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de Lange MA, Richmond RC, Eastwood SV, Davies NM. Insomnia symptom prevalence in England: a comparison of cross-sectional self-reported data and primary care records in the UK Biobank. BMJ Open 2024; 14:e080479. [PMID: 38719300 PMCID: PMC11086527 DOI: 10.1136/bmjopen-2023-080479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 03/27/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES We aimed to use a large dataset to compare self-reported and primary care measures of insomnia symptom prevalence in England and establish whether they identify participants with similar characteristics. DESIGN Cross-sectional study with linked electronic health records (EHRs). SETTING Primary care in England. PARTICIPANTS 163 748 UK Biobank participants in England (aged 38-71 at baseline) with linked primary care EHRs. OUTCOME MEASURES We compared the percentage of those self-reporting 'usually' having insomnia symptoms at UK Biobank baseline assessment (2006-2010) to those with a Read code for insomnia symptoms in their primary care records prior to baseline. We stratified prevalence in both groups by sociodemographic, lifestyle, sleep and health characteristics. RESULTS We found that 29% of the sample self-reported having insomnia symptoms, while only 6% had a Read code for insomnia symptoms in their primary care records. Only 10% of self-reported cases had an insomnia symptom Read code, while 49% of primary care cases self-reported having insomnia symptoms. In both primary care and self-reported data, prevalence of insomnia symptom cases was highest in females, older participants and those with the lowest household incomes. However, while snorers and risk takers were more likely to be a primary care case, they were less likely to self-report insomnia symptoms than non-snorers and non-risk takers. CONCLUSIONS Only a small proportion of individuals experiencing insomnia symptoms have an insomnia symptom Read code in their primary care record. However, primary care data do provide a clinically meaningful measure of insomnia prevalence. In addition, the sociodemographic characteristics of people attending primary care with insomnia were consistent with those with self-reported insomnia, thus primary care records are a valuable data source for studying risk factors for insomnia. Further studies should replicate our findings in other populations and examine ways to increase discussions about sleep health in primary care.
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Affiliation(s)
- Melanie A de Lange
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca C Richmond
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- NIHR Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Sophie V Eastwood
- Institute of Cardiovascular Science, University College London, London, UK
| | - Neil M Davies
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Division of Psychiatry & Department of Statistical Sciences, University College London, London, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Zeng Y, Li W, Chen X, You Z, Mai S, Lan X, Ning Y, Zhou Y. Mediating effect of inflammation on the relationship between sleep disruption and suicidal ideation in major depressive disorder. J Affect Disord 2024; 352:371-378. [PMID: 38401806 DOI: 10.1016/j.jad.2024.02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Sleep disruption, particularly insomnia, is a notable characteristic of depression and is associated with an increased risk of suicide in patients diagnosed with major depressive disorder (MDD). Moreover, the pathophysiology of depression and suicide has been linked to inflammation, specifically proinflammatory cytokines. However, the complex interplay among these factors in individuals with MDD remains poorly understood. This study investigated the mediating role of inflammatory cytokines in the relationship between sleep disruption and suicidal ideation (SI), with a particular emphasis on gender differences. METHODS This study used a cross-sectional design in which 281 individuals diagnosed with MDD were recruited from psychiatric clinics. The main assessments included the evaluation of sleep disruption, inflammatory markers, and SI. The Beck Scale for Suicide Ideation (SSI) scores was employed to quantify SI, whereas HAMD-SLD, a component of the Hamilton Rating Scale (HAMD-17), was used to evaluate sleep disruption. Blood analysis was performed to measure inflammatory markers. RESULT For females diagnosed with MDD, significant associations between sleep disruption and the levels of IL-6 (B = 0.994, p = 0.013) and TNF-α (B = 1.986, p = 0.016) were found when IL-6 or TNF-α were considered as mediators in the regression model. In addition, IL-6 (B = 5.689, p < 0.001) and TNF-α (B = 9.916, p = 0.006) exhibited strong correlation with SSI scores. CONCLUSIONS The primary results of this study indicate that IL-6 and TNF-α could function as potential mediators in the relationship between sleep disruption and SI among female patients diagnosed with MDD. CLINICAL TRIAL Name of the registry: Zhejiang University Trial registration number: ChiCTR1800017626 Date of registration: 2018-08-07, 'Retrospectively registered' URL of trial registry record: https://www.chictr.org.cn/showproj.html?proj=27321.
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Affiliation(s)
- Yexian Zeng
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Weicheng Li
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xiaoyu Chen
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Zerui You
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Siming Mai
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xiaofeng Lan
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Department of Psychology, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
| | - Yanling Zhou
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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Yang N, Shi L, Xu P, Ren F, Lv S, Li C, Qi X. Identification of potential drug targets for insomnia by Mendelian randomization analysis based on plasma proteomics. Front Neurol 2024; 15:1380321. [PMID: 38725646 PMCID: PMC11079244 DOI: 10.3389/fneur.2024.1380321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Insomnia, a common clinical disorder, significantly impacts the physical and mental well-being of patients. Currently, available hypnotic medications are unsatisfactory due to adverse reactions and dependency, necessitating the identification of new drug targets for the treatment of insomnia. Methods In this study, we utilized 734 plasma proteins as genetic instruments obtained from genome-wide association studies to conduct a Mendelian randomization analysis, with insomnia as the outcome variable, to identify potential drug targets for insomnia. Additionally, we validated our results externally using other datasets. Sensitivity analyses entailed reverse Mendelian randomization analysis, Bayesian co-localization analysis, and phenotype scanning. Furthermore, we constructed a protein-protein interaction network to elucidate potential correlations between the identified proteins and existing targets. Results Mendelian randomization analysis indicated that elevated levels of TGFBI (OR = 1.01; 95% CI, 1.01-1.02) and PAM ((OR = 1.01; 95% CI, 1.01-1.02) in plasma are associated with an increased risk of insomnia, with external validation supporting these findings. Moreover, there was no evidence of reverse causality for these two proteins. Co-localization analysis confirmed that PAM (coloc.abf-PPH4 = 0.823) shared the same variant with insomnia, further substantiating its potential role as a therapeutic target. There are interactive relationships between the potential proteins and existing targets of insomnia. Conclusion Overall, our findings suggested that elevated plasma levels of TGFBI and PAM are connected with an increased risk of insomnia and might be promising therapeutic targets, particularly PAM. However, further exploration is necessary to fully understand the underlying mechanisms involved.
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Affiliation(s)
- Ni Yang
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Liangyuan Shi
- Qingdao Traditional Chinese Medicine Hospital (Qingdao Hiser Hospital) Qingdao Hiser Hospital Affiliated of Qingdao University, Qingdao, China
| | - Pengfei Xu
- Qingdao Traditional Chinese Medicine Hospital (Qingdao Hiser Hospital) Qingdao Hiser Hospital Affiliated of Qingdao University, Qingdao, China
| | - Fang Ren
- Department of Laboratory, Jimo District Qingdao Hospital of Traditional Chinese Medicine, Qingdao, China
| | - Shimeng Lv
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Chunlin Li
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xianghua Qi
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Fernandez-Mendoza J, Calhoun SL, Bixler EO. Edward O. Bixler, PhD: from the Apollo project and chimpanzees to sleep epidemiology. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae020. [PMID: 38562675 PMCID: PMC10983785 DOI: 10.1093/sleepadvances/zpae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/26/2024] [Indexed: 04/04/2024]
Abstract
What an honor to write about Dr. Edward O. Bixler's contributions to the sleep field. In 1967, Dr. Bixler published a case report on a chimpanzee with implanted brain electrodes while working at an Air Force base in New Mexico. A few years later, in 1971, he published on the sleep effects of flurazepam in individuals with insomnia together with Dr. Anthony Kales, data that he had collected when the Sleep Research & Treatment Center (SRTC) was housed at the University of California Los Angeles. Dr. Bixler, a meticulous scientist, learned from Dr. Kales, a devoted clinician, to study "the whole patient, and all aspects of sleep," a legacy that continued when the SRTC moved to Penn State in Hershey. Indeed, Dr. Bixler's tenure at Penn State from 1971 until 2019 kept the science of the SRTC focused on that premise and helped translate scientific evidence into clinical care. He not only contributed early to the pharmacology of sleep and the effects of hypnotics, but he was also a pioneer in "sleep epidemiology." His "Prevalence of sleep disorders in the Los Angeles metropolitan area" study of 1979 was the first rigorous epidemiological study on sleep disturbances. Starting in 1990, he established the Penn State Adult Cohort to estimate the prevalence and natural history of sleep-disordered breathing and other sleep disorders in adults. Inspired by life-course epidemiology, he established in 2001 the Penn State Child Cohort to estimate the same phenomena in children. This Living Legend paper captures and highlights Dr. Bixler's enduring legacy to sleep science.
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Affiliation(s)
- Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Sleep Research & Treatment Center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Edward O Bixler
- Sleep Research & Treatment Center, Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
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Pieroni I, Raffone A, Simione L. Sleep reactivity mediates the relationship between sensory-processing sensitivity and insomnia symptoms severity: A cross-sectional correlational study. Stress Health 2024; 40:e3297. [PMID: 37492995 DOI: 10.1002/smi.3297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/14/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
Sensory-processing sensitivity (SPS) is a temperamental trait that describes individual differences in sensitivity to environmental stimuli. Previous studies have shown that highly sensitive individuals are more vulnerable to stress and to sleep-related difficulties. In light of this evidence, we hypothesized that SPS is associated with an increase in insomnia symptoms and that this correlation would be mediated by increased perceived stress and sleep reactivity. To test this hypothesis, we conducted a cross-sectional study on 358 adults who completed a survey that included self-report measures of sensitivity, perceived stress, sleep reactivity, and insomnia symptoms. Correlation analysis revealed that SPS was positively related to both stress-related and sleep-related variables. We then conducted a mediation analysis, which revealed that SPS was positively related to insomnia symptoms and that this relationship was fully mediated by sleep reactivity but not mediated at all by perceived stress. The current findings suggest that sleep reactivity may contribute to the development of insomnia symptoms in highly sensitive individuals. Therefore, these results suggests that sleep reactivity should be assessed in highly sensitive individuals and that it could be important to evaluate and further study this relationship.
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Affiliation(s)
- Ilde Pieroni
- Department of Psychology, "Sapienza," University of Rome, Rome, Italy
- Center of Sleep Medicine, Villa Serena Hospital, Città S. Angelo (Pescara), Italy
| | - Antonino Raffone
- Department of Psychology, "Sapienza," University of Rome, Rome, Italy
- School of Buddhist Studies, Philosophy, and Comparative Religions, Nalanda University, Rajgir, India
| | - Luca Simione
- Institute of Cognitive Sciences and Technologies, Rome, Italy
- Faculty of Interpreting and Translation, UNINT Università degli Studi Internazionali, Rome, Italy
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Lok R, Qian J, Chellappa SL. Sex differences in sleep, circadian rhythms, and metabolism: Implications for precision medicine. Sleep Med Rev 2024; 75:101926. [PMID: 38564856 DOI: 10.1016/j.smrv.2024.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/16/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
The number of individuals experiencing sleep loss has exponentially risen over the past decades. Extrapolation of laboratory findings to the real world suggests that females are more affected by extended wakefulness and circadian misalignment than males are. Therefore, long-term effects such as sleep and metabolic disorders are likely to be more prevalent in females than in males. Despite emerging evidence for sex differences in key aspects of sleep-wake and circadian regulation, much remains unknown, as females are often underrepresented in sleep and circadian research. This narrative review aims at highlighting 1) how sex differences systematically impinge on the sleep-wake and circadian regulation in humans, 2) how sex differences in sleep and circadian factors modulate metabolic control, and 3) the relevance of these differences for precision medicine. Ultimately, the findings justify factoring in sex differences when optimizing individually targeted sleep and circadian interventions in humans.
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Affiliation(s)
- Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
| | - Jingyi Qian
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Females's Hospital, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Sarah L Chellappa
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom.
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Wei J, Xu Y, Mao H. Mobile cognitive behavioral therapy for insomnia: analysis of factors affecting treatment prognosis. Sci Rep 2024; 14:3086. [PMID: 38321116 PMCID: PMC10847131 DOI: 10.1038/s41598-024-53119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
This study aims to explore the factors that affect the prognosis of patients with insomnia who are treated with mobile cognitive behavioral therapy. Patients with insomnia who visited the sleep disorders clinic were selected and completed mobile Cognitive behavioral therapy. Patients completed at least three evaluations (including baseline, monthly evaluations thereafter, and a final evaluation at the end of one year) and responded well to treatment within one year of follow-up. Insomnia, anxiety, and depression symptoms were evaluated using the Pittsburgh Sleep Quality Index (PSQI), the Generalized Anxiety Disorder 7-item (GAD-7) scale, and the 9-item Patient Health Questionnaire (PHQ-9), respectively. Treatment prognosis including relapse, recurrence, and remission group. These 339 patients were divided into three groups: 160 patients who remission, 100 patients who relapsed, and 79 patients who experienced recurrence after remission. Demographic characteristics of the 339 patients showed no significant difference in gender between the three groups (P = 0.978). However, significant differences were found in age (P = 0.006) and onset time (P = 0.000) among the three groups. The remission group had a higher average age than the recurrence group and the relapse group, and the onset time was slower than the other two groups. Multivariate logistic regression analysis showed that age and delayed onset time were protective factors for good treatment prognosis, while low educational level and high GAD-7 scores were independent risk factors for poor prognosis. There are many factors that affect the treatment prognosis of insomnia. Age, low educational level, high GAD-7 scores, and delayed onset time can be used to predict the prognosis of insomnia treatment.
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Affiliation(s)
- Jia Wei
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, Hangzhou, China
| | - You Xu
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, Hangzhou, China
| | - Hongjing Mao
- Affiliated Mental Health Center & Hangzhou Seventh People's Hospital, Zhejiang University, Hangzhou, China.
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Yu L, Yang L, Xu H, Zhao G, Dou Z, Luo Y, Yang J, Zhang Q, Yu S. Inhibitory Deficits of Insomnia Disorder: A Meta-Analysis on Event Related Potentials in Auditory Oddball Task. Behav Sleep Med 2024; 22:100-114. [PMID: 36994479 DOI: 10.1080/15402002.2023.2192499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Despite numerous studies on auditory event-related potentials (ERPs) in insomnia disorder (ID), the results are inconsistent across different ERP components (e.g. N1, P2, P3, and N350), types of auditory stimuli (e.g. standard and deviant), and stages of sleep (e.g. wakefulness, NREM sleep, and REM sleep). In light of this variability, we conducted a systematic meta-analysis of previous auditory ERP studies in ID to provide a quantitative review of the existing literature. METHODS Relevant literatures were searched on the Embase, PubMed/MEDLINE, PsycINFO and Cochrane Library. A total of 12 studies comprising 497 participants were finally included in this meta-analysis. The study protocol was registered with PROSPERO under the registration number CRD42022308348. RESULTS We found that patients with ID have significantly decreased N1 (Hedges' g = 0.34, 95%CI [0.04, 0.65]) and P3 (Hedges'g = -1.21, 95%CI [-2.37, -0.06]) amplitudes during wakefulness. In addition, decreases in P2 (Hedges'g = -0.57, 95%CI [-0.96, -0.17]) amplitude during wakefulness and N350 (Hedges' g = 0.73, 95%CI [0.36, 1.09]) amplitude during NREM. CONCLUSIONS This meta-analysis represents the first systematic investigation of ERP features across different stages of sleep in individuals with ID. Our results suggest that in patients with insomnia, the absence or deficiency of arousal inhibition during the nighttime sleep initiation or maintenance process may interfere with the normal process of sleep.
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Affiliation(s)
- Liyong Yu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lu Yang
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hao Xu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Rehabilitation and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guangli Zhao
- Acupuncture and Brain Science Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zeyang Dou
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Rehabilitation and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yucai Luo
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Rehabilitation and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Yang
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qi Zhang
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Siyi Yu
- Department of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Rehabilitation and Health, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Zhao W, Van Someren EJW, Xu Z, Ren Z, Tang L, Li C, Lei X. Identifying the insomnia-related psychological issues associated with hyperarousal: A network perspective. Int J Psychophysiol 2024; 195:112276. [PMID: 38056632 DOI: 10.1016/j.ijpsycho.2023.112276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/30/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023]
Abstract
Hyperarousal, recognized as a fundamental characteristic of insomnia for decades, has yielded limited evidence concerning its direct psychological associations. This study aimed to explore the psychological factors linked to hyperarousal within the framework of interrelated variables. Two independent samples, comprising n = 917 and n = 652 young adults, were included in the study. Employing the first dataset as a discovery sample and the second dataset as a replication sample, network analyses were conducted using 26 variables derived from 17 scales. The objective was to estimate the direct and indirect associations between psychological issues, including hyperarousal and insomnia. Additionally, linear regression analysis was employed to assess the convergence of findings obtained from the network analysis. Network analyses in both samples converged to reveal direct associations between insomnia severity and several psychological factors, including negative sleep beliefs, physical fatigue, insomnia response to stress, hyperarousal, self-reported depression, and mental fatigue. Notably, the nodes with relative importance within the network include trait anxiety, depressive rumination, hyperarousal, perfectionism sub-dimension of concern over mistakes, and private self-consciousness. Hyperarousal is one of the key factors linking insomnia with a variety of psychological issues, including emotion-related factors (rumination, perveived stress), sleep-related factors (dysfunctional sleep beliefs and attitudes, insomnia response to stress, fatigue, chronotype), and self-related factors (self-consciousness, perfectionism). The results suggest that forthcoming strategies for enhancing the treatment efficacy of insomnia could consider supplementary interventions that specifically address hyperarousal, other factors directly linked to insomnia, or the hub nodes within the network.
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Affiliation(s)
- Wenrui Zhao
- Sleep Center, Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam UMC, Vrije Universiteit, the Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, Vrije Universiteit Amsterdam, the Netherlands
| | - Ziye Xu
- Sleep and Neuroimaging Center, Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Zhiting Ren
- Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Ling Tang
- Sleep Center, Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Chenyu Li
- Sleep Center, Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China.
| | - Xu Lei
- Sleep and Neuroimaging Center, Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing 400715, China.
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Isaac F, Toukhsati SR, Klein B, Di Benedetto M, Kennedy GA. Differences in Anxiety, Insomnia, and Trauma Symptoms in Wildfire Survivors from Australia, Canada, and the United States of America. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:38. [PMID: 38248503 PMCID: PMC10815777 DOI: 10.3390/ijerph21010038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
Many survivors of wildfires report elevated levels of psychological distress following the trauma of wildfires. However, there is only limited research on the effects of wildfires on mental health. This study examined differences in anxiety, depression, insomnia, sleep quality, nightmares, and post-traumatic stress disorder (PTSD) symptoms following wildfires in Australia, Canada, and the United States of America (USA). One hundred and twenty-six participants from Australia, Canada, and the USA completed an online survey. The sample included 102 (81%) women, 23 (18.3%) men, and one non-binary (0.8%) individual. Participants were aged between 20 and 92 years (M age = 52 years, SD = 14.4). They completed a demographic questionnaire, the Disturbing Dream and Nightmare Severity Index (DDNSI), Generalized Anxiety Disorder Questionnaire (GAD-7), the Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-9), the Pittsburgh Sleep Quality Index (PSQI), and PTSD Checklist (PCL-5). Results showed that participants from the USA scored significantly higher on the GAD-7 (p = 0.009), ISI (p = 0.003), and PCL-5 (p = 0.021) than participants from Australia and Canada. The current findings suggest a need for more international collaboration to reduce the severity of mental health conditions in Australia, Canada, and the USA.
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Affiliation(s)
- Fadia Isaac
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
| | - Samia R. Toukhsati
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
| | - Britt Klein
- Health Innovation and Transformation Centre, Federation University, Mt Helen, VIC 3350, Australia;
- Biopsychosocial & eHealth Research & Innovation (BeRI) Hub, Federation University, Mt Helen, VIC 3350, Australia
| | | | - Gerard A. Kennedy
- Institute of Health and Wellbeing, Federation University, Mt Helen, VIC 3350, Australia (G.A.K.)
- School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC 3083, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, VIC 3084, Australia
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Guo Y, Zhao X, Liu X, Liu J, Li Y, Yue L, Yuan F, Zhu Y, Sheng X, Yu D, Yuan K. Electroencephalography microstates as novel functional biomarkers for insomnia disorder. Gen Psychiatr 2023; 36:e101171. [PMID: 38143715 PMCID: PMC10749048 DOI: 10.1136/gpsych-2023-101171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/14/2023] [Indexed: 12/26/2023] Open
Abstract
Background Insomnia disorder (ID) is one of the most common mental disorders. Research on ID focuses on exploring its mechanism of disease, novel treatments and treatment outcome prediction. An emerging technique in this field is the use of electroencephalography (EEG) microstates, which offer a new method of EEG feature extraction that incorporates information from both temporal and spatial dimensions. Aims To explore the electrophysiological mechanisms of repetitive transcranial magnetic stimulation (rTMS) for ID treatment and use baseline microstate metrics for the prediction of its efficacy. Methods This study included 60 patients with ID and 40 age-matched and gender-matched good sleep controls (GSC). Their resting-state EEG microstates were analysed, and the Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were collected to assess sleep quality. The 60 patients with ID were equally divided into active and sham groups to receive rTMS for 20 days to test whether rTMS had a moderating effect on abnormal microstates in patients with ID. Furthermore, in an independent group of 90 patients with ID who received rTMS treatment, patients were divided into optimal and suboptimal groups based on their median PSQI reduction rate. Baseline EEG microstates were used to build a machine-learning predictive model for the effects of rTMS treatment. Results The class D microstate was less frequent and contribute in patients with ID, and these abnormalities were associated with sleep onset latency as measured by PSG. Additionally, the abnormalities were partially reversed to the levels observed in the GSC group following rTMS treatment. The baseline microstate characteristics could predict the therapeutic effect of ID after 20 days of rTMS, with an accuracy of 80.13%. Conclusions Our study highlights the value of EEG microstates as functional biomarkers of ID and provides a new perspective for studying the neurophysiological mechanisms of ID. In addition, we predicted the therapeutic effect of rTMS on ID based on the baseline microstates of patients with ID. This finding carries great practical significance for the selection of therapeutic options for patients with ID.
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Affiliation(s)
- Yongjian Guo
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| | - Xumeng Zhao
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoyang Liu
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| | - Jiayi Liu
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan Li
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lirong Yue
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
| | - Fulai Yuan
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Yifei Zhu
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaona Sheng
- Department of Psychosomatic Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dahua Yu
- Information Processing Laboratory, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China
| | - Kai Yuan
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, China
- Information Processing Laboratory, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, China
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12
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Gong L, Chen K, Zhang H, Zhang S, Xu R, Liu D, Zhang B, Yu S, Xi C. Dopamine multilocus genetic profile influence on reward network in chronic insomnia disorder with depression. Sleep Med 2023; 112:122-128. [PMID: 37839273 DOI: 10.1016/j.sleep.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/31/2023] [Accepted: 09/23/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Chronic insomnia disorder (CID) is frequently comorbid with depression, and both conditions are believed to involve disruptions in the reward network. However, the potential effects of genetic polymorphisms in modulating this network remain largely unexplored. METHODS In this study, we recruited 50 CID patients with high (CID-HD) and low (CID-LD) depressive symptoms and assessed their reward networks using resting-state functional MRI. Additionally, we calculated the multilocus genetic profile score (MGPS) to examine the influence of depression and dopamine genetic variation on the nucleus accumbens functional connectivity (NAFC) network in CID patients. RESULTS Although the MGPS did not show a significant difference between the two CID groups, its influence on the NAFC network was observed in the salience network (SN) and visual network (VN) in CID patients. When comparing CID-HD patients to CID-LD patients, we found that CID-HD patients exhibited decreased NAFC in the internal reward network, default mode network, SN, and sensorimotor network, while showing increased NAFC in the executive control network (ECN) and VN. Furthermore, the influence of MGPS on the reward network was only significant in CID-HD patients, specifically in the internal reward network and ECN. CONCLUSION These findings suggest that genetic variations related to dopamine may modulate the reward network differently in CID patients with and without depressive symptoms. These results contribute to our understanding of the pathophysiology of polygenic effects underlying brain network abnormalities in CID patients with depression.
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Affiliation(s)
- Liang Gong
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Kang Chen
- Department of Radiology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Hongyu Zhang
- Chengdu Medical College, Chengdu, Sichuan, 610500, China; Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Shang Zhang
- North Sichuan Medical College, Nanchong, Sichuan, 637199, China; Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Ronghua Xu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Duan Liu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Bei Zhang
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, Sichuan, 610017, China
| | - Siyi Yu
- Department of Acupuncture & Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 610075, China.
| | - Chunhua Xi
- Department of Neurology, The Third Affiliated Hospital of Anhui Medical University, Heifei, Anhui, 230061, China.
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Morin CM, Chen SJ, Ivers H, Beaulieu-Bonneau S, Krystal AD, Guay B, Bélanger L, Cartwright A, Simmons B, Lamy M, Busby M, Edinger JD. Effect of Psychological and Medication Therapies for Insomnia on Daytime Functions: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2349638. [PMID: 38153735 PMCID: PMC10755607 DOI: 10.1001/jamanetworkopen.2023.49638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/23/2023] [Indexed: 12/29/2023] Open
Abstract
Importance Daytime functional impairments are the primary reasons for patients with insomnia to seek treatment, yet little is known about what the optimal treatment is for improving daytime functions and how best to proceed with treatment for patients whose insomnia has not remitted. Objectives To compare the efficacy of behavioral therapy (BT) and zolpidem as initial therapies for improving daytime functions among patients with insomnia and evaluate the added value of a second treatment for patients whose insomnia has not remitted. Design, Setting, and Participants In this sequential multiple-assignment randomized clinical trial conducted at institutions in Canada and the US, 211 adults with chronic insomnia disorder were enrolled between May 1, 2012, and December 31, 2015, and followed up for 12 months. Statistical analyses were performed on an intention-to-treat basis in April and October 2023. Interventions Participants were randomly assigned to either BT or zolpidem as first-stage therapy, and those whose insomnia had not remitted received a second-stage psychological therapy (BT or cognitive therapy) or medication therapy (zolpidem or trazodone). Main Outcomes and Measures Study outcomes were daytime symptoms of insomnia, including mood disturbances, fatigue, functional impairments of insomnia, and scores on the 36-item Short-Form Health Survey (SF-36) physical and mental health components. Results Among 211 adults with insomnia (132 women [63%]; mean [SD] age, 45.6 [14.9] years), 104 were allocated to BT and 107 to zolpidem at the first stage. First-stage treatment with BT or zolpidem yielded significant and equivalent benefits for most of the daytime outcomes, including depressive symptoms (Beck Depression Inventory-II mean score change, -3.5 [95% CI, -4.7 to -2.3] vs -4.3 [95% CI, -5.7 to -2.9]), fatigue (Multidimensional Fatigue Inventory mean score change, -4.7 [95% CI, -7.3 to -2.2] vs -5.2 [95% CI, -7.9 to -2.5]), functional impairments (Work and Social Adjustment Scale mean score change, -5.0 [95% CI, -6.7 to -3.3] vs -5.1 [95% CI, -7.2 to -2.9]), and mental health (SF-36 mental health subscale mean score change, 3.5 [95% CI, 1.9-5.1] vs 2.5 [95% CI, 0.4-4.5]), while BT produced larger improvements for anxiety symptoms relative to zolpidem (State-Trait Anxiety Inventory mean score change, -4.1 [95% CI, -5.8 to -2.4] vs -1.2 [95% CI, -3.0 to 0.5]; P = .02; Cohen d = 0.55). Second-stage therapy produced additional improvements for the 2 conditions starting with zolpidem at posttreatment in fatigue (Multidimensional Fatigue Inventory mean score change: zolpidem plus BT, -3.8 [95% CI, -7.1 to -0.4]; zolpidem plus trazodone, -3.7 [95% CI, -6.3 to -1.1]), functional impairments (Work and Social Adjustment Scale mean score change: zolpidem plus BT, -3.7 [95% CI, -6.4 to -1.0]; zolpidem plus trazodone, -3.3 [95% CI, -5.9 to -0.7]) and mental health (SF-36 mental health subscale mean score change: zolpidem plus BT, 5.3 [95% CI, 2.7-7.9]; zolpidem plus trazodone, 2.0 [95% CI, 0.1-4.0]). Treatment benefits achieved at posttreatment were well maintained throughout the 12-month follow-up, and additional improvements were noted for patients receiving the BT treatment sequences. Conclusions and Relevance In this randomized clinical trial of adults with insomnia disorder, BT and zolpidem produced improvements for various daytime symptoms of insomnia that were no different between treatments. Adding a second treatment offered an added value with further improvements of daytime functions. Trial Registration ClinicalTrials.gov Identifier: NCT01651442.
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Affiliation(s)
- Charles M. Morin
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | - Si-Jing Chen
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hans Ivers
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | - Simon Beaulieu-Bonneau
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | - Andrew D. Krystal
- Department of Psychiatry and Behavioral Services, University of California, San Francisco
| | - Bernard Guay
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | - Lynda Bélanger
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | | | | | - Manon Lamy
- Centre de Recherche CERVO/Brain Research Center, École de Psychologie, Université Laval, Quebec City, Quebec, Canada
| | | | - Jack D. Edinger
- National Jewish Health, Denver, Colorado
- Duke University Medical Center, Durham, North Carolina
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Yarosh RA, Jackson CL, Anderson C, Nichols HB, Sandler DP. Sleep disturbances among cancer survivors. Cancer Epidemiol 2023; 87:102471. [PMID: 37837808 PMCID: PMC10873004 DOI: 10.1016/j.canep.2023.102471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE We investigated sleep disturbances among cancer survivors compared to similarly aged women without cancer history. METHODS We identified 2067 women with a history of cancer other than breast or non-melanoma skin cancer at enrollment in the Sister Study, a US-wide cohort of women with a family history of breast cancer. Cancer survivors were matched with up to 5 cancer-free women (N = 9717) on age at enrollment. An index age (for covariate classification) was defined as the age at cancer diagnosis for survivors and the same age for their matched comparators. Sleep disturbances included duration, sleep medication usage, insomnia symptoms, long sleep-latency onset (≥30 min to fall asleep), frequent night awakenings (waking ≥3/night, ≥ 3 times/week), frequent napping (≥ 3 times/week), and a composite outcome of ≥ 1sleep disturbance. Multivariable linear regression (effect estimate, 95% confidence interval (CI)) and logistic regression (odds ratio, OR, 95% CI) were used for continuous and dichotomous outcomes, respectively. RESULTS At enrollment, cancer survivors were on average 13.8 years (range=0, 62) from diagnosis. After adjustment for age at enrollment and depression, diabetes, hypertension, and menopausal status prior to the index age, sleep disturbances were generally not more common among cancer survivors compared to those without cancer. However, among cancer survivors, those > 2 years from diagnosis were more likely to report ≥ 1 sleep disturbance (OR=1.44; 1.07, 1.93) compared to survivors 0-2 years from diagnosis. CONCLUSION Addressing sleep disturbances may improve well-being for cancer survivors.
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Affiliation(s)
- Rina A Yarosh
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Chandra L Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA; Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA.
| | - Chelsea Anderson
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Hazel B Nichols
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA.
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15
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Reid MJ, Quigg M, Finan PH. Sleep-EEG in comorbid pain and insomnia: implications for the treatment of pain disorders. Pain Rep 2023; 8:e1101. [PMID: 37899939 PMCID: PMC10599985 DOI: 10.1097/pr9.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/20/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Patients with chronic pain experience a high prevalence of comorbid insomnia, which is associated with functional impairment. Recent advances in sleep electroencephalography (sleep-EEG) may clarify the mechanisms that link sleep and chronic pain. In this clinical update, we outline current advancements in sleep-EEG assessments for pain and provide research recommendations. Results Promising preliminary work suggests that sleep-EEG spectral bands, particularly beta, gamma, alpha, and delta power, may create candidate neurophysiological signatures of pain, and macro-architectural parameters (e.g., total sleep time, arousals, and sleep continuity) may facilitate EEG-derived sleep phenotyping and may enable future stratification in the treatment of pain. Conclusion Integration of measures obtained through sleep-EEG represent feasible and scalable approaches that could be adopted in the future. We provide research recommendations to progress the field towards a deeper understanding of their utility and potential future applications in clinical practice.
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Affiliation(s)
- Matthew J. Reid
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Quigg
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Patrick H. Finan
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
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16
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Berro LF. Insomnia as a Risk Factor for Substance Use Disorders in Women. Sleep Med Clin 2023; 18:511-520. [PMID: 38501523 PMCID: PMC10950003 DOI: 10.1016/j.jsmc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Gender differences exist for both insomnia and substance use disorders. Women show a higher prevalence of insomnia and increased susceptibility to the effects of drugs than men. Importantly, a growing body of evidence suggests that insufficient sleep predicts and puts individuals at a higher risk for substance use and associated psychosocial problems. However, the role of insomnia in substance use disorders among women remains poorly understood. The present article discusses gender differences in insomnia and in substance use disorders and reviews evidence suggesting that an increased prevalence of insomnia may be a risk factor for substance use disorders in women.
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Affiliation(s)
- Laís F Berro
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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17
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Kivelä LMM, Antypa N, Fried EI, Schoevers R, van Hemert AM, Penninx BWJH, van der Does AJW. Suicidal ideation across depressive episodes: 9-year longitudinal cohort study. BJPsych Open 2023; 9:e218. [PMID: 37981566 PMCID: PMC10755669 DOI: 10.1192/bjo.2023.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/25/2023] [Accepted: 10/16/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Depression is a highly recurrent disorder, with more than 50% of those affected experiencing a subsequent episode. Although there is relatively little stability in symptoms across episodes, some evidence indicates that suicidal ideation may be an exception. However, these findings warrant replication, especially over longer periods and across multiple episodes. AIMS To assess the relative stability of suicidal ideation in comparison with other non-core depressive symptoms across episodes. METHOD We examined 490 individuals with current major depressive disorder (MDD) at baseline and at least one subsequent episode during 9-year follow-up within the Netherlands Study of Depression and Anxiety (NESDA). The Inventory of Depressive Symptomatology (IDS) was used to assess DSM-5 non-core MDD symptoms (fatigue, appetite/weight change, sleep disturbance, psychomotor disturbance, concentration difficulties, worthlessness/guilt, suicidal ideation) at baseline and 2-, 4-, 6- and 9-year follow-up. We examined consistency in symptom presentation (i.e. whether the symptom met the diagnostic threshold, based on a binary categorisation of the IDS) using kappa (κ) and percentage agreement, and stability in symptom severity using Spearman correlation, based on the continuous IDS scores. RESULTS Out of all non-core depressive symptoms, insomnia appeared the most stable across episodes (r = 0.55-0.69, κ = 0.31-0.47) and weight decrease the least stable (r = 0.03-0.33, κ = 0.06-0.19). For suicidal ideation, correlations across episodes ranged from r = 0.36 to r = 0.55 and consistency ranged from κ = 0.28 to κ = 0.49. CONCLUSIONS Suicidal ideation is moderately stable in recurrent depression over 9 years. Contrary to prior reports, however, it does not exhibit substantially more stability than most other non-core symptoms of depression.
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Affiliation(s)
- Liia M. M. Kivelä
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Niki Antypa
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Eiko I. Fried
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Robert Schoevers
- University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert M. van Hemert
- Department of Psychiatry, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Brenda W. J. H. Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - A. J. Willem van der Does
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands; and Leiden University Treatment Center (LUBEC), Leiden, The Netherlands
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18
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Schuffelen J, Maurer LF, Lorenz N, Rötger A, Pietrowsky R, Gieselmann A. The clinical effects of digital cognitive behavioral therapy for insomnia in a heterogenous study sample: results from a randomized controlled trial. Sleep 2023; 46:zsad184. [PMID: 37428712 PMCID: PMC10636251 DOI: 10.1093/sleep/zsad184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
STUDY OBJECTIVES Numerous studies worldwide have reported the beneficial effects of digital cognitive behavioral therapy for insomnia (dCBT-I). However, few focus on real-world study samples that reflect people in regular care. To test whether dCBT-I is suitable within German regular care, we designed a randomized controlled trial recruiting a heterogenous insomnia population. METHODS Participants aged ≥18 who met the criteria for insomnia disorder were randomized to 8-weeks dCBT-I + care-as-usual (CAU) or they were set on a waitlist + CAU. The intervention group was followed-up at 6- and 12-months. The primary outcome was self-reported insomnia severity, assessed with the Insomnia Severity Index (ISI) at 8-weeks post-randomization. A one-way ANCOVA with baseline score as a covariate was fitted to determine group differences. Secondary outcomes included measures of daytime functioning, quality of life, depression, anxiety, dreams, and nightmares. RESULTS Of the N = 238 participants (67.6% female), age range 19-81 years, n = 118 were randomized to dCBT-I and n = 120 to the control group. At posttreatment, the use of dCBT-I was associated with a large reduction in the ISI (Diffadj = -7.60) in comparison to WLC (d = -2.08). This clinical improvement was also reflected in responder and remission rates. Treatment effects were also observed for daytime functioning, quality of life, symptoms of depression and anxiety (ds = 0.26-1.02) and at long-term follow-up (intervention group only; ds = 0.18-1.65). No effects were found for dream and nightmare frequency. CONCLUSIONS This study showed that dCBT-I reduces insomnia symptoms and improves daytime functioning in a heterogenous insomnia population in Germany with sustained long-term treatment effects in the intervention group. Our results underscore the potential of digital health applications, their suitability within regular care, and their role in facilitating widespread implementation of CBT-I as a first-line treatment for insomnia.
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Affiliation(s)
- Jennifer Schuffelen
- Heinrich Heine University Düsseldorf, Institute of Experimental Psychology, Department of Clinical Psychology, GermanyGermany
| | | | - Noah Lorenz
- mementor DE GmbH, Department of Science, Germany
| | | | - Reinhard Pietrowsky
- Heinrich Heine University Düsseldorf, Institute of Experimental Psychology, Department of Clinical Psychology, GermanyGermany
| | - Annika Gieselmann
- Heinrich Heine University Düsseldorf, Institute of Experimental Psychology, Department of Clinical Psychology, GermanyGermany
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Wang M, Cooper R, Green D. Insomnia Medication Use by University Students: A Systematic Review. PHARMACY 2023; 11:171. [PMID: 37987381 PMCID: PMC10661327 DOI: 10.3390/pharmacy11060171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/22/2023] Open
Abstract
Problematic sleep or insomnia has been a recognised issue for many individuals in society, and university students can be of particular concern due to unique academic pressures. A systematic review was designed to summarise the current evidence about the extent of insomnia medication used by university students and identify characteristics of those more willing to use medication to manage insomnia. Searches were undertaken using Psych INFO, PubMed, Embase, and Web of Science, resulting in 25 eligible studies across multiple countries between 1994 and 2020. The prevalence of sleep medication use by students varied widely, from 2% to 41.2%, with an average of 13.1%. Female gender, students experiencing poor sleep, smoking, drinking stimulant beverages, and undertaking fewer physical activities were associated with the use of insomnia medication. Insomnia medication use exists within university student populations but appears to vary considerably worldwide; identifying multiple population characteristics associated with such use would offer opportunities to identify and support those affected.
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Affiliation(s)
- Menghan Wang
- School of Medicine and Population Health, University of Sheffield, Sheffield S1 4DA, UK;
| | - Richard Cooper
- School of Medicine and Population Health, University of Sheffield, Sheffield S1 4DA, UK;
| | - Dan Green
- College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK;
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20
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Bjorvatn B, Waage S, Pallesen S, Buysse DJ, Saxvig IW. The association between different sleep health dimensions and sex, age, education, circadian preference, and chronic insomnia: a representative population-based study. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad041. [PMID: 37954092 PMCID: PMC10635412 DOI: 10.1093/sleepadvances/zpad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/12/2023] [Indexed: 11/14/2023]
Abstract
Objectives The aims were to explore multidimensional sleep health and the different dimensions of sleep health in the adult Norwegian population in relation to sex, age, education, circadian preference, and chronic insomnia. Methods A representative sample of 1028 Norwegians, aged 18 + years completed a cross-sectional web-based survey. Sleep health was measured with the multidimensional RU_SATED scale, which assesses the dimensions of regularity, satisfaction, alertness, timing, efficiency, and duration. Insomnia was assessed with the Bergen Insomnia Scale. Data were analyzed with chi-square tests, t-tests, one-way ANOVAs, and regression analyses, as appropriate. Response rate was 33.5%. Results Sleep health was better in males, with increasing age, and with higher educational level, and was poorer in participants with evening preference and chronic insomnia, compared to their respective counterparts. When investigating the different sleep health dimensions, males scored better than females on satisfaction (adjusted odds ratio [aOR] = 0.69, 95% CI = 0.51 to 0.93), timing (aOR = 0.66, 95% CI = 0.49 to 0.88), and efficiency (aOR = 0.68, 95% CI = 0.52 to 0.89). Older age was associated with better scores on regularity and satisfaction, whereas young age was associated with better scores on alertness and duration. High educational level was associated with better scores on alertness, timing, and duration. Evening types scored worse than morning types on regularity (aOR = 0.27, 95% CI = 0.18 to 0.41), satisfaction (aOR = 0.37, 95% CI = 0.26 to 0.53), and timing (aOR = 0.36, 95% CI = 0.26 to 0.51). Participants with chronic insomnia scored worse than participants without insomnia on all six sleep health dimensions. Conclusions Sleep health differed significantly in relation to sex, age, education, circadian preference, and chronic insomnia. However, specific group differences were not equally evident in all sleep health dimensions.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Siri Waage
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Ingvild W Saxvig
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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Vargas I. Scaling up sleep education and cognitive behavioral therapy for insomnia training across multiple health disciplines. Sleep 2023; 46:zsad204. [PMID: 37527469 PMCID: PMC11009685 DOI: 10.1093/sleep/zsad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- Ivan Vargas
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
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22
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Eigl ES, Hauser T, Topalidis PI, Schabus M. On the Efficacy of a CBT-I-Based Online Program for Sleep Problems: A Randomized Controlled Trial. Clocks Sleep 2023; 5:590-603. [PMID: 37873840 PMCID: PMC10594462 DOI: 10.3390/clockssleep5040039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
There is an urgent need for easily accessible treatment options for sleep problems to reduce the current treatment gap in receiving cognitive behavioral therapy for insomnia (CBT-I). Using a randomized controlled trial, we evaluated the efficacy of a CBT-I-based online program on sleep. Fifty-three volunteers (21-71 years; MAge = 44.6 ± 12.5; 27 female) suffering from impaired sleep were randomly allocated either to the experimental group (EG, n = 27) or to an active control group (CG, n = 26). The EG participated in a 6-week CBT-I-based online program, while the CG received psychoeducation and sleep hygiene instructions. Sleep was assessed both objectively via ambulatory polysomnography (PSG) as well as subjectively via questionnaires at three time points (baseline, pre- and post-intervention). A one-month follow-up assessment was performed using questionnaires. The EG showed small but reliable improvements from pre- to post-intervention in PSG-derived wake after sleep onset (from 58.6 min to 42.5 min; p < 0.05) and sleep efficiency (from 86.0% to 89.2%; p < 0.05). Furthermore, subjective sleep quality (assessed via Pittsburgh Sleep Quality Index) improved significantly during intervention (p = 0.011) and follow-up (p = 0.015) in the EG alone. The Insomnia Severity Index decreased from pre- to post-intervention in both groups (EG: p = 0.003, CG: p = 0.008), while it further improved during follow-up (p = 0.035) in the EG alone. We show that a CBT-I-based online program can improve sleep not only subjectively but also objectively and can be a viable alternative when face-to-face interventions are not available.
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Affiliation(s)
- Esther-Sevil Eigl
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
| | - Theresa Hauser
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
| | - Pavlos I. Topalidis
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
| | - Manuel Schabus
- Laboratory for Sleep, Cognition & Consciousness Research, Department of Psychology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria; (E.-S.E.)
- Centre for Cognitive Neuroscience Salzburg (CCNS), Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
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23
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Jeon JY, Kim KT, Lee SY, Cho YW. Insomnia during coronavirus disease 2019 pandemic in Korea: a National sleep survey. Sleep Biol Rhythms 2023; 21:431–438. [PMID: 37363639 PMCID: PMC10196317 DOI: 10.1007/s41105-023-00464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/08/2023] [Indexed: 06/28/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has caused widespread increase in stress and affected sleep quality and quantity, with up to 30% prevalence of sleep disorders being reported after the declaration of the pandemic. This study aimed to assess perceived changes due to the pandemic in the prevalence of insomnia and excessive daytime sleepiness (EDS) in Korea, and identify the associated factors. An online survey was conducted among 4000 participants (2035 men and 1965 women) aged 20-69 years enrolled using stratified multistage random sampling according to age, sex, and residential area, between January, 2021 and February, 2022. The questionnaire included various items, such as socio-demographics, Insomnia Severity Index, and Epworth Sleepiness Scale (ESS). Insomnia was defined as difficulty falling asleep and difficulty maintaining sleep more than twice a week. EDS was classified as an ESS score ≥ 11. Insomnia was reported by 32.9% (n = 1316) of the participants (37.3% among women and 28.6% among men). Multivariate logistic regression revealed that insomnia was associated with female sex [odds ratio (OR) = 1.526, 95% confidence interval (CI) = 1.297-1.796], night workers (OR 1.561, 95% CI 1.160-2.101), and being unmarried (OR 1.256, 95% CI 1.007-1.566). EDS was reported by 12.8% (n = 510) of the participants (14.7% among men and 10.7% among women). EDS was associated with male sex (OR 1.333, 95% CI 1.062-1.674), and being employed (OR 1.292, 95% CI 1.017-1.641). During the COVID-19 pandemic, the prevalence of insomnia increased in Korea, while there was no significant change in EDS compared with pre-pandemic evidence.
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Affiliation(s)
- Ji-Ye Jeon
- Department of Neurology, School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Keun Tae Kim
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seo-Yong Lee
- Department of Neurology, School of Medicine, Kangwon National University, Chuncheon, Korea
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea
| | - Yong Won Cho
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - the Sleep Epidemiology Committee of the Korean Sleep Research Society
- Department of Neurology, School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
- Department of Neurology, School of Medicine, Kangwon National University, Chuncheon, Korea
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon, Korea
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24
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Höglund P, Hakelind C, Nordin M, Nordin S. Risk factors for insomnia and burnout: A longitudinal population-based cohort study. Stress Health 2023; 39:798-812. [PMID: 36634111 DOI: 10.1002/smi.3218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/13/2022] [Accepted: 01/01/2023] [Indexed: 01/13/2023]
Abstract
Insomnia and burnout are highly prevalent in the general population, calling for understanding of its causes. Taking a broad approach, the aim of this study was to determine various mental and somatic risk factors for development of insomnia and burnout and stratifying for sex and age group. Questionnaire data were used from a Swedish population-based sample aged 18-79 years, from which cohorts without insomnia (n = 1702) and without burnout (n = 1972) at baseline were followed-up after 3 years. Self-reports of eight mental and somatic conditions at baseline were used as independent variables in logistic regression analyses to predict development of insomnia and burnout at 3-year follow-up. All eight studied conditions were significant risk factors for development of both insomnia (odds ratio, OR = 1.62-2.73) and burnout (OR = 2.20-3.21). Burnout and poor self-rated health had the highest ORs for insomnia, and poor self-rated health, anxiety and somatic symptoms had the highest ORs for burnout. The ORs were generally similar between men and women, whereas age groups tended to differ in some of the risk factors. The study highlights the importance of a broad assessment of both mental and somatic conditions in the prevention of insomnia and burnout.
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Affiliation(s)
- Per Höglund
- Department of Psychology, Umeå University, Umeå, Sweden
| | | | - Maria Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
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25
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Liu X, Han M, Lv T, Li J, Zhang X. TBSS analysis of white matter fasciculus in chronic insomnia and the relationship with sleep quality and cognitive function. Sleep Biol Rhythms 2023; 21:467-470. [PMID: 38476185 PMCID: PMC10899946 DOI: 10.1007/s41105-023-00468-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/21/2023] [Indexed: 03/14/2024]
Abstract
Eighty patients with chronic insomnia and 50 normal controls were selected. Evaluation scales included Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep, Montreal Cognitive Assessment, Self-Rating Anxiety Scale, Self-Rating Depression Scale, Ruminative Responses Scale and Social Disability Screening Schedule. All patients and controls underwent whole-brain DTI scanning and Tract-Based Spatial Statistics (TBSS) analysis was performed. Chronic insomnia patients are mainly accompanied by white matter lesions of right posterior thalamic radiation, right sagittal tract, and right upper longitudinal tract. TBSS is helpful in the diagnosis of chronic insomnia and can reflect the changes of cognitive function.
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Affiliation(s)
- Xiaoran Liu
- School of Nursing, Binzhou Medical University, Yantai, China
| | - Mingxing Han
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Tongyu Lv
- School of Nursing, Binzhou Medical University, Yantai, China
| | - Jun Li
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Xueyan Zhang
- School of Nursing, Binzhou Medical University, Yantai, China
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26
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Hakami A, Hakami RA, Al-Amer MA, Sharahili LM, Zuqayl AH, Hakami TK, Dighriri IM. Prevalence of Sleep Disorders Among the General Population of the Jazan Region of Southwest Saudi Arabia. Cureus 2023; 15:e46218. [PMID: 37905270 PMCID: PMC10613507 DOI: 10.7759/cureus.46218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Sleep disorders impose a substantial burden on the global population, leading to an array of health complications. Understanding their prevalence and associated risk factors is crucial to formulating effective interventions. OBJECTIVE This study aimed to determine the prevalence and associated risk factors of sleep disorders among residents of the Jazan region of Saudi Arabia. METHODS This cross-sectional study conducted an online survey from December 2022 to March 2023. The sample comprised 670 respondents aged 18 years and older residing in Jazan. Demographic data, lifestyle habits, sleep patterns, and sleep disorder symptoms were assessed. RESULTS The participants were predominantly women (62.2%), with an average age of 30.99 years and a normal body mass index. The analyses revealed that 28.8% of the respondents reported experiencing sleep disorders, and 13.4% particularly had obstructive sleep apnea. Nearly half of the participants reported having primary insomnia, excessive daytime sleepiness, and restless leg syndrome. Significant associations were found between sleep disorders and older age (p = 0.012), obesity (p = 0.043), short or thin neck (p = 0.034), smoking (p = 0.003), caffeine use (p = 0.001), existing health conditions (p = 0.001), medication use (p = 0.013), lack of daytime naps (p = 0.043), and frequent nighttime awakenings to urinate (p = 0.001). The most common self-reported reasons for nightly awakenings were urination, anxiety or stress, discomfort or noise, and health conditions. CONCLUSIONS The findings suggest a high prevalence of sleep disorders among adults in Jazan, Saudi Arabia. Various demographic, lifestyle, and health-related factors are linked to these disorders. Therefore, targeted sleep health education and interventions could be instrumental in tackling this significant public health issue.
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Affiliation(s)
- Abdulrahman Hakami
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan, SAU
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27
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Irwin MR, Straub RH, Smith MT. Heat of the night: sleep disturbance activates inflammatory mechanisms and induces pain in rheumatoid arthritis. Nat Rev Rheumatol 2023; 19:545-559. [PMID: 37488298 DOI: 10.1038/s41584-023-00997-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/26/2023]
Abstract
Sleep has a homeostatic role in the regulation of the immune system and serves to constrain activation of inflammatory signalling and expression of cellular inflammation. In patients with rheumatoid arthritis (RA), a misaligned inflammatory profile induces a dysregulation of sleep-wake activity, which leads to excessive inflammation and the induction of increased sensitivity to pain. Given that multiple biological mechanisms contribute to sleep disturbances (such as insomnia), and that the central nervous system communicates with the innate immune system via neuroendocrine and neural effector pathways, potential exists to develop prevention opportunities to mitigate the risk of insomnia in RA. Furthermore, understanding these risk mechanisms might inform additional insomnia treatment strategies directed towards steering and reducing the magnitude of the inflammatory response, which together could influence outcomes of pain and disease activity in RA.
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Affiliation(s)
- Michael R Irwin
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- Cousins Center for Psychoneuroimmunology, UCLA Semel Institute for Neuroscience and Human Behaviour, Los Angeles, CA, USA.
| | - Rainer H Straub
- Laboratory of Experimental Rheumatology and Neuroendocrine Immunology, Department of Internal Medicine I, University Hospital, Regensburg, Germany
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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28
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Klimt F, Jacobi C, Brähler E, Stöbel-Richter Y, Zenger M, Berth H. Insomnia symptoms in adulthood. Prevalence and incidence over 25 years. Sleep Med 2023; 109:240-244. [PMID: 37480825 DOI: 10.1016/j.sleep.2023.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE/BACKGROUND Despite its high prevalence, little information is available about the course of insomnia symptoms over the life span. In this study, we analyzed the self-reported insomnia symptoms of the general population over more than 20 years, covering young up to middle adulthood. PATIENTS/METHODS Data from waves 12 to 32 of the Saxon Longitudinal Study (1996-2021), were analyzed. Based on data from the 12th wave, n = 115 adults (48 men (41.7%), 67 women (58.3%), Mage = 23.59, SD = 0.59) completed the G-Score Item #3 in the following 18 waves, thus forming the basis for our analyses. The G-Score Item #3 reads "In the last 12 months, have you had the following complaints? Please indicate how often they occurred - Insomnia". The G-Score Item #3 was dichotomized using a cut-off score of 2, and prevalence and incidence rates were calculated by gender. RESULTS The minimum prevalence rate was 23.48% (Mage = 32.11, SD = 0.40), and the maximum was 47.83% (Mage = 48.43, SD = 0.64), indicating an increase in insomnia symptoms with age. In most cases, no evidence was found for gender differences in prevalence rates. The incidence rates were 10.43% for the 1st year of follow-up and 8.7% for the 5th year and 6th year of follow-up, respectively. CONCLUSIONS This study provides further evidence for the high prevalence rates of insomnia symptoms in the general population. As this study is the first epidemiological study of insomnia symptoms based on a single-item (screening) instrument, it should be rather seen as an extension than a replication of previous study findings.
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Affiliation(s)
- Franziska Klimt
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Division of Psychological and Social Medicine and Developmental Neurosciences, Research Group Applied Medical Psychology and Medical Sociology, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Clara Jacobi
- Technische Universität Dresden, School of Humanities and Social Sciences, Disruption and Societal Change Center TUDiSC, 01217, Dresden, Germany.
| | - Elmar Brähler
- University Medical Center Mainz, Department of Psychosomatic Medicine and Psychotherapy, 55131, Mainz, Germany; Universitätsklinikum Leipzig, Klinik und Poliklinik für Psychiatrie und Psychotherapie, 04103, Leipzig, Germany.
| | - Yve Stöbel-Richter
- University of Applied Science Zittau/Görlitz, Faculty of Management and Cultural Studies, 02826, Görlitz, Germany.
| | - Markus Zenger
- University of Applied Sciences Magdeburg-Stendal, 39576, Stendal, Germany; Integrated Research and Treatment Center AdiposityDiseases - Behavioral Medicine, Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, 04103, Leipzig, Germany.
| | - Hendrik Berth
- Technische Universität Dresden, Carl Gustav Carus Faculty of Medicine, Division of Psychological and Social Medicine and Developmental Neurosciences, Research Group Applied Medical Psychology and Medical Sociology, Fetscherstr. 74, 01307, Dresden, Germany.
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29
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Wu J, Zhang B, Zhou S, Huang Z, Xu Y, Lu X, Zheng X, Ouyang D. Associations between gut microbiota and sleep: a two-sample, bidirectional Mendelian randomization study. Front Microbiol 2023; 14:1236847. [PMID: 37645227 PMCID: PMC10461450 DOI: 10.3389/fmicb.2023.1236847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction Previous research has reported that the gut microbiota performs an essential role in sleep through the microbiome-gut-brain axis. However, the causal association between gut microbiota and sleep remains undetermined. Methods We performed a two-sample, bidirectional Mendelian randomization (MR) analysis using genome-wide association study summary data of gut microbiota and self-reported sleep traits from the MiBioGen consortium and UK Biobank to investigate causal relationships between 119 bacterial genera and seven sleep-associated traits. We calculated effect estimates by using the inverse-variance weighted (as the main method), maximum likelihood, simple model, weighted model, weighted median, and MR-Egger methods, whereas heterogeneity and pleiotropy were detected and measured by the MR pleiotropy residual sum and outlier method, Cochran's Q statistics, and MR-Egger regression. Results In forward MR analysis, inverse-variance weighted estimates concluded that the genetic forecasts of relative abundance of 42 bacterial genera had causal effects on sleep-associated traits. In the reverse MR analysis, sleep-associated traits had a causal effect on 39 bacterial genera, 13 of which overlapped with the bacterial genera in the forward MR analysis. Discussion In conclusion, our research indicates that gut microbiota may be involved in the regulation of sleep, and conversely, changes in sleep-associated traits may also alter the abundance of gut microbiota. These findings suggest an underlying reciprocal causal association between gut microbiota and sleep.
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Affiliation(s)
- Jun Wu
- Department of Vascular Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Baofu Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shengjie Zhou
- Department of Obstetrics and Gynecology, Taizhou Women and Children’s Hospital of Wenzhou Medical University, Taizhou, Zhejiang, China
| | - Ziyi Huang
- Department of Vascular Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yindong Xu
- Department of Vascular Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xinwu Lu
- Department of Vascular Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Vascular Surgery, Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangtao Zheng
- Department of Vascular Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dong Ouyang
- Department of Vascular Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Obstetrics and Gynecology, Taizhou Women and Children’s Hospital of Wenzhou Medical University, Taizhou, Zhejiang, China
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30
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Edinger JD, Wamboldt FS, Johnson RL, Simmons B, Tsai S, Morin CM, Holm KE. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med 2023; 19:1495-1503. [PMID: 37086054 PMCID: PMC10394369 DOI: 10.5664/jcsm.10616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBTI) has been paired with supervised medication tapering to help hypnotic-dependent individuals discontinue their hypnotics. This study examined the hypothesis that higher participant adherence to behavioral recommendations of CBTI will predict lower odds of using sleep medications 3 months after completion of a combined CBTI/sleep medication tapering protocol. METHODS Fifty-eight individuals who used sedative hypnotics completed four CBTI sessions followed by sleep medication tapering. Logistic regression was used to examine the association of stability of time in bed and stability of rise time (measured as the within-person standard deviation) at completion of CBTI with two outcomes at 3-month follow-up: use of sedative hypnotics and use of any medication/substance for sleep. RESULTS Participants with more stability in their rise time after CBTI than at baseline (ie, a decrease in their within-person standard deviation) had 69.5% lower odds of using sedative hypnotics at follow-up (odds ratio = 0.305, 95% confidence interval = 0.095-0.979, P = .046) than individuals who had no change or a decrease in the stability of their rise time. Results were similar for time in bed: participants with more stability in their time in bed after CBTI than at baseline had 83.2% lower odds of using sedative hypnotics (odds ratio = 0.168, 95% confidence interval = 0.049-0.580, P = .005). Increase in stability of rise time and stability of time in bed was also associated with reduced odds of using any medication/substance for sleep at follow-up. CONCLUSIONS Participants who implement behavioral recommendations of CBTI appear to have more success with discontinuing use of sleep medications. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The Role of Tapering Pace and Selected Traits on Hypnotic Discontinuation; URL: https://clinicaltrials.gov/ct2/show/NCT02831894; Identifier: NCT02831894. CITATION Edinger JD, Wamboldt FS, Johnson RL, et al. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med. 2023;19(8):1495-1503.
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Affiliation(s)
- Jack D. Edinger
- National Jewish Health, Denver, Colorado
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | | | - Kristen E. Holm
- National Jewish Health, Denver, Colorado
- Colorado School of Public Health, Denver, Colorado
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31
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Carroll JE, Olmstead R, Cole SW, Breen EC, Arevalo JM, Irwin MR. Remission of insomnia in older adults treated with cognitive behavioral therapy for insomnia (CBT-I) reduces p16 INK4a gene expression in peripheral blood: secondary outcome analysis from a randomized clinical trial. GeroScience 2023; 45:2325-2335. [PMID: 36849678 PMCID: PMC10651570 DOI: 10.1007/s11357-023-00741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/23/2023] [Indexed: 03/01/2023] Open
Abstract
Late life insomnia may increase risk for accelerated biological aging. Intervening to treat insomnia may provide protection from biological aging by reducing the prevalence of senescent cells in the immune system, as indicated by gene expression of a marker of cellular senescence, p16INK4a. In the present study, we determine whether treatment of insomnia in older adults with cognitive behavioral therapy for insomnia (CBT-I) would reduce p16INK4a gene expression in peripheral blood mononuclear cells (PBMC), compared to a sleep education therapy (SET), an active comparator condition. Secondly, we investigate the relationship between sustained insomnia remission and reduced expression of p16INK4a. Participants 60 + years old with insomnia were enrolled in a randomized controlled trial and assigned to CBT-I or SET. Analyses of 231 older adults (CBT-I = 119; SET = 112) examine baseline, post (2 months), and 24 months gene expression of p16INK4a. Compared to baseline, expression of p16INK4a increased in the SET group over 24 months (P = 0.03), but showed no change in the CBT-I group. Those who received CBT-I and experienced sustained remission of insomnia had a significant decline in p16INK4a expression by 24 months compared to baseline (P = 0.02). Individuals not sustaining remission of insomnia exhibited overall increase expression of p16INK4a by 24 months (P = 0.03). In older adults with insomnia, p16INK4a increases over 24 months, while CBT-I treatment of insomnia mitigates the increase in p16INK4a. Further, sustained remission of insomnia using CBT-I leads to a decrease in p16INK4a. These results suggest that behavioral interventions that are effective at treating insomnia might reduce the population of senescent cells in circulating blood.
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Affiliation(s)
- Judith E Carroll
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA.
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA.
| | - Richard Olmstead
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Steve W Cole
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Elizabeth C Breen
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Jesusa M Arevalo
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
| | - Michael R Irwin
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles, Los Angeles, CA, USA
- Jane & Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza, Suite 3330, Los Angeles, CA, 90095, USA
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32
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Jespersen KV, Hansen MH, Vuust P. The effect of music on sleep in hospitalized patients: A systematic review and meta-analysis. Sleep Health 2023; 9:441-448. [PMID: 37380591 DOI: 10.1016/j.sleh.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/07/2023] [Accepted: 03/21/2023] [Indexed: 06/30/2023]
Abstract
Sleep is often severely disturbed in hospitalized patients due to multiple factors such as noise, pain, and an unfamiliar environment. Since sleep is important for patient recovery, safe strategies to improve sleep in hospitalized patients are warranted. Music interventions have been found to improve sleep in general, and the aim of this systematic review is to assess the effect of music on sleep among hospitalized patients. We searched 5 databases to identify randomized controlled trials evaluating the effect of music interventions on sleep in hospitalized patients. Ten studies including a total of 726 patients matched the inclusion criteria. The sample sizes ranged from 28 to 222 participants per study. The music interventions varied in how the music was chosen as well as duration and time of day. However, in most studies, participants in the intervention group listened to soft music for 30 minutes in the evening. Our meta-analysis showed that music improved sleep quality compared to standard treatment (standardized mean difference 1.55 [95% CI 0.29-2.81], z = 2.41; p = 0.0159). Few studies reported other sleep parameters, and only one study used polysomnography for objective sleep measurement. No adverse events were reported in any of the trials. Hence, music may constitute a safe and low-cost adjunctive intervention to improve sleep in hospitalized patients. Prospero registration number: CRD42021278654.
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Affiliation(s)
- Kira V Jespersen
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & the Royal Academy of Music, Aarhus/Aalborg, Denmark.
| | | | - Peter Vuust
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University & the Royal Academy of Music, Aarhus/Aalborg, Denmark
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Saitoh K, Yoshiike T, Kaneko Y, Utsumi T, Matsui K, Nagao K, Kawamura A, Otsuki R, Otsuka Y, Aritake-Okada S, Kaneita Y, Kadotani H, Kuriyama K, Suzuki M. The effect of nonrestorative sleep on incident hypertension 1-2 years later among middle-aged Hispanics/Latinos. BMC Public Health 2023; 23:1456. [PMID: 37525185 PMCID: PMC10388461 DOI: 10.1186/s12889-023-16368-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Insomnia is known to be a major risk factor for incident hypertension. Nonrestorative sleep (NRS), which refers to insufficiently rested sleep, has reported to associate with various diseases. This study aimed to investigate the longitudinal association between insomnia-related symptoms including NRS and incident hypertension 1-2 years later by age group (young, 18-39 years and middle-age, 40-64 years) using existing cohort data involving Hispanics/Latinos. METHODS This study included 1100 subjects who had participated in both the Hispanic Community Health Study/Study of Latinos and its follow-up study, the Sueño Ancillary Study, and met additional eligibility criteria. Incident hypertension was assessed by self-reported history and/or the use of antihypertensives. The Women's Health Initiative Insomnia Rating Scale (WHIIRS) was used to evaluate insomnia-related symptoms (difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, difficulty returning to sleep, and NRS). Logistic regression analyses were conducted to assess the degree to which insomnia-related symptoms at baseline predicted incident hypertension. RESULTS Among the participants (64% middle-aged, 36% young adults), 140 (12.7%) developed hypertension during the follow-up period. Among the sleep-related symptoms, only NRS predicted incident hypertension after adjusting for sociodemographic factors and physical condition (odds ratio: 1.88, 95% confidence interval: 1.10-3.21, p = 0.022) in middle-aged adults. None of the insomnia-related symptoms were associated with incident hypertension in the young adults. No association was found between WHIIRS-defined insomnia (total score ≥ 9) and incident hypertension in middle-aged adults or young adults. CONCLUSION The present findings suggest the importance of focusing on NRS to help prevent the development of hypertension in middle-aged adults.
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Affiliation(s)
- Kaori Saitoh
- Department of Psychiatry, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Fondation FondaMental, Créteil, France
- Université Paris Est Créteil, INSERM U955, IMRB, Laboratoire Neuro-Psychiatrie translationnelle, Créteil, France
| | - Takuya Yoshiike
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshiyuki Kaneko
- Department of Psychiatry, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Matsui
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Clinical Laboratory, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Kentaro Nagao
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Aoi Kawamura
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Rei Otsuki
- Department of Psychiatry, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sayaka Aritake-Okada
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Health Sciences, Saitama Prefectural University, Saitama, Japan
| | - Yoshitaka Kaneita
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroshi Kadotani
- Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Psychiatry, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
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Ju S, Cho SS, Kim JI, Ryu H, Kim H. Association between discrimination in the workplace and insomnia symptoms. Ann Occup Environ Med 2023; 35:e25. [PMID: 37614338 PMCID: PMC10442583 DOI: 10.35371/aoem.2023.35.e25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/12/2023] [Accepted: 06/13/2023] [Indexed: 08/25/2023] Open
Abstract
Background In Korea, little research has focused on the relationship between discrimination in the workplace and sleep health. Thus, this study aims to investigate the association between such discriminatory experiences and insomnia, a common sleep disorder, using Korean employees' data. Methods This study used data from the 6th Korea Working Conditions Survey. Discrimination experiences due to age, ethnic background, nationality, race, sex, religion, disability, sexual orientation, educational level, hometown, and employment status were investigated. The Minimal Insomnia Symptom Scale estimated insomnia symptoms. The association between discrimination experience and insomnia symptoms were analyzed using survey-weighted logistic regression analysis. Results Based on experiences of discrimination over the past 12 months, insomnia symptoms were associated with discrimination experience due to religion (odds ratio [OR]: 3.70; 95% confidential interval [CI]: 1.58-8.69), sex (OR: 2.51; 95% CI: 1.87-3.37), age (OR: 2.30; 95% CI: 1.88-2.81), hometown (OR: 2.07; 95% CI: 1.44-2.97), employment status (OR: 1.69; 95% CI: 1.37-2.10), and educational level (OR: 1.67; 95% CI: 1.31-2.14). Furthermore, the prevalence of insomnia symptoms increased with the number of discrimination experiences. Conclusions In this study, discrimination experiences due to religion, sex, age, hometown, employment status, and educational level were significantly associated with insomnia symptoms. Furthermore, as the number of discrimination experiences increased, so did the prevalence of insomnia. Preventing workplace discrimination may improve workers' sleep health.
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Affiliation(s)
- Suhwan Ju
- Department of Occupational and Environmental Medicine, Dong-A University Hospital, Busan, Korea
| | - Seong-Sik Cho
- Department of Occupational and Environmental Medicine, Dong-A University Hospital, Busan, Korea
- Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Jung Il Kim
- Department of Occupational and Environmental Medicine, Dong-A University Hospital, Busan, Korea
- Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Hoje Ryu
- Department of Occupational and Environmental Medicine, Dong-A University Hospital, Busan, Korea
- Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Hyunjun Kim
- Department of Occupational and Environmental Medicine, Dong-A University Hospital, Busan, Korea
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Dong W, Zhou H, Wu R, He X, Chen X, Zhou H, Gong T, Wang C. Acupuncture methods for insomnia disorder in the elderly: protocol for a systematic review and network meta-analysis. Syst Rev 2023; 12:124. [PMID: 37452408 PMCID: PMC10347792 DOI: 10.1186/s13643-023-02287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 06/30/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Insomnia disorder remains one of the most common sleep disorders in the elderly, with high prevalence and substantial consequences for patients' general health. Despite that increasing clinical trials have indicated that acupuncture seems to be effective for insomnia disorder in the elderly, comparative efficacy and safety of different acupuncture methods for elderly individuals with insomnia disorder has been unclear. Therefore, this protocol outlined a plan to evaluate and rank the efficacy and safety of various acupuncture approaches for insomnia disorder in the elderly. METHODS A systematic search of 8 bibliographic databases will be conducted from their inception to 18 June 2023, including Cochrane Library, MEDLINE (via PubMed), Embase, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Database, and Chinese Biomedical Literature Database (CBM). Randomized controlled trials investigating acupuncture methods for insomnia disorder in the elderly, published in English or Chinese will be included. The primary outcome is sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). Two reviewers will independently perform study selection, data extraction and risk assessment of bias. The quality of included literatures will be appraised using Cochrane risk-of-bias tool (ROB 2.0). ADDIS (Aggregate Data Drug Information System) V.1.16.8 will be used to conduct Bayesian network meta-analysis. The quality of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation System (GRADE). DISCUSSION In this study, the results will provide credible evidence to assess the efficacy and safety of acupuncture therapies for elderly patients with insomnia disorder, assisting patients, physicians and clinical research investigators to select the most appropriate acupuncture method. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered at OSF ( https://osf.io/3kjpq/ ) with a registration number https://doi.org/10.17605/OSF.IO/3KJPQ .
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Affiliation(s)
- Weitao Dong
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hao Zhou
- Sichuan Integrative Medicine Hospital, Chengdu, China
| | - Rong Wu
- Department of Rheumatology Immunohematology, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Ximeng He
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xingliang Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongchi Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tingting Gong
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chao Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Sichuan Integrative Medicine Hospital, Chengdu, China
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Zhao N, Zhao YJ, An F, Zhang Q, Sha S, Su Z, Cheung T, Jackson T, Zang YF, Xiang YT. Network analysis of comorbid insomnia and depressive symptoms among psychiatric practitioners during the COVID-19 pandemic. J Clin Sleep Med 2023; 19:1271-1279. [PMID: 36988299 PMCID: PMC10315603 DOI: 10.5664/jcsm.10586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES Insomnia and depression are common mental health problems reported by mental health professionals during the COVID-19 pandemic. Network analysis is a fine-grained approach used to examine associations between psychiatric syndromes at a symptom level. This study was designed to elucidate central symptoms and bridge symptoms of a depression-insomnia network among psychiatric practitioners in China. The identification of particularly important symptoms via network analysis provides an empirical foundation for targeting specific symptoms when developing treatments for comorbid insomnia and depression within this population. METHODS A total of 10,516 psychiatric practitioners were included in this study. The Insomnia Severity Index (ISI) and 9-item Patient Health Questionnaire (PHQ-9) were used to estimate prevalence rates of insomnia and depressive symptoms, respectively. Analyses also generated a network model of insomnia and depression symptoms in the sample. RESULTS Prevalence rates of insomnia (ISI total score ≥8), depression (PHQ-9 total score ≥5) and comorbid insomnia and depression were 22.2% (95% confidence interval: 21.4-22.9%), 28.5% (95% confidence interval: 27.6-29.4%), and 16.0% (95% confidence interval: 15.3-16.7%), respectively. Network analysis revealed that "Distress caused by sleep difficulties" (ISI7) and "Sleep maintenance" (ISI2) had the highest strength centrality, followed by "Motor dysfunction" (PHQ8) and "Sad mood" (PHQ2). Furthermore, the nodes "Sleep dissatisfaction" (ISI4), "Fatigue" (PHQ4), and "Motor dysfunction" (PHQ8) had the highest bridge strengths in linking depression and insomnia communities. CONCLUSIONS Both central and bridge symptoms (ie, Distress caused by sleep difficulties, Sleep maintenance, Motor dysfunction, Sad mood, Sleep dissatisfaction, and Fatigue) should be prioritized when testing preventive measures and specific treatments to address comorbid insomnia and depression among psychiatric practitioners during the COVID-19 pandemic. CITATION Zhao N, Zhao Y-J, An F, et al. Network analysis of comorbid insomnia and depressive symptoms among psychiatric practitioners during the COVID-19 pandemic. J Clin Sleep Med. 2023;19(7):1271-1279.
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Affiliation(s)
- Na Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao Special Administrative Region (SAR), China
- Center for Cognition and Brain Disorders, Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
| | - Yan-Jie Zhao
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao Special Administrative Region (SAR), China
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
| | - Fengrong An
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University & Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qinge Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University & Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sha Sha
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University & Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Todd Jackson
- Department of Psychology, University of Macau, Macao SAR, China
| | - Yu-Feng Zang
- Center for Cognition and Brain Disorders, Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, and Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao Special Administrative Region (SAR), China
- Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
- Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao SAR, China
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DuPont CM, Olmstead R, Reid MJ, Hamilton KR, Campbell CM, Finan PH, Sadeghi N, Castillo D, Irwin MR, Smith MT. A randomized, placebo-controlled, double-blinded mechanistic clinical trial using endotoxin to evaluate the relationship between insomnia, inflammation, and affective disturbance on pain in older adults: A protocol for the sleep and Healthy Aging Research for pain (SHARE-P) study. Brain Behav Immun Health 2023; 30:100642. [PMID: 37256193 PMCID: PMC10225887 DOI: 10.1016/j.bbih.2023.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
Chronic pain is prevalent in older adults. Treatment, especially with opioids, is often ineffective and poses considerable negative consequences in this population. To improve treatment, it is important to understand why older adults are at a heightened risk for developing chronic pain. Insomnia is a major modifiable risk factor for chronic pain that is ubiquitous among older adults. Insomnia can also lead to heightened systemic inflammation and affective disturbance, both of which may further exacerbate pain conditions in older adults. Endotoxin exposure can be used as an experimental model of systemic inflammation and affective disturbance. The current study aims to understand how insomnia status and endotoxin-induced changes in inflammation and affect (increased negative affect and decreased positive affect) may interact to impact pain facilitatory and inhibitory processes in older adults. Longitudinal data will also assess how pain processing, affective, and inflammatory responses to endotoxin may predict the development of pain and/or depressive symptoms. The current study is a randomized, double-blinded, placebo-controlled, mechanistic clinical trial in men and women, with and without insomnia, aged 50 years and older. Participants were randomized to either 0.8ng/kg endotoxin injection or saline placebo injection. Daily diaries were used to collect variables related to sleep, mood, and pain at two-week intervals during baseline and 3-, 6-, 9-, and 12-months post-injection. Primary outcomes during the experimental phase include conditioned pain modulation, temporal summation, and affective pain modulation ∼5.5 hours after injection. Primary outcomes for longitudinal assessments are self-reported pain intensity and depressive symptoms. The current study uses endotoxin as an experimental model for pain. In doing so, it aims to extend the current literature by: (1) including older adults, (2) investigating insomnia as a potential risk factor for chronic pain, (3) evaluating the role of endotoxin-induced affective disturbances on pain sensitivity, and (4) assessing sex differences in endotoxin-induced hyperalgesia. Clinicaltrialsgov NCT03256760. Trial sponsor NIH R01AG057750-01.
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Affiliation(s)
- Caitlin M. DuPont
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Richard Olmstead
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Matthew J. Reid
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Katrina R. Hamilton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Claudia M. Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Patrick H. Finan
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Nina Sadeghi
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Daisy Castillo
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael R. Irwin
- Department of Psychiatry and Biobehavioral Sciences, Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Michael T. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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Ali RM, Zolezzi M, Awaisu A, Eltorki Y. Sleep Quality and Sleep Hygiene Behaviours Among University Students in Qatar. Int J Gen Med 2023; 16:2427-2439. [PMID: 37333875 PMCID: PMC10276586 DOI: 10.2147/ijgm.s402399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023] Open
Abstract
Background Insomnia is a highly prevalent health problem, affecting about one-third of the adult population globally. University students are at a high risk for developing insomnia due to the stressful nature of academic life and often unhealthy sleeping habits. The aim of this study was to explore the prevalence of poor sleep quality and investigate sleep hygiene patterns among university students in Qatar. Methods A cross-sectional study was conducted among university students using two validated instruments: the Pittsburgh Sleep Quality Index (PSQI) and the Sleep Hygiene Index (SHI). Data were analyzed using descriptive and inferential statistics, including correlation and multivariate regression analyses. Results Two thousand and sixty-two students responded to the web-based survey. The mean PSQI score (7.57±3.03) was indicative of poor sleep quality in approximately 70% of the students. Similarly, the mean SHI score (21.79±6.69) was indicative of poor sleep hygiene patterns in 79% of the students. Academic program type, marital status, gender, and sleep hygiene significantly influenced sleep quality. After controlling for all possible covariates in the multiple regression analysis, sleep hygiene remained as the only factor significantly predicting sleep quality. Students with a good sleep hygiene were about four times more likely to have a good sleep quality compared to those with poor sleep hygiene (adjusted OR= 3.66, 95% CI= 2.8-4.8, p <0.001). Conclusion Poor sleep quality and inadequate sleep hygiene practices were highly prevalent among university students in Qatar. Sleep hygiene was found to be the only significant predictor of sleep quality such that those adopting healthy sleep hygiene practices were more likely to have better sleep quality. Interventions to raise awareness on the effect of sleep hygiene on sleep quality among university students are needed.
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Affiliation(s)
- Raja Mahamade Ali
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Monica Zolezzi
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Yassin Eltorki
- Department of Pharmacy, Mental Health Hospital, Hamad Medical Corporation, Doha, Qatar
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Edinger JD, Smith ED, Buysse DJ, Thase M, Krystal AD, Wiskniewski S, Manber R. Objective sleep duration and response to combined pharmacotherapy and cognitive behavioral insomnia therapy among patients with comorbid depression and insomnia: a report from the TRIAD study. J Clin Sleep Med 2023; 19:1111-1120. [PMID: 36798983 PMCID: PMC10235719 DOI: 10.5664/jcsm.10514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
STUDY OBJECTIVES Several studies have shown that patients with short sleep duration show a poor response to cognitive behavioral therapy for insomnia (CBT-I), but such studies have not included patients with comorbid conditions. The current study was conducted to determine whether pretreatment sleep duration moderates the response of patients with major depression and insomnia disorders to a combined CBT-I and antidepressant medication treatment. METHODS This study comprised a secondary analysis of a larger randomized trial that tested combined CBT-I/antidepressant medication treatment of patients with major depression and insomnia. Participants (n = 99; 70 women; Mage = 47.712.4 years) completed pretreatment polysomnography and then were randomly assigned to a 12-week treatment with antidepressant medication combined with CBT-I or a sham therapy. Short and longer sleepers were defined using total sleep time cutoffs of < 5, < 6, and < 7 hours for short sleep. Insomnia and depression remission ascertained respectively from the Insomnia Severity Index and Hamilton Rating Scale for Depression were used to compare treatment responses of short and longer sleepers defined by the cutoffs mentioned. RESULTS Logistic regression analyses showed that statistically significant results were obtained only when the cutoff of < 5 hours of sleep was used to define "short sleep." Both the CBT-I recipients with < 5 hours of sleep (odds ratio = 0.053; 95% confidence interval = 0.006-0.499) and the sham-therapy group with ≥ 5 hours of sleep (odds ratio = 0.149; 95% confidence interval = 0.045-0.493) were significantly less likely to achieve insomnia remission than were CBT-I recipients with ≥ 5 hours of sleep. The shorter sleeping CBT-I group (odds ratio = 0.118; 95% confidence interval = 0.020-0.714) and longer sleeping sham-therapy group (odds ratio = 0.321; 95% confidence interval = 0.105-0.983) were also less likely to achieve insomnia and/or depression remission than was the longer sleeping CBT-I group with ≥ 5 hours of sleep. CONCLUSIONS Sleeping < 5 hours may dispose comorbid major depression/insomnia patients to a poor response to combined CBT-I/medication treatments for their insomnia and depression. Future studies to replicate these findings and explore mechanisms of treatment response seem warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Treatment of Insomnia and Depression (TRIAD); URL: https://clinicaltrials.gov/ct2/show/results/NCT00767624; Identifier: NCT00767624. CITATION Edinger JD, Smith ED, Buysse DJ, et al. Objective sleep duration and response to combined pharmacotherapy and cognitive behavioral insomnia therapy among patients with comorbid depression and insomnia: a report from the TRIAD study. J Clin Sleep Med. 2023;19(6):1111-1120.
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Affiliation(s)
- Jack D. Edinger
- National Jewish Health, Denver, Colorado
- Duke University Medical Center, Durham, North Carolina
| | | | | | - Michael Thase
- University of Pennsylvania, Philadelphia, Pennsylvania
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Sun Y, Tsai MK, Wen CP. Association of sleep duration and sleeping pill use with mortality and life expectancy: A cohort study of 484,916 adults. Sleep Health 2023; 9:354-362. [PMID: 37045661 DOI: 10.1016/j.sleh.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 01/15/2023] [Accepted: 01/31/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To compare mortality risk and life expectancy among individuals with different sleep durations and sleeping pill use. METHODS A cohort of 484,916 community-dwelling adults in Taiwan was recruited into a health screening program from 1994 to 2011. Subjects were categorized by daily sleep duration into 4 groups: extremely short (<4 hours), short (4-6 hours), medium (6-8 hours), and long (>8 hours). Cox proportional hazards models were used to investigate the associations of mortality risk with sleep duration and sleeping pill use. Models were adjusted for sociodemographic characteristics, lifestyle, and comorbidities. Life expectancy tables were calculated among sleeping pill users and nonusers with different sleep durations. RESULTS With 6- 8 hours of daily sleep, sleeping pill nonusers had the lowest mortality risk. Sleeping pill users, even with this optimal amount of sleep, had a 55% (p < .001, 95% CI, 1.38-1.73) higher mortality risk than nonusers. The life expectancy of 30-year-old male sleeping pill users with extremely short or long sleep durations was 12-13 years shorter than sleeping pill nonusers who had 6-8 hours of sleep. On average, life expectancy in individuals using sleeping pills (vs. nonusers) was shorter by 5.3 (95% CI, 4.10-6.32) years in men and 5.7 (95% CI, 5.28-7.98) years in women. CONCLUSIONS This study suggests that the use of sleeping pills is associated with an increased risk of mortality and shortened life expectancy, especially in extreme sleepers. Regular users should be aware of potential harms from sleeping pills.
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Affiliation(s)
- Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan; Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Min-Kuang Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chi-Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan; China Medical University, Taichung, Taiwan.
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Han H, Kim D, Kim JS, Kwac LK, Hyeon J, Oh J. A novel sleep aid device to reduce sleep latency using air-CO 2 mixed gas. Front Neurol 2023; 14:1163904. [PMID: 37251228 PMCID: PMC10213737 DOI: 10.3389/fneur.2023.1163904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/19/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Sleep is an indispensable component of human life. However, in modern times, the number of people suffering from sleep disorders, such as insomnia and sleep deprivation, has increased significantly. Therefore, to alleviate the discomfort to the patient due to lack of sleep, sleeping pills and various sleep aids are being introduced and used. However, sleeping drugs are prescribed only to a limited extent due to the side effects posed by them and resistance to such drugs developed by patients in the long term, and the majority of sleep aids are scientifically groundless products. This study aimed to develop a device that induced sleep by spraying a mixed gas of carbon dioxide and air to create an environment that could induce sleep, similar to the inside of a sealed vehicle, to control oxygen saturation in the body. Methods Based on the stipulated safety standards and the human tidal volume, the target concentration of carbon dioxide was determined to be of three types: 15,000, 20,000, and 25,000 ppm. After analyzing diverse structures for safely mixing gases, the most appropriate shape, the reserve tank, was selected as the best suited structure. Various variables, such as spraying angle and distance, flow rate, atmospheric temperature, and nozzle length, were comprehensively measured and tested. Furthermore based on this aspect, diffusion simulation of carbon dioxide concentration and actual experiments were conducted. To secure the stability and reliability of the developed product, an accredited test was performed to investigate the error rate of carbon dioxide concentration. Furthermore, clinical trials comprising polysomnography and questionnaires confirmed the effectiveness of the developed product not only in reducing sleep latency but also in enhancing the overall sleep quality. Results When the developed device was put to use in reality, sleep latency was decreased by 29.01%, on average, for those with a sleep latency of 5 min or more, compared to when the device was not in use. Moreover, the total sleep time was increased by 29.19 min, WASO was decreased by 13.17%, and sleep efficiency was increased by 5.48%. We also affirmed that the ODI and 90% ODI did not decrease when the device was used. Although different questions may be raised about the safety of using a gas such as carbon dioxide (CO2), the result that tODI was not reduced shows that sleep aids using CO2 mixtures do not adversely affect human health. Discussion The results of this study suggest a new method that can be used to treat sleep disorders including insomnia.
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Affiliation(s)
- Hyewon Han
- Department of Computer Engineering, Hongik University, Seoul, Republic of Korea
| | | | | | - Lee Ku Kwac
- Department of Carbon Convergence Engineering, Jeonju University, Jeonju, Republic of Korea
| | - Janghun Hyeon
- Semiconductor Research Institute, Korea University, Seoul, Republic of Korea
| | - Junhyoung Oh
- Institute for Business Research and Education, Korea University, Seoul, Republic of Korea
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42
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Shan J, Song Y, Wang Y, Fan P, Lu B, Luo J, Xu W, Jing L, Mo F, Hu R, Luo Y, Mao G, Wang Y, Cai X. Highly Activated Neuronal Firings Monitored by Implantable Microelectrode Array in the Paraventricular Thalamus of Insomnia Rats. SENSORS (BASEL, SWITZERLAND) 2023; 23:4629. [PMID: 37430543 DOI: 10.3390/s23104629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 07/12/2023]
Abstract
Insomnia is a common sleep disorder around the world, which is harmful to people's health, daily life, and work. The paraventricular thalamus (PVT) plays an essential role in the sleep-wake transition. However, high temporal-spatial resolution microdevice technology is lacking for accurate detection and regulation of deep brain nuclei. The means for analyzing sleep-wake mechanisms and treating sleep disorders are limited. To detect the relationship between the PVT and insomnia, we designed and fabricated a special microelectrode array (MEA) to record electrophysiological signals of the PVT for insomnia and control rats. Platinum nanoparticles (PtNPs) were modified onto an MEA, which caused the impedance to decrease and improved the signal-to-noise ratio. We established the model of insomnia in rats and analyzed and compared the neural signals in detail before and after insomnia. In insomnia, the spike firing rate was increased from 5.48 ± 0.28 spike/s to 7.39 ± 0.65 spike/s, and the power of local field potential (LFP) decreased in the delta frequency band and increased in the beta frequency band. Furthermore, the synchronicity between PVT neurons declined, and burst-like firing was observed. Our study found neurons of the PVT were more activated in the insomnia state than in the control state. It also provided an effective MEA to detect the deep brain signals at the cellular level, which conformed with macroscopical LFP and insomnia symptoms. These results laid the foundation for studying PVT and the sleep-wake mechanism and were also helpful for treating sleep disorders.
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Affiliation(s)
- Jin Shan
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yilin Song
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yiding Wang
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Penghui Fan
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Botao Lu
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jinping Luo
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wei Xu
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Luyi Jing
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Fan Mo
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ruilin Hu
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yan Luo
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Gang Mao
- The Fourth People's Hospital of Jinan, Jinan 250031, China
| | - Ying Wang
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Xinxia Cai
- State Key Laboratory of Transducer Technology, Aerospace Information Research Institute, Chinese Academy of Sciences, Beijing 100190, China
- School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China
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43
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Lee W, Kim H, Shim J, Kim D, Hyeon J, Joo E, Joo BE, Oh J. The simplification of the insomnia severity index and epworth sleepiness scale using machine learning models. Sci Rep 2023; 13:6214. [PMID: 37069247 PMCID: PMC10106896 DOI: 10.1038/s41598-023-33474-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/13/2023] [Indexed: 04/19/2023] Open
Abstract
Insomnia and excessive daytime sleepiness (EDS) are the most common complaints in sleep clinics, and the cost of healthcare services associated with them have also increased significantly. Though the brief questionnaires such as the Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) can be useful to assess insomnia and EDS, there are some limitations to apply for large numbers of patients. As the researches using the Internet of Things technology become more common, the need for the simplification of sleep questionnaires has been also growing. We aimed to simplify ISI and ESS using machine learning algorithms and deep neural networks with attention models. The medical records of 1,241 patients who examined polysomnography for insomnia or EDS were analyzed. All patients are classified into five groups according to the severity of insomnia and EDS. To develop the model, six machine learning algorithms were firstly applied. After going through normalization, the process with the CNN+ Attention model was applied. We classified a group with an accuracy of 93% even with only the results of 6 items (ISI1a, ISI1b, ISI3, ISI5, ESS4, ESS7). We simplified the sleep questionnaires with maintaining high accuracy by using machine learning models.
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Affiliation(s)
- Woodo Lee
- Department of Physics, Korea University, Seoul, 02841, South Korea
| | - Hyejin Kim
- College of Pharmacy, Sookmyung Women's University, Seoul, 04310, South Korea
| | - Jaekwoun Shim
- Institute of Educational Research, Korea University, Seoul, 02841, South Korea
| | - Dongsin Kim
- Sleep Research Center, NYX Corporation, Hanam, 12902, South Korea
| | - Janghun Hyeon
- Semiconductor Research Institute, Korea University, Seoul, 02841, South Korea
| | - Eunyeon Joo
- Department of Neurology, Samsung Medical Center, Seoul, 06351, South Korea
| | - Byung-Euk Joo
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University, Seoul, 31151, South Korea
| | - Junhyoung Oh
- Institute for Business Research and Education, Korea University, Seoul, 02841, South Korea.
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44
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Bjorvatn B, Waage S, Saxvig IW. Do people use methods or tricks to fall asleep? A comparison between people with and without chronic insomnia. J Sleep Res 2023; 32:e13763. [PMID: 36316962 DOI: 10.1111/jsr.13763] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
The present study estimated the frequency of using methods or tricks to fall asleep in the general Norwegian population. Further, people with chronic insomnia were compared with people without chronic insomnia. A representative sample of 1028 participants aged 18 years or older completed a web-based survey. The response rate was 33.5%. Insomnia symptoms were assessed with the validated Bergen Insomnia Scale, and chronic insomnia based on ICSD-3/DSM-5 criteria. Data were analysed with chi-square tests and logistic regression with adjustment for sex, age, education, and circadian preference. The results showed that 34.3% reported using a method or a trick to fall asleep, with relaxation exercises/breathing exercises being the most common. More females (39.5%) compared with males (29.1%) reported the use of a method/trick to fall asleep with an adjusted odds ratio (aOR) of 1.44. Chronic insomnia was reported by 24.9%, and clearly associated with higher use of such methods/tricks (53.7%; aOR = 3.49). Among the participants without chronic insomnia, 28.1% reported using methods/tricks to fall asleep. In conclusion, most people do not use methods or tricks to fall asleep, but chronic insomnia was associated with a higher frequency of such use. Still, since methods/tricks were also used by some participants without chronic insomnia, this may suggest that, for some people, this strategy may be effective or at least does not seem to disrupt the sleep onset process.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Siri Waage
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ingvild W Saxvig
- Centre for Sleep Medicine, Haukeland University Hospital, Bergen, Norway
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45
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Watson NF, Benca RM, Krystal AD, McCall WV, Neubauer DN. Alliance for Sleep Clinical Practice Guideline on Switching or Deprescribing Hypnotic Medications for Insomnia. J Clin Med 2023; 12:jcm12072493. [PMID: 37048577 PMCID: PMC10095217 DOI: 10.3390/jcm12072493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/29/2023] Open
Abstract
Determining the most effective insomnia medication for patients may require therapeutic trials of different medications. In addition, medication side effects, interactions with co-administered medications, and declining therapeutic efficacy can necessitate switching between different insomnia medications or deprescribing altogether. Currently, little guidance exists regarding the safest and most effective way to transition from one medication to another. Thus, we developed evidence-based guidelines to inform clinicians regarding best practices when deprescribing or transitioning between insomnia medications. Five U.S.-based sleep experts reviewed the literature involving insomnia medication deprescribing, tapering, and switching and rated the quality of evidence. They used this evidence to generate recommendations through discussion and consensus. When switching or discontinuing insomnia medications, we recommend benzodiazepine hypnotic drugs be tapered while additional CBT-I is provided. For Z-drugs zolpidem and eszopiclone (and not zaleplon), especially when prescribed at supratherapeutic doses, tapering is recommended with a 1–2-day delay in administration of the next insomnia therapy when applicable. There is no need to taper DORAs, doxepin, and ramelteon. Lastly, off-label antidepressants and antipsychotics used to treat insomnia should be gradually reduced when discontinuing. In general, offering individuals a rationale for deprescribing or switching and involving them in the decision-making process can facilitate the change and enhance treatment success.
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46
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Scarratt RJ, Heggli OA, Vuust P, Sadakata M. Music that is used while studying and music that is used for sleep share similar musical features, genres and subgroups. Sci Rep 2023; 13:4735. [PMID: 36959270 PMCID: PMC10036617 DOI: 10.1038/s41598-023-31692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/15/2023] [Indexed: 03/25/2023] Open
Abstract
Music is an integral part of daily human life, and certain types of music are often associated with certain contexts, such as specific music for sleeping or for studying. The mood-arousal hypothesis suggests that music used for studying should be uplifting to boost arousal and increase cognitive performance while previous studies suggest that music used as a sleep aid should be calm, gentle and slow to decrease arousal. In this study, we created the Study music dataset by collecting tracks from Spotify playlists with the words 'study' or 'studying' in the title or description. In comparison with a pre-existing dataset, the Sleep music dataset, we show that the music's audio features, as defined by Spotify, are highly similar. Additionally, they share most of the same genres and have similar subgroups after a k-means clustering analysis. We suggest that both sleep music and study music aim to create a pleasant but not too disturbing auditory environment, which enables one to focus on studying and to lower arousal for sleeping. Using large Spotify-based datasets, we were able to uncover similarities between music used in two different contexts one would expect to be different.
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Affiliation(s)
- Rebecca Jane Scarratt
- Department of Clinical Medicine, Center for Music in the Brain, Aarhus University and The Royal Academy of Music Aarhus/Aalborg, Aarhus, Denmark.
| | - Ole Adrian Heggli
- Department of Clinical Medicine, Center for Music in the Brain, Aarhus University and The Royal Academy of Music Aarhus/Aalborg, Aarhus, Denmark
| | - Peter Vuust
- Department of Clinical Medicine, Center for Music in the Brain, Aarhus University and The Royal Academy of Music Aarhus/Aalborg, Aarhus, Denmark
| | - Makiko Sadakata
- Music Department, The Netherlands and Institute for Logic, Language and Computation, University of Amsterdam, Amsterdam, The Netherlands
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47
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Vollert B, Müller L, Jacobi C, Trockel M, Beintner I. Effectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e39052. [PMID: 36943337 PMCID: PMC10131838 DOI: 10.2196/39052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/15/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use. OBJECTIVE This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep. METHODS In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment. RESULTS We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good. CONCLUSIONS An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed. TRIAL REGISTRATION ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517.
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Affiliation(s)
- Bianka Vollert
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Luise Müller
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Ina Beintner
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
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48
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Campbell RL, Bridges AJ. Bedtime procrastination mediates the relation between anxiety and sleep problems. J Clin Psychol 2023; 79:803-817. [PMID: 36169391 DOI: 10.1002/jclp.23440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 05/08/2022] [Accepted: 08/23/2022] [Indexed: 11/12/2022]
Abstract
The prevalence of sleep problems is high in primary care patients and in anxious individuals. This study assessed whether total sleep time and bedtime procrastination mediated the association between anxiety and sleep problems. We predicted higher anxiety would be negatively associated with total sleep time and positively associated with bedtime procrastination and sleep problems, and these variables would statistically mediate the association between anxiety and sleep problems. Participants were 308 adult primary care patients, predominantly female (non-Hispanic White = 158, Latinx = 111, mean age = 33.30), who initiated behavioral health services at an integrated primary care clinic. Patients completed a questionnaire regarding psychological health and sleep behaviors. Using structural equation modeling, we found higher anxiety related to higher sleep problems, partially mediated by bedtime procrastination but not total sleep time. This study highlights related factors like anxiety and prebedtime behaviors that may be effective treatment targets for sleep challenges.
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Affiliation(s)
- Rebecca L Campbell
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
| | - Ana J Bridges
- Department of Psychological Science, University of Arkansas, Fayetteville, Arkansas, USA
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49
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Ong JC, Kalmbach DA. Mindfulness as an Adjunct or Alternative to CBT-I. Sleep Med Clin 2023; 18:59-71. [PMID: 36764787 DOI: 10.1016/j.jsmc.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Mindfulness-based interventions (MBIs) are programs that teach mindfulness concepts through guided meditation and self-regulation practices. MBIs have been found to improve sleep and reduce cognitive arousal, which are central to the development and perpetuation of insomnia. In this article, we review theoretic frameworks and clinical trial effectiveness data supporting MBIs for insomnia. Based on this review, we provide suggestions for using MBIs as an adjunct or alternative treatment option to CBT-I with regard to how, when, and for whom. We conclude with an agenda for future directions that can clarify the use of mindfulness as a treatment option for insomnia.
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Affiliation(s)
- Jason C Ong
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Dr, Chicago, IL 60625, USA; Behavioral Sleep Medicine, Nox Health, 5000 Research Court, Suite 500, Suwanee, GA 30024, USA.
| | - David A Kalmbach
- Thomas Roth Sleep Disorders Center, Henry Ford Health System, 39450 W 12 Mile Road, Novi, Detroit, MI 48377, USA; Department of Pulmonary & Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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50
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Peltonen H, Paavonen EJ, Saarenpää-Heikkilä O, Vahlberg T, Paunio T, Polo-Kantola P. Sleep disturbances and depressive and anxiety symptoms during pregnancy: associations with delivery and newborn health. Arch Gynecol Obstet 2023; 307:715-728. [PMID: 35461389 PMCID: PMC9984335 DOI: 10.1007/s00404-022-06560-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 04/01/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Sleep disturbances and mood symptoms are common in late pregnancy; according to the literature, they can affect delivery and newborn outcomes. This study evaluated the effect of sleep and mood symptoms on delivery and newborn health, because there are insufficient and partly contradictory studies on the topic. METHODS A cohort of 1414 mothers in their third trimester was enrolled in this prospective cross-sectional questionnaire study. Validated questionnaires were assessed for the measurement of sleep disturbances and depressive and anxiety symptoms. The data on delivery and newborn outcomes were obtained from hospital medical records. RESULTS Sleep disturbances were very common. A higher insomnia score (β = - 0.06, p = 0.047) and longer sleep need (β = 0.07, p = 0.047) were related to delivery at a lower gestational age. In addition, a higher insomnia score (β = - 28.30, p = 0.010) and lower general sleep quality (β = - 62.15, p = 0.025) were associated with lower birth weight, but longer sleep duration and longer sleep need with a higher birth weight (β = 28.06, p = 0.019; β = 27.61, p = 0.028, respectively). However, the findings regarding birth weight lost their significance when the birth weight was standardized by gestational weeks. Concerning Apgar scores and umbilical artery pH, no associations were found. Snoring was associated with a shorter duration of the first phase of delivery (β = - 78.71, p = 0.015) and total duration of delivery (β = - 79.85, p = 0.016). Mothers with higher insomnia, depressive, or anxiety symptoms were more often treated with oxytocin (OR 1.54 95% CI 1.00-2.38, p = 0.049, OR 1.76, 95% CI 1.02-3.04, p = 0.049 and OR 1.91, CI 95% 1.28-2.84, p < 0.001, respectively) and those with higher depressive and anxiety symptoms were delivered more often with elective cesarean section (OR 4.67, 95% CI 2.04-12.68, p < 0.001 and OR 2.22, 95% CI 1.03-4.79, p = 0.042). CONCLUSIONS Maternal sleep disturbances and mood symptoms during pregnancy are associated with delivery and newborn health. However, nearly, all the outcomes fell within a normal range, implying that the actual risks are low.
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Affiliation(s)
- Hilla Peltonen
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
| | - E Juulia Paavonen
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Outi Saarenpää-Heikkilä
- Centre for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Tiina Paunio
- Department of Psychiatry, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.,Sleep Research Unit, University of Turku, Turku, Finland
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