Open-loop Audio-Visual Stimulation for sleep promotion in older adults with comorbid insomnia and osteoarthritis pain: results of a pilot randomized controlled trial

Sleep as a Therapeutic Target for Pain Management

PURPOSE OF REVIEW

The purpose of this review is to provide a summary of the utilization of sleep as a therapeutic target for chronic pain and to evaluate the recent literature on current and proposed pharmacologic and non-pharmacologic sleep interventions used in the management of pain disorders.

RECENT FINDINGS

Sleep is a promising therapeutic target in the treatment of pain disorders with both non-pharmacologic and pharmacologic therapies. Non-pharmacologic therapies include cognitive behavioral therapy and sensory-based therapies such as pink noise, audio-visual stimulation, and morning bright light therapy. Pharmacologic therapies include melatonin, z-drugs, gabapentinoids, and the novel orexin antagonists. However, more research is needed to clarify if these therapies can improve pain specifically by improving sleep. There is a vast array of investigational opportunities in sleep-targeted therapies for pathologic pain, and larger controlled, prospective trials are needed to fully elucidate their efficacy.

A feasibility study of pre-sleep audio and visual alpha brain entrainment for people with chronic pain and sleep disturbance

Introduction

Chronic pain and sleep disturbance are bi-directionally related. Cortical electrical activity in the alpha frequency band can be enhanced with sensory stimulation via the phenomenon of entrainment, and may reduce pain perception. A smartphone based programme which delivers 10 Hz stimulation through flickering light or binaural beats was developed for use at night, pre-sleep, with the aim of improving night time pain and sleep and thereby subsequent pain and related daytime symptoms. The aim of this study was to assess the feasibility and give an indication of effect of this programme for individuals with chronic pain and sleep disturbance.

Materials and methods

In a non-controlled feasibility study participants used audio or visual alpha entrainment for 30 min pre-sleep each night for 4 weeks, following a 1 week baseline period. The study was pre-registered at ClinicalTrials.gov with the ID NCT04176861.

Results

28 participants (79% female, mean age 45 years) completed the study with high levels of data completeness (86%) and intervention adherence (92%). Daily sleep diaries showed an increase compared to baseline in total sleep time of 29 min (p = 0.0033), reduction in sleep onset latency of 13 min (p = 0.0043), and increase in sleep efficiency of 4.7% (p = 0.0009). Daily 0-10 numerical rating scale of average pain at night improved by 0.5 points compared to baseline (p = 0.027). Standardised questionnaires showed significant within-participant improvements in sleep quality (change in median Global PSQI from 16 to 12.5), pain interference (change in median BPI Pain Interference from 7.5 to 6.8), fatigue (change in median MFI total score from 82.5 to 77), and depression and anxiety (change in median HADS depression score from 12 to 10.5 and anxiety from 13.5 to 11).

Discussion

Pre-sleep use of a smartphone programme for alpha entrainment by audio or visual stimulation was feasible for individuals with chronic pain and sleep disturbance. The effect on symptoms requires further exploration in controlled studies.

Osteoarthritis is positively associated with self-reported sleep trouble in older adults

BACKGROUND

Osteoarthritis (OA) is a leading cause of disability in older adults. Most research has focused on minimizing pain and maximizing physical function so as to maintain patient mobility preceding joint arthroplasty. However, few studies have formally studied the relationship between OA and sleep trouble, although it is clinically recognized that OA may affect sleep.

METHODS

The study was based on the National Health and Nutrition Examination Survey (NHANES) database from 2011-2018. Participants were defined as adults aged 60 years or older with diagnoses of OA and self-reported sleep trouble. Multivariable regression analyses were applied to assess the association between OA and sleep trouble, adjusting for age, sex, body mass index, race/ethnicity, education level, marital status, income, depression level, etc. RESULTS: This study included 4154 participants, consisting of the control group (n = 2966) and the OA group (n = 1188). OA individuals were 2.11 (95% CI 1.79-2.47, p < 0.001) times more likely to have sleep trouble compared with those without OA. On subgroup analyses, there was lower odds ratio value of sleep trouble in men compared with women, and in the highest income group compared with the other income groups.

CONCLUSIONS

OA was positively associated with sleep trouble in older adults, with different odds ratio values among different subgroups. Our results suggest that older adults with OA should be aggressively screened for sleep problems.

Associations between Health Education and Mental Health, Burnout, and Work Engagement by Application of Audiovisual Stimulation

Due to the COVID-19 pandemic, health education programs and workplace health promotion (WHP) could only be offered under difficult conditions, if at all. In Germany for example, mandatory lockdowns, working from home, and physical distancing have led to a sharp decline in expenditure on prevention and health promotion from 2019 to 2020. At the same time, the pandemic has negatively affected many people’s mental health. Therefore, our goal was to examine audiovisual stimulation as a possible measure in the context of WHP, because its usage is contact-free, time flexible, and offers, additionally, voice-guided health education programs. In an online survey following a cross-sectional single case study design with 393 study participants, we examined the associations between audiovisual stimulation and mental health, work engagement, and burnout. Using multiple regression analyses, we could identify positive associations between audiovisual stimulation and mental health, burnout, and work engagement. However, longitudinal data are needed to further investigate causal mechanisms between mental health and the use of audiovisual stimulation. Nevertheless, especially with regard to the pandemic, audiovisual stimulation may represent a promising measure for improving mental health at the workplace.

AI Empowered Virtual Reality Integrated Systems for Sleep Stage Classification and Quality Enhancement

Insomnia is a common public health problem and an open biomedical research topic. Insomnia results in various health problems, including memory decline, decreases concentration and weakens problem-solving ability. The insufficient sleep also leads to skin ageing, heart disease, high blood pressure, arrhythmia and stroke. While it remains as a global health concern, sleep quality improvement using modern technologies, such as machine learning, classification technologies, virtual reality (VR), becomes an open and hot research problem. These modern technologies offer new curing solutions under certain conditions. In this paper, we present a sleeping-aid system with a single-channel electroencephalogram (EEG) sleep stage classification algorithm to improve the sleep quality. The sleeping-aid system promotes machine learning integrated VR and multimedia technology for sleep improvement. Ninety participants were invited to test on three different systems with 3D VR, 2D video, and music only. An adequate stimulus of audio-vision can be a complement of the drug treatment. The experimental results showed that the proposed method demonstrated superior performance over existing methods.