women and clinical services, deserve more attention from health care providers during prenatal counseling and health care services.
Collapse
|
53
|
Jahrami H, Abdelaziz A, Binsanad L, Alhaj OA, Buheji M, Bragazzi NL, Saif Z, BaHammam AS, Vitiello MV. The Association between Symptoms of Nomophobia, Insomnia and Food Addiction among Young Adults: Findings of an Exploratory Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020711. [PMID: 33467561 PMCID: PMC7830658 DOI: 10.3390/ijerph18020711] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
No previous research has examined the association between symptoms of nomophobia and food addiction. Similarly, only a few studies have examined the association between nomophobia and symptoms of insomnia. This exploratory study utilized an online self-administered, structured questionnaire that included: basic sociodemographic and anthropometrics; the nomophobia questionnaire (NMP-Q); the insomnia severity index (ISI); and the Yale Food Addiction Scale (YFAS) in a convenience sample of young adults (18–35 years) in Bahrain (n = 654), 304 (46%) males and 350 (54%) females. Symptoms of severe nomophobia, moderate-severe insomnia, and food addiction were more common among female participants both for each disorder separately and in combination; however, differences did not reach statistical significance. For severe nomophobia, the rate for females was 76 (21.7%) and for males was 57 (18.8%) p = 0.9. For moderate-severe insomnia, the rate for females was 56 (16%) and for males was 36 (11.84%) p = 0.1. For food addiction, the rate for females was 71 (20.29%) and for males was 53 (17.43%) p = 0.3. A statistically significant association was present between nomophobia and insomnia r = 0.60, p < 0.001. No association was found between nomophobia and food addiction. Nomophobia is very common in young adults, particularly in females; nomophobia is associated with insomnia but not with food addiction.
Collapse
|
54
|
Jahrami H, Rashed M, AlRasheed MM, Bragazzi NL, Saif Z, Alhaj O, BaHammam AS, Vitiello MV. Nomophobia is Associated with Insomnia but Not with Age, Sex, BMI, or Mobile Phone Screen Size in Young Adults. Nat Sci Sleep 2021; 13:1931-1941. [PMID: 34737661 PMCID: PMC8560167 DOI: 10.2147/nss.s335462] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/22/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE NOMOPHOBIA (NO MObile PHone PhoBIA) or problematic smartphone use is a psychological disorder in which people are afraid of being cut off from their mobile phones. Currently, there has been no direct assessment of mobile phone screen size in the home setting and its effect on nomophobia and related symptoms, such as insomnia. Thus, we investigated the association between nomophobia, insomnia, and mobile phone screen size in a young adult population in Bahrain. PATIENTS AND METHODS Using a descriptive, cross-sectional design, we surveyed participants aged 18 to 35 between August and September 2020 using an online questionnaire. Participants completed demographic questions and questions about personal mobile phones, the Nomophobia Questionnaire (NMP-Q), and the Insomnia Severity Index (ISI). The mobile phone screen size was determined using an open-source online database. Crude and adjusted regression analyses were fitted to examine the associations between the study variables. RESULTS A total of 549 individuals, 54% females, were included in the final analyses. One hundred and fourteen participants (21%) had severe nomophobia, and 81 (14%) had clinical insomnia. A strong positive pair-wise linear association was observed between NMP-Q and ISI β 0.15, P = 0.001. Age, sex, BMI, and mobile phone screen size showed no association with the NMP-Q. CONCLUSION Nomophobia is very prevalent in young adult men and women, and it is closely associated with insomnia, regardless of mobile phone screen size, suggesting that mobile phone screen size should not be used as a proxy for hazardous usage.
Collapse
|
55
|
Yuan K, Gong YM, Liu L, Sun YK, Tian SS, Wang YJ, Zhong Y, Zhang AY, Su SZ, Liu XX, Zhang YX, Lin X, Shi L, Yan W, Fazel S, Vitiello MV, Bryant RA, Zhou XY, Ran MS, Bao YP, Shi J, Lu L. Prevalence of posttraumatic stress disorder after infectious disease pandemics in the twenty-first century, including COVID-19: a meta-analysis and systematic review. Mol Psychiatry 2021; 26:4982-4998. [PMID: 33542468 PMCID: PMC7861006 DOI: 10.1038/s41380-021-01036-x] [Citation(s) in RCA: 145] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
Pandemics have become more frequent and more complex during the twenty-first century. Posttraumatic stress disorder (PTSD) following pandemics is a significant public health concern. We sought to provide a reliable estimate of the worldwide prevalence of PTSD after large-scale pandemics as well as associated risk factors, by a systematic review and meta-analysis. We systematically searched the MedLine, Embase, PsycINFO, Web of Science, CNKI, WanFang, medRxiv, and bioRxiv databases to identify studies that were published from the inception up to August 23, 2020, and reported the prevalence of PTSD after pandemics including sudden acute respiratory syndrome (SARS), H1N1, Poliomyelitis, Ebola, Zika, Nipah, Middle Eastern respiratory syndrome coronavirus (MERS-CoV), H5N1, and coronavirus disease 2019 (COVID-19). A total of 88 studies were included in the analysis, with 77 having prevalence information and 70 having risk factors information. The overall pooled prevalence of post-pandemic PTSD across all populations was 22.6% (95% confidence interval (CI): 19.9-25.4%, I2: 99.7%). Healthcare workers had the highest prevalence of PTSD (26.9%; 95% CI: 20.3-33.6%), followed by infected cases (23.8%: 16.6-31.0%), and the general public (19.3%: 15.3-23.2%). However, the heterogeneity of study findings indicates that results should be interpreted cautiously. Risk factors including individual, family, and societal factors, pandemic-related factors, and specific factors in healthcare workers and patients for post-pandemic PTSD were summarized and discussed in this systematic review. Long-term monitoring and early interventions should be implemented to improve post-pandemic mental health and long-term recovery.
Collapse
|
56
|
Vitiello MV. Maintaining a tradition of excellence. Sleep Med Rev 2020; 55:101396. [PMID: 33249397 DOI: 10.1016/j.smrv.2020.101396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/08/2020] [Indexed: 10/23/2022]
|
57
|
Sun J, Yan W, Zhang XN, Lin X, Li H, Gong YM, Zhu XM, Zheng YB, Guo XY, Ma YD, Liu ZY, Liu L, Gao JH, Vitiello MV, Chang SH, Liu XG, Lu L. Polygenic evidence and overlapped brain functional connectivities for the association between chronic pain and sleep disturbance. Transl Psychiatry 2020; 10:252. [PMID: 32709872 PMCID: PMC7381677 DOI: 10.1038/s41398-020-00941-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/08/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic pain and sleep disturbance are highly comorbid disorders, which leads to barriers to treatment and significant healthcare costs. Understanding the underlying genetic and neural mechanisms of the interplay between sleep disturbance and chronic pain is likely to lead to better treatment. In this study, we combined 1206 participants with phenotype data, resting-state functional magnetic resonance imaging (rfMRI) data and genotype data from the Human Connectome Project and two large sample size genome-wide association studies (GWASs) summary data from published studies to identify the genetic and neural bases for the association between pain and sleep disturbance. Pittsburgh sleep quality index (PSQI) score was used for sleep disturbance, pain intensity was measured by Pain Intensity Survey. The result showed chronic pain was significantly correlated with sleep disturbance (r = 0.171, p-value < 0.001). Their genetic correlation was rg = 0.598 using linkage disequilibrium (LD) score regression analysis. Polygenic score (PGS) association analysis showed PGS of chronic pain was significantly associated with sleep and vice versa. Nine shared functional connectivity (FCs) were identified involving prefrontal cortex, temporal cortex, precentral/postcentral cortex, anterior cingulate cortex, fusiform gyrus and hippocampus. All these FCs mediated the effect of sleep disturbance on pain and seven FCs mediated the effect of pain on sleep disturbance. The chronic pain PGS was positively associated with the FC between middle temporal gyrus and hippocampus, which further mediated the effect of chronic pain PGS on PSQI score. Mendelian randomization analysis implied a possible causal relationship from chronic pain to sleep disturbance was stronger than that of sleep disturbance to chronic pain. The results provided genetic and neural evidence for the association between pain and sleep disturbance, which may inform future treatment approaches for comorbid chronic pain states and sleep disturbance.
Collapse
|
58
|
Landrigan CP, Rahman SA, Sullivan JP, Vittinghoff E, Barger LK, Sanderson AL, Wright KP, O'Brien CS, Qadri S, St Hilaire MA, Halbower AC, Segar JL, McGuire JK, Vitiello MV, de la Iglesia HO, Poynter SE, Yu PL, Zee PC, Lockley SW, Stone KL, Czeisler CA. Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts. N Engl J Med 2020; 382:2514-2523. [PMID: 32579812 PMCID: PMC7405505 DOI: 10.1056/nejmoa1900669] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effects on patient safety of eliminating extended-duration work shifts for resident physicians remain controversial. METHODS We conducted a multicenter, cluster-randomized, crossover trial comparing two schedules for pediatric resident physicians during their intensive care unit (ICU) rotations: extended-duration work schedules that included shifts of 24 hours or more (control schedules) and schedules that eliminated extended shifts and cycled resident physicians through day and night shifts of 16 hours or less (intervention schedules). The primary outcome was serious medical errors made by resident physicians, assessed by intensive surveillance, including direct observation and chart review. RESULTS The characteristics of ICU patients during the two work schedules were similar, but resident physician workload, described as the mean (±SD) number of ICU patients per resident physician, was higher during the intervention schedules than during the control schedules (8.8±2.8 vs. 6.7±2.2). Resident physicians made more serious errors during the intervention schedules than during the control schedules (97.1 vs. 79.0 per 1000 patient-days; relative risk, 1.53; 95% confidence interval [CI], 1.37 to 1.72; P<0.001). The number of serious errors unitwide were likewise higher during the intervention schedules (181.3 vs. 131.5 per 1000 patient-days; relative risk, 1.56; 95% CI, 1.43 to 1.71). There was wide variability among sites, however; errors were lower during intervention schedules than during control schedules at one site, rates were similar during the two schedules at two sites, and rates were higher during intervention schedules than during control schedules at three sites. In a secondary analysis that was adjusted for the number of patients per resident physician as a potential confounder, intervention schedules were no longer associated with an increase in errors. CONCLUSIONS Contrary to our hypothesis, resident physicians who were randomly assigned to schedules that eliminated extended shifts made more serious errors than resident physicians assigned to schedules with extended shifts, although the effect varied by site. The number of ICU patients cared for by each resident physician was higher during schedules that eliminated extended shifts. (Funded by the National Heart, Lung, and Blood Institute; ROSTERS ClinicalTrials.gov number, NCT02134847.).
Collapse
|
59
|
McCurry SM, Vitiello MV, Pike KC, Thakral M, Morin CM, Von Korff M. 0469 Perceptions of an Education Only Control Group in the Osteoarthritis and Therapy for Sleep (OATS) Study: An Ongoing Statewide, Telephone-Delivered CBT for Insomnia (CBT-I) Randomized Trial. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Comorbid osteoarthritis (OA) and insomnia is common in older adults. CBT-I is efficacious for improving sleep in older persons with OA but not widely accessible. We examined treatment process data from OATS, a large ongoing clinical trial of telephone-delivered CBT-I.
Methods
327 Kaiser Permanente Washington members aged 60+ with OA, Insomnia Severity Index scores of 11+, and Brief Pain Inventory scores of 9+ were randomized to individual CBT-I vs. education only control (EOC). Six telephone sessions of CBT-I or EOC were offered over eight weeks. Participants rated their perceptions of treatment (credibility, acceptability, suitability, perceived effectiveness, adherence, and therapeutic relationship) on a 7-point Likert scale after session 1 and at 2-month post-test.
Results
Participants (mean age=70.2 years, 74.6% female) were randomized to the two treatment arms (CBT-I=163, EOC=164). Participants did not differ significantly across arms by age, gender, education, or by sleep, pain, or mood (depression, fatigue) outcome measures at baseline. CBT-I had significantly (p=.03) more white participants (90% CBT-I, 78% EOC). Study retention was 82% and 88% at post-test for CBT-I versus EOC, respectively. There was no difference in number of sessions attended (median=6). CBT-I sessions were somewhat longer than EOC (24.2 vs. 22.8 minutes; p=.005). Most participants in both groups at both time points gave high rankings (5+/7 points) on all six treatment perception ratings (CBT-I range: 75.9-99.3%; EOC range: 69.0-97.9%). Average summed treatment perception ratings improved between Session 1 and post-test for both conditions (mean=5.9 and 6.1, respectively, for CBT-I; mean=5.6 and 5.8, respectively, for EOC).
Conclusion
The OATS EOC group was credible and acceptable to participants, resulting in equivalently high levels of participation and retention compared to CBT-I. Findings suggest the ongoing trial has adequately controlled for nonspecific participant treatment effects that might confound interpretation of efficacy outcomes.
Support
This work was supported by PHS grant 5R01AG053221.
Collapse
|
60
|
Wang YH, Wang J, Chen SH, Li JQ, Lu QD, Vitiello MV, Wang F, Tang XD, Shi J, Lu L, Wu SL, Bao YP. Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality. JAMA Netw Open 2020; 3:e205246. [PMID: 32442289 PMCID: PMC7244989 DOI: 10.1001/jamanetworkopen.2020.5246] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Single self-reported measures of sleep duration are associated with adverse health outcomes; however, long-term patterns of self-reported sleep duration and their association with cardiovascular events (CVEs) and all-cause mortality remain unknown. OBJECTIVE To determine whether trajectories of long-term vs single-measure sleep duration are associated with subsequent risk of CVEs and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS The Kailuan study is a prospective, population-based cohort study that began in 2006. The present cohort included 52 599 Chinese adults without atrial fibrillation, myocardial infarction, stroke, or cancer to 2010. Trajectories in sleep duration from January 1, 2006, to December 31, 2010, were identified to investigate the association with risk of CVEs and all-cause mortality from January 1, 2010, to December 31, 2017. Data analysis was conducted from July 1 to October 31, 2019. EXPOSURES Habitual self-reported nocturnal sleep durations were collected in 2006, 2008, and 2010. Trajectories in sleep duration for 4 years were identified by latent mixture modeling. MAIN OUTCOMES AND MEASURES All-cause mortality and first incident CVEs (atrial fibrillation, myocardial infarction, and stroke) from 2010 to 2017 were confirmed by medical records. Based on the baseline sleep duration and patterns over time, 4 trajectories were categorized (normal stable, normal decreasing, low increasing, and low stable). RESULTS Of the 52 599 adults included in the study (mean [SD] age at baseline, 52.5 [11.8] years), 40 087 (76.2%) were male and 12 512 (23.8%) were female. Four distinct 4-year sleep duration trajectory patterns were identified: normal stable (range, 7.4 to 7.5 hours [n = 40 262]), normal decreasing (mean decrease from 7.0 to 5.5 hours [n = 8074]), low increasing (mean increase from 4.9 to 6.9 hours [n = 3384]), and low stable (range, 4.2 to 4.9 hours [n = 879]). During a mean (SD) follow-up of 6.7 (1.1) years, 2361 individuals died and 2406 had a CVE. Compared with the normal-stable pattern and adjusting for potential confounders, a low-increasing pattern was associated with increased risk of first CVEs (hazard ratio [HR], 1.22; 95% CI, 1.04-1.43), a normal-decreasing pattern was associated with increased risk of all-cause mortality (HR, 1.34; 95% CI, 1.15-1.57), and the low-stable pattern was associated with the highest risk of CVEs (HR, 1.47; 95% CI, 1.05-2.05) and death (HR, 1.50; 95% CI, 1.07-2.10). CONCLUSIONS AND RELEVANCE In this study, sleep duration trajectories with lower or unstable patterns were significantly associated with increased risk of subsequent first CVEs and all-cause mortality. Longitudinal sleep duration patterns may assist in more precise identification of different at-risk groups for possible intervention. People reporting consistently sleeping less than 5 hours per night should be regarded as a population at higher risk for CVE and mortality.
Collapse
|
61
|
Barger LK, Sullivan JP, Blackwell T, O'Brien CS, St Hilaire MA, Rahman SA, Phillips AJK, Qadri S, Wright KP, Segar JL, McGuire JK, Vitiello MV, de la Iglesia HO, Poynter SE, Yu PL, Zee P, Sanderson AL, Halbower AC, Lockley SW, Landrigan CP, Stone KL, Czeisler CA. Effects on resident work hours, sleep duration, and work experience in a randomized order safety trial evaluating resident-physician schedules (ROSTERS). Sleep 2020; 42:5489525. [PMID: 31106381 DOI: 10.1093/sleep/zsz110] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/12/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES We compared resident physician work hours and sleep in a multicenter clustered-randomized crossover clinical trial that randomized resident physicians to an Extended Duration Work Roster (EDWR) with extended-duration (≥24 hr) shifts or a Rapidly Cycling Work Roster (RCWR), in which scheduled shift lengths were limited to 16 or fewer consecutive hours. METHODS Three hundred two resident physicians were enrolled and completed 370 1 month pediatric intensive care unit rotations in six US academic medical centers. Sleep was objectively estimated with wrist-worn actigraphs. Work hours and subjective sleep data were collected via daily electronic diary. RESULTS Resident physicians worked fewer total hours per week during the RCWR compared with the EDWR (61.9 ± 4.8 versus 68.4 ± 7.4, respectively; p < 0.0001). During the RCWR, 73% of work hours occurred within shifts of ≤16 consecutive hours. In contrast, during the EDWR, 38% of work hours occurred on shifts of ≤16 consecutive hours. Resident physicians obtained significantly more sleep per week on the RCWR (52.9 ± 6.0 hr) compared with the EDWR (49.1 ± 5.8 hr, p < 0.0001). The percentage of 24 hr intervals with less than 4 hr of actigraphically measured sleep was 9% on the RCWR and 25% on the EDWR (p < 0.0001). CONCLUSIONS RCWRs were effective in reducing weekly work hours and the occurrence of >16 consecutive hour shifts, and improving sleep duration of resident physicians. Although inclusion of the six operational healthcare sites increases the generalizability of these findings, there was heterogeneity in schedule implementation. Additional research is needed to optimize scheduling practices allowing for sufficient sleep prior to all work shifts.Clinical Trial: Multicenter Clinical Trial of Limiting Resident Work Hours on ICU Patient Safety (ROSTERS), https://clinicaltrials.gov/ct2/show/NCT02134847.
Collapse
|
62
|
Yang PL, Ward TM, Burr RL, Kapur VK, McCurry SM, Vitiello MV, Hough CL, Parsons EC. Sleep and Circadian Rhythms in Survivors of Acute Respiratory Failure. Front Neurol 2020; 11:94. [PMID: 32117040 PMCID: PMC7033606 DOI: 10.3389/fneur.2020.00094] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Little is known about sleep and circadian rhythms in survivors of acute respiratory failure (ARF) after hospital discharge. Objectives: To examine sleep and rest-activity circadian rhythms in ARF survivors 3 months after hospital discharge, and to compare them with a community-dwelling population. Methods: Sleep diary, actigraphy data, and insomnia symptoms were collected in a pilot study of 14 ARF survivors. Rest-activity circadian rhythms were assessed with wrist actigraphy and sleep diary for 9 days, and were analyzed by cosinor and non-parametric circadian rhythm analysis. Results: All participants had remarkable actigraphic sleep fragmentation, 71.5% had subclinical or clinical insomnia symptoms. Compared to community-dwelling adults, this cohort had less stable rest-activity circadian rhythms (p < 0.001), and weaker circadian strength (p < 0.001). Conclusion: Insomnia and circadian disruption were common in ARF survivors. Sleep improvement and circadian rhythm regularity may be a promising approach to improve quality of life and daytime function after ARF.
Collapse
|
63
|
Vitiello MV. Continuing to strive for timeliness, quality and impact. Sleep Med Rev 2020; 49:101236. [DOI: 10.1016/j.smrv.2019.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
64
|
Thakral M, Von Korff M, McCurry SM, Morin CM, Vitiello MV. Changes in dysfunctional beliefs about sleep after cognitive behavioral therapy for insomnia: A systematic literature review and meta-analysis. Sleep Med Rev 2020; 49:101230. [PMID: 31816582 PMCID: PMC7012685 DOI: 10.1016/j.smrv.2019.101230] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/30/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for chronic insomnia and sleep-related cognitions are one target of treatment. There has been little systematic investigation of how sleep-related cognitions are being assessed in CBT-I trials and no meta-analysis of the impact of CBT-I on dysfunctional beliefs about sleep, a core cognitive component of treatment. Academic Search Complete, Medline, CINAHL and PsychInfo from 1990 to 2018 were searched to identify randomized controlled trials of CBT-I in adults (≥18 years) reporting some measure of sleep-related cognitions. Sixteen randomized controlled trials were identified comparing 1134 CBT-I and 830 control subjects. The Dysfunctional Beliefs and Attitudes about Sleep Scale was utilized almost exclusively to assess sleep-related cognitions in these trials. Hedge's g at 95% confidence interval (CI) was calculated to assess CBT-I effect size at post-treatment compared to controls. CBT-I significantly reduced dysfunctional beliefs about sleep (g = -0.90, 95% CI -1.19, -0.62) at post-treatment. Three trials contributed data to estimate effect size for long-term effects (g = -1.04, 95% CI -2.07, -0.02) with follow up time ranging from 3 to 18 mo. We concluded that cognitive behavioral therapy for insomnia has moderate to large effects on dysfunctional beliefs about sleep.
Collapse
|
65
|
Neikrug AB, Chen IY, Palmer JR, McCurry SM, Von Korff M, Perlis M, Vitiello MV. Characterizing Behavioral Activity Rhythms in Older Adults Using Actigraphy. SENSORS (BASEL, SWITZERLAND) 2020; 20:E549. [PMID: 31963889 PMCID: PMC7014517 DOI: 10.3390/s20020549] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 12/23/2022]
Abstract
Wrist actigraphy has been used to assess sleep in older adult populations for nearly half a century. Over the years, the continuous raw activity data derived from actigraphy has been used for the characterization of factors beyond sleep/wake such as physical activity patterns and circadian rhythms. Behavioral activity rhythms (BAR) are useful to describe individual daily behavioral patterns beyond sleep and wake, which represent important and meaningful clinical outcomes. This paper reviews common rhythmometric approaches and summarizes the available data from the use of these different approaches in older adult populations. We further consider a new approach developed in our laboratory designed to provide graphical characterization of BAR for the observed behavioral phenomenon of activity patterns across time. We illustrate the application of this new approach using actigraphy data collected from a well-characterized sample of older adults (age 60+) with osteoarthritis (OA) pain and insomnia. Generalized additive models (GAM) were implemented to fit smoothed nonlinear curves to log-transformed aggregated actigraphy-derived activity measurements. This approach demonstrated an overall strong model fit (R2 = 0.82, SD = 0.09) and was able to provide meaningful outcome measures allowing for graphical and parameterized characterization of the observed activity patterns within this sample.
Collapse
|
66
|
McCurry SM, Von Korff M, Morin CM, Cunningham A, Pike KC, Thakral M, Wellman R, Yeung K, Zhu W, Vitiello MV. Telephone interventions for co-morbid insomnia and osteoarthritis pain: The OsteoArthritis and Therapy for Sleep (OATS) randomized trial design. Contemp Clin Trials 2019; 87:105851. [PMID: 31614214 PMCID: PMC6886712 DOI: 10.1016/j.cct.2019.105851] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 12/25/2022]
Abstract
The OsteoArthritis and Therapy for Sleep (OATS) study is a population-based randomized controlled trial of cognitive behavioral therapy for insomnia (CBTI) with four innovative methodological aims. These are to: (1) Enroll representative participants across Washington state, including those from medically underserved communities; (2) Enroll persons with persistent insomnia and chronic osteoarthritis (OA) pain; (3) Test a scalable CBT-I intervention; and (4) Evaluate patient-reported outcomes (insomnia, pain severity, fatigue, depression) and cost-effectiveness over one year. This paper describes progress towards achieving these aims. The target population was persons age 60+ who had received OA care within the Kaiser Permanente Washington (KPW) health care system. We employed a two-phase screening via mail survey and telephone follow-up, with a 3-week interval between screens to exclude persons with spontaneous improvement in sleep or pain symptoms. Participants were randomized to a 6-session telephone-delivered CBT-I intervention or a 6-session telephone education only control condition (EOC). Blinded outcome assessments (completed online or on mailed paper forms) included primary and secondary sleep and pain outcome measures and quality of life measures. We obtained healthcare utilization from administrative claims data. Intent to treat analyses, including all participants randomized when they scheduled the first telephone session, will be conducted to compare CBT-I and EOC outcomes. The trial will be the largest experimental evaluation of telephone CBT-I to date, and the first to evaluate its cost-effectiveness. Trial registration: ClinicalTrials.gov identifier: NCT02946957.
Collapse
|
67
|
Winston CN, Goetzl EJ, Baker LD, Vitiello MV, Rissman RA. Growth Hormone-Releasing Hormone Modulation of Neuronal Exosome Biomarkers in Mild Cognitive Impairment. J Alzheimers Dis 2019; 66:971-981. [PMID: 30372675 DOI: 10.3233/jad-180302] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Age-related changes in cognition are linked to decreased expression of somatotropins, GHRH and IGF-1. Mild cognitive impairment (MCI) and Alzheimer's disease (AD) are heterogeneous conditions. The loss of GHRH signaling in the brain may be mechanistically involved in AD pathogenesis. The consequent need to identify AD at an early and perhaps more treatable stage has fueled research into blood-based, exosome biomarkers. Plasma exosomes from participants enrolled in a randomized, double-blind, placebo-controlled 20-week trial of GHRH administration, were isolated, precipitated, and enriched by immuno-absorption with anti-L1CAM antibody (neural adhesion protein) from adults with MCI and age-matched, cognitively normal controls (CNC). Extracted protein cargo from neuronally-derived exosomes (NDEs) were assessed by ELISAs for protein levels implicated in AD neuropathology and for synaptic proteins altered by AD. Plasma NDE concentrations of Aβ1-42 were significantly increased while plasma NDE concentrations of NRGN, synaptophysin, synaptotagmin, and synaptopodin were significantly decreased in patients with MCI, independent of GHRH treatment. Plasma NDE concentrations of ptau-S396 and GAP43 were not affected by cognitive status (CNC versus MCI) or by GHRH treatment. Aβ1-42, neurogranin (NRGN), synaptophysin, synaptotagmin, and synaptopodin demonstrated the highest diagnostic accuracy for distinguishing between CNC and MCI patients, while synaptophysin and synaptotagmin demonstrated moderate accuracy in distinguishing between placebo-treated and GHRH-treated, MCI patients.
Collapse
|
68
|
Liu M, Szanton SL, Vitiello MV. BIDIRECTIONAL ASSOCIATIONS BETWEEN SLEEP COMPLAINTS AND DEPRESSION: FINDINGS FROM THE NHATS STUDY. Innov Aging 2019. [PMCID: PMC6840737 DOI: 10.1093/geroni/igz038.1340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Depression and insomnia are prevalent in older adults and show bidirectional relationships. Sleep initiating and maintenance difficulties are the two frequently seen complaints of insomnia diagnostic criteria. Whether these two sleep complaints differ in their associations with depression is unknown. Using the National Health and Aging Trends Study (NHATS), we examined whether sleep initiating and maintenance difficulties at baseline (T1) predicted depression onset at 12 months (T2) and 24 months (T3) in 4,048 T1 non-depressed participants and whether depression at T1 predicted these two sleep complaints at T2 and T3 in 3,581 T1 non-insomnia participants. Participants who developed depression at T2 tended to be Hispanic, non-Hispanic black, less educated, live alone, physically inactive, and have more painful locations and chronic conditions. Participants with sleep complaints at T2 tended to be less educated, live alone, physically inactive, and have more painful locations and chronic conditions. Sleep initiating difficulty persistently predicted depression onset at T2 (OR: 1.62, 95% CI: 1.14, 2.31) and T3 (OR: 1.84, 95% CI: 1.21, 2.81) after adjusting demographics, lifestyles and health condition-related covariates. Depression at T1 persistently predicted sleep initiating difficulty at T2 (RRR: 2.19, 95% CI: 1.44, 3.34) and T3 (RRR: 1.70, 95% CI: 1.07, 2.70) after adjustment. Sleep maintenance difficulty at T1 did not predict depression onset at either time point and vice versa. This study suggests a bidirectional association of depression with sleep initiating difficulty but not sleep maintenance difficulty in older adults. Interventions targeting difficulty initiating sleep may moderate depression onset in older adults.
Collapse
|
69
|
Liu M, McCurry SM, Belza B, Dobra A, Buchanan DT, Vitiello MV, Von Korff M. Effects of Osteoarthritis Pain and Concurrent Insomnia and Depression on Health Care Use in a Primary Care Population of Older Adults. Arthritis Care Res (Hoboken) 2019; 71:748-757. [PMID: 30067892 DOI: 10.1002/acr.23695] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/03/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine independent and combined effects of pain with concurrent insomnia and depression symptoms on the use of health care services in older adults with osteoarthritis (OA). METHODS Patients were Group Health Cooperative (GHC) patients with a primary diagnosis of OA (n = 2,976). We used survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8), and health care use extracted from GHC electronic health records (office visits, length of stay, outpatient and inpatient costs, and hip or knee replacement) for 3 years after the survey. Negative binomial, logistic, and generalized linear models were used to assess predictors of health care use. RESULTS Approximately 34% and 29% of patients displayed at least subclinical insomnia and at least subclinical depression symptoms, respectively, in addition to moderate-to-severe pain. Pain had the greatest independent effects on increasing all types of health care use, followed by depression (moderate effects) on increased office visits, length of stay, outpatient and inpatient costs, and insomnia (mild effects) on decreased length of stay. No synergistic effects of the 3 symptoms on use of health care services were observed. The combined effects of pain plus insomnia and pain plus depression were significant for all types of health care use and increased greatly with increasing severity of insomnia and depression, except for hip/knee replacement. CONCLUSION Pain is the main driver for health care use in patients with OA. In addition to pain, insomnia plus depression jointly increased diverse types of health care use, and these combined effects increased greatly with increasing severity of insomnia and depression. These findings indicate the important role that concurrent symptomatic conditions may play in increasing use of health care services.
Collapse
|
70
|
Tang HY(J, McCurry SM, Riegel B, Pike KC, Vitiello MV. Open-Loop Audiovisual Stimulation Induces Delta EEG Activity in Older Adults With Osteoarthritis Pain and Insomnia. Biol Res Nurs 2019; 21:307-317. [PMID: 30862174 PMCID: PMC6700899 DOI: 10.1177/1099800419833781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE People with chronic insomnia tend to have cortical hyperarousal marked by excessive beta-/gamma-frequency brain activity during both wake and sleep. Currently, treatment options for managing hyperarousal are limited. Open-loop audiovisual stimulation (AVS) may be such a treatment. The purpose of this study was to provide a mechanistic foundation for future AVS research in sleep promotion by examining quantitative electroencephalogram (QEEG) responses to an AVS sleep-induction program. METHOD Sixteen older adults with both chronic insomnia and osteoarthritis pain were randomly assigned to either active- or placebo-control AVS. Electroencephalogram (EEG) was collected during baseline (5 min, eyes closed/resting) and throughout 30 min of AVS. RESULTS Findings showed significantly elevated mean baseline gamma (35-45 Hz) power in both groups compared to an age- and gender-matched, noninsomnia normative database, supporting cortical hyperarousal. After 30 min of exposure to AVS, the active group showed significantly increased delta power compared to the placebo-control group, providing the first controlled evidence that active AVS induction increases delta QEEG activity in insomnia patients and that these changes are immediate. In the active group, brain locations that showed the most delta induction (Cz, Fp, O1, and O2) were associated with the sensory-thalamic pathway, consistent with the sensory stimulation provided by the active AVS program. CONCLUSIONS Findings demonstrate that delta induction, which can promote sleep, is achievable using a 30-min open-loop AVS program. The potential for AVS treatment of insomnia in the general population remains to be demonstrated in well-designed clinical trials.
Collapse
|
71
|
Fogelberg D, Blanchard J, Leland NE, Vitiello MV, Clark FA. 0955 Subjectively Reported Barriers to Sleep in People with Spinal Cord Injuries. Sleep 2019. [DOI: 10.1093/sleep/zsz067.953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
72
|
Tang J, McCurry SM, Riegel B, Pike KC, Vitiello MV. 0403 Older Adults with Sleep Onset Insomnia Are More Responsive to Open-Loop Audio-Visual Stimulation Based Delta Induction Than Are Those with Sleep Maintenance Insomnia. Sleep 2019. [DOI: 10.1093/sleep/zsz067.402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
73
|
Vitiello MV. Another year of change, growing impact and widening readership. Sleep Med Rev 2019; 43:129-130. [DOI: 10.1016/j.smrv.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
|
74
|
Irwin MR, Vitiello MV. Implications of sleep disturbance and inflammation for Alzheimer's disease dementia. Lancet Neurol 2019; 18:296-306. [PMID: 30661858 DOI: 10.1016/s1474-4422(18)30450-2] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/30/2018] [Accepted: 11/13/2018] [Indexed: 02/08/2023]
Abstract
Nearly half of all adults older than 60 years of age report sleep disturbance, as characterised either by reports of insomnia complaints with daytime consequences, dissatisfaction with sleep quality or quantity, or the diagnosis of insomnia disorder. Accumulating evidence shows that sleep disturbance contributes to cognitive decline and might also increase the risk of Alzheimer's disease dementia by increasing β-amyloid burden. That sleep disturbance would be a candidate risk factor for Alzheimer's disease might seem surprising, given that disturbed sleep is usually considered a consequence of Alzheimer's disease. However, a bidirectional relationship between sleep and Alzheimer's disease is supported by advances in our understanding of sleep disturbance-induced increases in systemic inflammation, which can be viewed as an early event in the course of Alzheimer's disease. Inflammation increases β-amyloid burden and is thought to drive Alzheimer's disease pathogenesis. Improved understanding of the mechanisms linking sleep disturbance and Alzheimer's disease risk could facilitate the identification of targets for prevention, given that both sleep disturbance and inflammatory activation might be modifiable risk factors for Alzheimer's disease.
Collapse
|
75
|
Liu M, McCurry SM, Belza B, Buchanan DT, Dobra A, Korff MV, Vitiello MV. Effects of Pain, Insomnia, and Depression on Psychoactive Medication Supply in Older Adults With Osteoarthritis. Med Care 2018; 56:1024-1031. [PMID: 30256279 PMCID: PMC6380364 DOI: 10.1097/mlr.0000000000000982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Determinants of prescribing psychoactive medications for symptom management in older adults remain underexamined despite known risks and cautions concerning these medications. OBJECTIVE To examine independent and combined effects of pain, concurrent insomnia and depression symptoms on psychoactive medications supplied to older adults with osteoarthritis (OA). RESEARCH DESIGN Survey data on pain, insomnia, and depression obtained from OA patients screened for a randomized controlled trial were used to identify predictors of psychoactive medication supply [opioids, sedatives, tricyclic antidepressants (TCAs), and non-TCAs] over a 4-year period. SUBJECTS Group Health Cooperative patients with a diagnosis of OA (N=2976). MEASURES Survey data on pain (Graded Chronic Pain Scale), insomnia (Insomnia Severity Index), and depression (Patient Health Questionnaire-8); and medications supply assessed from electronic medical records. RESULTS In negative binomial models, pain [incidence rate ratio (IRR), 2.8-3.5; P<0.001], insomnia (IRR, 2.0; P<0.001), and depression (IRR, 1.5; P<0.05) each independently predicted opioid supply. Insomnia (IRR, 3.2; P<0.001) and depression (IRR, 3.0; P<0.001) each independently predicted sedative supply. Pain (IRR, 2.1; P<0.05) and insomnia (IRR, 2.0; P<0.05) independently predicted TCA supply, whereas only depression (IRR, 2.2; P<0.001) independently predicted non-TCA supply. Combined effects of pain and insomnia/depression on these medications were additive and increased the rate of medication supply 1.5-7.5 times. Combined effects increased with insomnia or depression severity. CONCLUSIONS Concurrent insomnia and depressive symptoms predicted increased supply of opioids, sedatives, and antidepressants after accounting for pain, indicating the importance of sleep and mood disorders as factors increasing supply of these medications.
Collapse
|