1
|
Türkarslan KK, Canel Çınarbaş D. Insomnia Severity Predicts Psychiatric Symptoms: A Cross-Sectional Study Investigating the Partial Mediations of Worry and Rumination. Psychiatry 2024; 87:179-193. [PMID: 38758524 DOI: 10.1080/00332747.2024.2347100] [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: 05/18/2024]
Abstract
OBJECTIVE Insomnia as a disorder on its own or as a symptom of other mental disorders can lead to significant distress and lower quality of life. By exacerbating negative affect and emotion dysregulation, poor sleep and insomnia can contribute to the initiation and maintenance of mental disorders. The aim of this cross-sectional study was to investigate the relationship between insomnia severity and overall psychiatric symptoms (anxiety, depression, obsessive-compulsive symptoms, somatization, phobic anxiety, hostility, interpersonal sensitivity, paranoid ideation, and psychoticism), and the mediational roles of worry and rumination in this relationship. METHOD The data was collected from a community sample of 1444 participants (females 69.39%, Mage = 27.95, SD = 9.37) who completed self-report measures of insomnia severity, worry, rumination, and psychiatric symptoms. The mediational roles of worry and rumination were tested with mediation analysis using the PROCESS Macro. RESULTS It was found that insomnia severity (β = 0.20, p < .001) significantly predicted psychiatric symptoms directly and via worry and rumination (β = 0.33, p < .001), meaning that worry and rumination partially mediated the relationship between insomnia severity and psychiatric symptoms. The findings were similar after controlling for smoking status, daily screen time, coffee consumption in the evening, weekly exercise frequency, and pre-sleep screen time. CONCLUSIONS Interventions targeting the reduction of insomnia severity and maladaptive emotion regulation strategies (e.g., worry and rumination), as well as the enhancement of adaptive emotion regulation strategies (e.g., positive refocusing and mindfulness), may alleviate the adverse effects of insomnia on psychiatric symptoms.
Collapse
|
2
|
Sun Y, Zhong M, Xu N, Zhang X, Sun H, Wang Y, Lu Y, Nie Y, Li Q, Sun Q, Jiang J, Tang YC, Chang HC. High-frequency neural activity dysregulation is associated with sleep and psychiatric disorders in BMAL1-deficient animal models. iScience 2024; 27:109381. [PMID: 38500822 PMCID: PMC10946332 DOI: 10.1016/j.isci.2024.109381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/29/2024] [Accepted: 02/27/2024] [Indexed: 03/20/2024] Open
Abstract
Sleep disturbance led by BMAL1-deficiency has been recognized both in rodent and non-human primate models. Yet it remained unclear how their diurnal brain oscillations were affected upon BMAL1 ablation and what caused the discrepancy in the quantity of sleep between the two species. Here, we investigated diurnal electroencephalographs of BMAL1-deficient mice and cynomolgus monkeys at young adult age and uncovered a shared defect of dysregulated high-frequency oscillations by Kullback-Leibler divergence analysis. We found beta and gamma oscillations were significantly disturbed in a day versus night manner in BMAL1-deficient monkeys, while in mice the beta band difference was less evident. Notably, the dysregulation of beta oscillations was particularly associated with psychiatric behaviors in BMAL1-deficient monkeys, including the occurrence of self-injuring and delusion-like actions. As such psychiatric phenotypes were challenging to uncover in rodent models, our results offered a unique method to study the correlation between circadian clock dysregulation and psychiatric disorders.
Collapse
Affiliation(s)
- Yu Sun
- Lingang Laboratory, Shanghai 201203, China
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Mingzhu Zhong
- Lingang Laboratory, Shanghai 201203, China
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Niannian Xu
- Lingang Laboratory, Shanghai 201203, China
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | | | | | - Yan Wang
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Yong Lu
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Yanhong Nie
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Qing Li
- Lingang Laboratory, Shanghai 201203, China
| | - Qiang Sun
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Jian Jiang
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | | | - Hung-Chun Chang
- Lingang Laboratory, Shanghai 201203, China
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
- Shanghai Center for Brain Science and Brain-Inspired Intelligence Technology, Shanghai 201210, China
| |
Collapse
|
3
|
Haller HC, Moore SL, Green KK, Johnson RL, Sammel MD, Epperson CN, Novick AM. Harnessing technology to improve sleep in frontline healthcare workers: A pilot study of electronic noise-masking earbuds on subjective and objective sleep measures. Sci Prog 2024; 107:368504241242276. [PMID: 38614463 PMCID: PMC11016237 DOI: 10.1177/00368504241242276] [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: 04/15/2024]
Abstract
Objective: This pilot study assessed the effects of electronic noise-masking earbuds on subjective sleep perception and objective sleep parameters among healthcare workers (HCWs) reporting sleep difficulties during the COVID-19 pandemic. Methods: Using a pre-post design, 77 HCWs underwent 3 nights of baseline assessment followed by a 7-night intervention period. Participants wore an at-home sleep monitoring headband to assess objective sleep measures and completed subjective self-report assessments. The difference in mean sleep measures from baseline to intervention was estimated in linear mixed models. Results: Compared to baseline assessments, HCWs reported significant improvements in sleep quality as measured by the Insomnia Severity Index (ISI) (Cohen's d = 1.74, p < 0.001) and a significant reduction in perceived sleep onset latency (SOL) during the intervention (M = 17.2 minutes, SD = 7.7) compared to baseline (M = 24.7 minutes, SD = 16.1), (Cohen's d = -0.42, p = 0.001). There were no significant changes in objective SOL (p = 0.703). However, there was a significant interaction between baseline objective SOL (<20 minutes vs >20 minutes) and condition (baseline vs intervention) (p = 0.002), such that individuals with objective SOL >20 minutes experienced a significant decrease in objective SOL during the intervention period compared to baseline (p = 0.015). Conclusions: HCWs experienced a significant improvement in perceived SOL and ISI scores after using the electronic noise-masking earbuds. Our data provide preliminary evidence for a nonpharmacological intervention to improve the sleep quality of HCWs which should be confirmed by future controlled studies.
Collapse
Affiliation(s)
- Heinrich C Haller
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Susan L Moore
- Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine K Green
- Department of Otolaryngology, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel L Johnson
- Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Mary D Sammel
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
- Department of Family Medicine, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew M Novick
- Department of Psychiatry, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
4
|
Perrault AA, Kebets V, Kuek NMY, Cross NE, Tesfaye R, Pomares FB, Li J, Chee MW, Dang-Vu TT, Thomas Yeo B. A multidimensional investigation of sleep and biopsychosocialprofiles with associated neural signatures. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.15.580583. [PMID: 38559143 PMCID: PMC10979931 DOI: 10.1101/2024.02.15.580583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Sleep is essential for optimal functioning and health. Interconnected to multiple biological, psychological and socio-environmental factors (i.e., biopsychosocial factors), the multidimensional nature of sleep is rarely capitalized on in research. Here, we deployed a data-driven approach to identify sleep-biopsychosocial profiles that linked self-reported sleep patterns to inter-individual variability in health, cognition, and lifestyle factors in 770 healthy young adults. We uncovered five profiles, including two profiles reflecting general psychopathology associated with either reports of general poor sleep or an absence of sleep complaints (i.e., sleep resilience) respectively. The three other profiles were driven by sedative-hypnotics-use and social satisfaction, sleep duration and cognitive performance, and sleep disturbance linked to cognition and mental health. Furthermore, identified sleep-biopsychosocial profiles displayed unique patterns of brain network organization. In particular, somatomotor network connectivity alterations were involved in the relationships between sleep and biopsychosocial factors. These profiles can potentially untangle the interplay between individuals' variability in sleep, health, cognition and lifestyle - equipping research and clinical settings to better support individual's well-being.
Collapse
Affiliation(s)
- Aurore A. Perrault
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l’Ile-de-Montréal, QC, Canada
- Sleep & Circadian Research Group, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Valeria Kebets
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
- Centre for Sleep and Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore
- McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute (MNI), McGill University, Montreal, QC, Canada
- McGill University, Montreal, QC, Canada
| | - Nicole M. Y. Kuek
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
- Centre for Sleep and Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore
| | - Nathan E. Cross
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l’Ile-de-Montréal, QC, Canada
- School of Psychology, University of Sydney, NSW, Australia
| | | | - Florence B. Pomares
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l’Ile-de-Montréal, QC, Canada
| | - Jingwei Li
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
- Centre for Sleep and Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore
- Institute of Neuroscience and Medicine (INM-7: Brain and Behavior), Research Center Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany
| | - Michael W.L. Chee
- Centre for Sleep and Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Thien Thanh Dang-Vu
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l’Ile-de-Montréal, QC, Canada
| | - B.T. Thomas Yeo
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore
- Centre for Sleep and Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- N.1 Institute for Health, National University of Singapore, Singapore
- Department of Medicine, Human Potential Translational Research Programme & Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore
- Martinos Center for Biomedical Imaging, Massachussetts General Hospital, Charlestown, MA, USA
| |
Collapse
|
5
|
Maltezos A, Perrault AA, Walsh NA, Phillips EM, Gong K, Tarelli L, Smith D, Cross NE, Pomares FB, Gouin JP, Dang-Vu TT. Methodological approach to sleep state misperception in insomnia disorder: Comparison between multiple nights of actigraphy recordings and a single night of polysomnography recording. Sleep Med 2024; 115:21-29. [PMID: 38325157 DOI: 10.1016/j.sleep.2024.01.027] [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: 09/05/2023] [Revised: 12/11/2023] [Accepted: 01/28/2024] [Indexed: 02/09/2024]
Abstract
STUDY OBJECTIVE To provide a comprehensive assessment of sleep state misperception in insomnia disorder (INS) and good sleepers (GS) by comparing recordings performed for one night in-lab (PSG and night review) and during several nights at-home (actigraphy and sleep diaries). METHODS Fifty-seven INS and 29 GS wore an actigraphy device and filled a sleep diary for two weeks at-home. They subsequently completed a PSG recording and filled a night review in-lab. Sleep perception index (subjective/objective × 100) of sleep onset latency (SOL), sleep duration (TST) and wake duration (TST) were computed and compared between methods and groups. RESULTS GS displayed a tendency to overestimate TST and WASO but correctly perceived SOL. The degree of misperception was similar across methods within the GS group. In contrast, INS underestimated their TST and overestimated their SOL both in-lab and at-home, yet the severity of misperception of SOL was larger at-home than in-lab. Finally, INS overestimated WASO only in-lab while correctly perceiving it at-home. While only the degree of TST misperception was stable across methods in INS, misperception of SOL and WASO were dependent on the method used. CONCLUSIONS We found that GS and INS exhibit opposite patterns and severity of sleep misperception. While the degree of misperception in GS was similar across methods, only sleep duration misperception was reliably detected by both in-lab and at-home methods in INS. Our results highlight that, when assessing sleep misperception in insomnia disorder, the environment and method of data collection should be carefully considered.
Collapse
Affiliation(s)
- Antonia Maltezos
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Neuroscience, Université de Montreal, Montreal, QC, Canada
| | - Aurore A Perrault
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada.
| | - Nyissa A Walsh
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Emma-Maria Phillips
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Neuroscience, Université de Montreal, Montreal, QC, Canada
| | - Kirsten Gong
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Lukia Tarelli
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Dylan Smith
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada
| | - Nathan E Cross
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada
| | - Florence B Pomares
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada
| | - Jean-Philippe Gouin
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Psychology & Centre for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Thien Thanh Dang-Vu
- Sleep, Cognition and Neuroimaging Lab, Department of Health, Kinesiology and Applied Physiology & Center for Studies in Behavioral Neurobiology, Concordia University, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, QC, Canada; Department of Neuroscience, Université de Montreal, Montreal, QC, Canada.
| |
Collapse
|
6
|
Berra F, Fasiello E, Zucconi M, Casoni F, De Gennaro L, Ferini-Strambi L, Galbiati A. Neurophysiological Parameters Influencing Sleep-Wake Discrepancy in Insomnia Disorder: A Preliminary Analysis on Alpha Rhythm during Sleep Onset. Brain Sci 2024; 14:97. [PMID: 38275517 PMCID: PMC10813212 DOI: 10.3390/brainsci14010097] [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: 12/07/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Sleep state misperception (SSM) is a common issue in insomnia disorder (ID), causing a discrepancy between objective and subjective sleep/wake time estimation and increased daytime impairments. In this context, the hyperarousal theory assumes that sustained central nervous system activation contributes to the SSM. This study investigates factors influencing SSM during sleep latency (SL) and total sleep time (TST). Objective polysomnographic sleep variables (the alpha density index, latency-to-sleep stages and the first K-complex, and Rapid Eye Movement (REM) arousal density) and subjective sleep indices, taken from sleep diaries, were analyzed in 16 ID patients. Correlation analyses revealed a positive association between the degree of SL misperception (SLm) and the percentage of epochs that contained a visually scored stereotyped alpha rhythm during objective SL. A regression analysis showed that the REM arousal density and alpha density index significantly predicted TST misperception (TSTm). Furthermore, the degree of SLm was associated with an increased probability of transitioning from stage 1 of non-REM sleep to wakefulness during subjective SL. These findings support the role of hyperarousal in SSM and highlight the importance of alpha activity in unravelling the heterogeneous underpinnings of SSM.
Collapse
Affiliation(s)
- Francesca Berra
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Elisabetta Fasiello
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Marco Zucconi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Francesca Casoni
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy;
- Body and Action Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Luigi Ferini-Strambi
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| | - Andrea Galbiati
- Department of Psychology, “Vita-Salute” San Raffaele University, 20132 Milan, Italy; (F.B.); (E.F.); (L.F.-S.)
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology–Sleep Disorders Center, 20132 Milan, Italy; (M.Z.); (F.C.)
| |
Collapse
|
7
|
Kawai K, Iwamoto K, Miyata S, Okada I, Ando M, Fujishiro H, Ando M, Noda A, Ozaki N. LPS and its relationship with subjective-objective discrepancies of sleep onset latency in patients with psychiatric disorders. Sci Rep 2023; 13:22637. [PMID: 38114534 PMCID: PMC10730694 DOI: 10.1038/s41598-023-49261-4] [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: 04/18/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
Subjective-objective discrepancies in sleep onset latency (SOL), which is often observed among psychiatric patients, is attributed partly to the definition of sleep onset. Recently, instead of SOL, latency to persistent sleep (LPS), which is defined as the duration from turning out the light to the first consecutive minutes of non-wakefulness, has been utilized in pharmacological studies. This study aimed to determine the non-awake time in LPS that is most consistent with subjective sleep onset among patients with psychiatric disorders. We calculated the length of non-awake time in 30-s segments from lights-out to 0.5-60 min. The root mean square error was then calculated to determine the most appropriate length. The analysis of 149 patients with psychiatric disorders showed that the optimal non-awake time in LPS was 12 min. On the other hands, when comorbid with moderate or severe obstructive sleep apnea (OSA), the optimal length was 19.5 min. This study indicates that 12 min should be the best fit for the LPS non-awake time in patients with psychiatric disorders. When there is comorbidity with OSA, however, a longer duration should be considered. Measuring LPS minimizes discrepancies in SOL and provides important clinical information.
Collapse
Affiliation(s)
- Keita Kawai
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan.
| | - Seiko Miyata
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Ippei Okada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Motoo Ando
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Hiroshige Fujishiro
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
| | - Masahiko Ando
- Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Akiko Noda
- Department of Biomedical Sciences, Chubu University Graduate School of Life and Health Sciences, Kasugai, Aichi, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa, Nagoya, Aichi, 466-8550, Japan
- Pathophysiology of Mental Disorders, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| |
Collapse
|
8
|
Stephan AM, Siclari F. Reconsidering sleep perception in insomnia: from misperception to mismeasurement. J Sleep Res 2023; 32:e14028. [PMID: 37678561 DOI: 10.1111/jsr.14028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023]
Abstract
So-called 'sleep misperception' refers to a phenomenon in which individuals have the impression of sleeping little or not at all despite normal objective measures of sleep. It is unknown whether this subjective-objective mismatch truly reflects an abnormal perception of sleep, or whether it results from the inability of standard sleep recording techniques to capture 'wake-like' brain activity patterns that could account for feeling awake during sleep. Here, we systematically reviewed studies reporting sleep macro- and microstructural, metabolic, and mental correlates of sleep (mis)perception. Our findings suggest that most individuals tend to accurately estimate their sleep duration measured with polysomnography (PSG). In good sleepers, feeling awake during sleep is the rule at sleep onset, remains frequent in the first non-rapid eye movement sleep cycle and almost never occurs in rapid eye movement (REM) sleep. In contrast, there are patients with insomnia who consistently underestimate their sleep duration, regardless of how long they sleep. Unlike good sleepers, they continue to feel awake after the first sleep cycle and importantly, during REM sleep. Their mental activity during sleep is also more thought-like. Initial studies based on standard PSG parameters largely failed to show consistent differences in sleep macrostructure between these patients and controls. However, recent studies assessing sleep with more refined techniques have revealed that these patients show metabolic and microstructural electroencephalography changes that likely reflect a shift towards greater cortical activation during sleep and correlate with feeling awake. We discuss the significance of these correlates and conclude with open questions and possible ways to address them.
Collapse
Affiliation(s)
- Aurélie M Stephan
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| | - Francesca Siclari
- The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Center for Investigation and Research on Sleep, Lausanne University Hospital, Lausanne, Switzerland
- The Sense Innovation and Research Center, Lausanne and Sion, Switzerland
| |
Collapse
|
9
|
Nyhuis CC, Fernandez-Mendoza J. Insomnia nosology: a systematic review and critical appraisal of historical diagnostic categories and current phenotypes. J Sleep Res 2023; 32:e13910. [PMID: 37122153 DOI: 10.1111/jsr.13910] [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: 03/27/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/02/2023]
Abstract
Insomnia nosology has significantly evolved since the Diagnostic and Statistical Manual (DSM)-III-R first distinguished between 'primary' and 'secondary' insomnia. Prior International Classification of Sleep Disorders (ICSD) nosology 'split' diagnostic phenotypes to address insomnia's heterogeneity and the DSM nosology 'lumped' them into primary insomnia, while both systems assumed causality for insomnia secondary to health conditions. In this systematic review, we discuss the historical phenotypes in prior insomnia nosology, present findings for currently proposed insomnia phenotypes based on more robust approaches, and critically appraise the most relevant ones. Electronic databases PsychINFO, PubMED, Web of Science, and references of eligible articles, were accessed to find diagnostic manuals, literature on insomnia phenotypes, including systematic reviews or meta-analysis, and assessments of the reliability or validity of insomnia diagnoses, identifying 184 articles. The data show that previous insomnia diagnoses lacked reliability and validity, leading current DSM-5-TR and ICSD-3 nosology to 'lump' phenotypes into a single diagnosis comorbid with health conditions. However, at least two new, robust insomnia phenotyping approaches were identified. One approach is multidimensional-multimethod and provides evidence for self-reported insomnia with objective short versus normal sleep duration linked to clinically relevant outcomes, while the other is multidimensional and provides evidence for two to five clusters (phenotypes) based on self-reported trait, state, and/or life-history data. Some approaches still need replication to better support whether their findings identify true phenotypes or simply different patterns of symptomatology. Regardless, these phenotyping efforts aim at improving insomnia nosology both as a classification system and as a mechanism to guide treatment.
Collapse
Affiliation(s)
- Casandra C Nyhuis
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
10
|
Ojalvo D, Pacheco AP, Benedict C. A useful tool or a new challenge? Hand-wrist-worn sleep trackers in patients with insomnia. J Sleep Res 2023; 32:e13883. [PMID: 36966819 DOI: 10.1111/jsr.13883] [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: 01/25/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
Consumer sleep wearables are increasingly popular, even among patients with sleep problems. However, the daily feedback provided by these devices could exacerbate sleep-related worry. To investigate this issue, 14 patients received a self-help guide booklet to improve sleep and wore the sleep tracker Fitbit Inspire 2 on their non-dominant hand for 4 weeks, while a control group of 12 patients only kept a handwritten sleep diary. All patients completed questionnaires at a primary care centre's first and final visit to assess general anxiety, sleep quality, sleep reactivity to stress, and quality of life. Our analysis showed that sleep quality, sleep reactivity to stress, and quality of life improved significantly for all patients between the first and final visit (p < 0.05). However, there were no significant differences between the Fitbit and control groups. Using sleep diary-derived estimates from the first and last week, we found that the control group but not the Fitbit group, increased their average time asleep each night and sleep efficiency (p < 0.05). However, these differences were primarily driven by baseline differences between the two groups. Our findings suggest that using wearables does not necessarily exacerbate sleep worries among people with insomnia.
Collapse
Affiliation(s)
| | | | - Christian Benedict
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
11
|
Takano Y, Ibata R, Machida N, Ubara A, Okajima I. Effect of cognitive behavioral therapy for insomnia in workers: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2023; 71:101839. [PMID: 37657127 DOI: 10.1016/j.smrv.2023.101839] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/03/2023]
Abstract
Although cognitive behavioral therapy for insomnia (CBT-I) is recommended as a first-line treatment, its efficacy for workers with insomnia remains unclear. This systematic review and meta-analysis aimed to determine the effectiveness of CBT-I in the management of insomnia symptoms in workers. We searched the literature in three electronic databases, namely PubMed, PsycINFO, and Embase, and included 21 studies in the meta-analysis. Compared with the control group, CBT-I overall resulted in significant improvements in terms of severity of insomnia (g = -0.91), sleep onset latency (g = -0.62), wakefulness after sleep onset (g = -0.60), early morning awakening (g = -0.58), and sleep efficiency (g = 0.71). However, there was no improvement in the total sleep time relative to that in the control group. Furthermore, CBT-I significantly alleviated depressive (g = -0.37) and anxiety (g = -0.35) symptoms and fatigue (g = -0.47) compared with the control group. Our study findings suggest that both web-based and face-to-face CBT-I are effective interventions for managing insomnia symptoms in daytime workers, although it is important to note that only face-to-face CBT-I achieved clinically meaningful changes. The effectiveness of CBT-I for shift workers could not be determined.
Collapse
Affiliation(s)
- Yuta Takano
- Department of Somnology, Tokyo Medical University, Tokyo, Japan; Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan.
| | - Rui Ibata
- Graduate School of Psychological Science, Health Sciences University of Hokkaido, Hokkaido, Japan; Goryokai Medical Corporation, Hokkaido, Japan
| | - Naho Machida
- Osaka Counseling Center Bellflower, Osaka, Japan
| | | | - Isa Okajima
- Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan
| |
Collapse
|
12
|
Spina MA, Andrillon T, Quin N, Wiley JF, Rajaratnam SMW, Bei B. Does providing feedback and guidance on sleep perceptions using sleep wearables improve insomnia? Findings from "Novel Insomnia Treatment Experiment": a randomized controlled trial. Sleep 2023; 46:zsad167. [PMID: 37294865 PMCID: PMC10485571 DOI: 10.1093/sleep/zsad167] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/08/2023] [Indexed: 06/11/2023] Open
Abstract
STUDY OBJECTIVES Insomnia is a disorder diagnosed based on self-reported sleep complaints. Differences between self-reported and sensor-based sleep parameters (sleep-wake state discrepancy) are common but not well-understood in individuals with insomnia. This two-arm, parallel-group, single-blind, superiority randomized-controlled trial examined whether monitoring sleep using wearable devices and providing support for interpretation of sensor-based sleep data improved insomnia symptoms or impacted sleep-wake state discrepancy. METHODS A total of 113 (age M = 47.53; SD = 14.37, 64.9% female) individuals with significant insomnia symptoms (Insomnia Severity Index(ISI) ≥10) from the community were randomized 1:1 (permuted block randomization) to receive 5 weeks (1) Intervention (n = 57): feedback about sensor-based sleep (Fitbit and EEG headband) with guidance for data interpretation and ongoing monitoring, and (2) Control (n = 56): sleep education and hygiene. Both groups received one individual session and two check-in calls. The ISI (primary outcome), sleep disturbance (SDis), sleep-related impairment (SRI), depression, and anxiety were assessed at baseline and post-intervention. RESULTS In total, 103 (91.2%) participants completed the study. Intention-to-treat multiple regression with multiple imputations showed that after controlling for baseline values, compared to the Control group (n = 51), the Intervention group (n = 52) had lower ISI (p = .011, d = 0.51) and SDis (p = .036, d = 0.42) post-intervention, but differences in SRI, depression, anxiety, and sleep-wake state discrepancy parameters (total sleep time, sleep onset latency, and wake after sleep onset) were not meaningful (P-values >.40). CONCLUSIONS Providing feedback and guidance about sensor-based sleep parameters reduced insomnia severity and sleep disturbance but did not alter sleep-wake state discrepancy in individuals with insomnia more than sleep hygiene and education. The role of sleep wearable devices among individuals with insomnia requires further research. CLINICAL TRIAL REGISTRATION The Novel Insomnia Treatment Experiment (NITE): the effectiveness of incorporating appropriate guidance for sleep wearables in users with insomnia. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378452, Australia New Zealand Clinical Trials Registry: ACTRN12619001636145.
Collapse
Affiliation(s)
- Marie-Antoinette Spina
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Thomas Andrillon
- School of Philosophical, Historical, and International Studies, Centre for Consciousness and Contemplative Studies, Monash University, Melbourne, VIC, Australia
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Joshua F Wiley
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
13
|
Åkerstedt T, Schwarz J, Theorell-Haglöw J, Lindberg E. What do women mean by poor sleep? A large population-based sample with polysomnographical indicators, inflammation, fatigue, depression, and anxiety. Sleep Med 2023; 109:219-225. [PMID: 37478658 DOI: 10.1016/j.sleep.2023.06.029] [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: 03/28/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/23/2023]
Abstract
Survey studies indicate that reports of disturbed sleep are prevalent and may be prospectively linked to several major diseases. However, it is not clear what self-reported disturbed sleep represents, since the link with objective sleep measures (polysomnography; PSG) seems very weak. The purpose of the present study was to try to investigate what combination of variables (PSG, inflammation, fatigue, anxiety, depression) that would characterize those who complain of disturbed sleep. This has never been done before. Participants were 319 women in a population-based sample, who gave ratings of sleep quality, fatigue, depression, and anxiety, then had their sleep recorded at home, and had blood drawn the following morning for analysis of immune parameters. Correlations and hierarchical multivariable regression analyses were applied to the data. For ratings of difficulties initiating sleep, the associations in the final step were ß = .22, (p < .001) for fatigue, ß = 0.22 (p < .001) for anxiety, and ß = 0.17 (p < .01) for sleep latency, with R2 = 0.14. The rating of repeated awakenings was associated with fatigue (ß = 0.35, p < .001) and C-reactive protein (CRP) (ß = 0.12, p < .05), with R2 = 0.19. The rating of early morning awakenings was associated with fatigue (ß = 0.31, p < .001), total sleep time (TST) (ß = -0.20, p < .01), and CRP (ß = 0.15, p < .05), with R2 = 0.17. Interleukin-6 and Tumour Necrosis Factor were not associated with ratings of sleep problems. The results indicate that subjective fatigue, rather than objective sleep variables, is central in the perception of poor sleep, together with CRP.
Collapse
Affiliation(s)
- Torbjörn Åkerstedt
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden.
| | - Johanna Schwarz
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Stress Research Institute, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Sweden
| |
Collapse
|
14
|
Ren W, Zhang N, Sun Y, Pan L, Hou Y, Li D, Huang X, Liu K, Sun H, Sun Y, Lv C, Yu Y, Han F. The REM microarousal and REM duration as the potential indicator in paradoxical insomnia. Sleep Med 2023; 109:110-117. [PMID: 37429109 DOI: 10.1016/j.sleep.2023.06.011] [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: 03/22/2023] [Revised: 06/10/2023] [Accepted: 06/10/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE Although paradoxical insomnia is a prevalent subtype of chronic insomnia, the etiology of it is unclear. Contrary to complaints of little or no sleep, polysomnography (PSG) findings show that paradoxical insomnia patients have near normal sleep macrostructure. The purpose of this study is to determine the changes of microstructure and explore the etiology of paradoxical insomnia. METHODS The PSG findings of 89 paradoxical insomnia patients were compared with those of 41 gender balanced healthy controls without sleep complaints. All subjects underwent nocturnal PSG recordings. Conventional PSG measures and microarousals were quantified and statistically analyzed. Receiver operating characteristic curve and correlation analysis were used to evaluate the potential of REM sleep microarousals and REM duration as indicators of paradoxical insomnia. RESULTS Compared with the controls, paradoxical insomnia patients had no significant differences in sleep macrostructures. Statistical analysis showed that non-rapid eye movement (NREM) microarousals revealed no significant differences between paradoxical insomnia patients and controls. Noticeably, more spontaneous microarousals appeared in rapid eye movement (REM) stage for paradoxical insomnia patients. Based on receiver operating characteristic curve (ROC), the optimal cutoff value of REM sleep microarousals could predict paradoxical insomnia. Furthermore, a positive correlation between microarousals in REM sleep and the duration of REM sleep was presented in paradoxical insomnia patients. CONCLUSIONS The frequency of REM microarousals and the duration of REM sleep could reflect the real sleep state of paradoxical insomnia patients. That suggested PSG investigation extended to microarousal could be helpful to understand the etiology in paradoxical insomnia.
Collapse
Affiliation(s)
- Wenjing Ren
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China; Department of the First School of Clinical Medicine, Binzhou Medical University, Binzhou, China
| | - Na Zhang
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China; Department of the First School of Clinical Medicine, Binzhou Medical University, Binzhou, China
| | - Yunliang Sun
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Lei Pan
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Yanyan Hou
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Dongze Li
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Xiao Huang
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Kuikui Liu
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China
| | - Hongliu Sun
- Department of Pharmaceutical Sciences, Binzhou Medical University, Yantai, China
| | - Yeying Sun
- Department of Pharmaceutical Sciences, Binzhou Medical University, Yantai, China
| | - Changjun Lv
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China; Department of the First School of Clinical Medicine, Binzhou Medical University, Binzhou, China
| | - Yan Yu
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China; Department of the First School of Clinical Medicine, Binzhou Medical University, Binzhou, China.
| | - Fang Han
- Department of Respiratory and Critical Care Medicine, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, China; Department of the First School of Clinical Medicine, Binzhou Medical University, Binzhou, China.
| |
Collapse
|
15
|
Tassone LM, Moyano MD, Laiño F, Brusco LI, Ramele RE, Forcato C. One-week sleep hygiene education improves episodic memory in young but not in older adults during social isolation. Front Psychol 2023; 14:1155776. [PMID: 37599745 PMCID: PMC10433204 DOI: 10.3389/fpsyg.2023.1155776] [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: 01/31/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Memory formation is a dynamic process that comprises different phases, such as encoding, consolidation and retrieval. It could be altered by several factors such as sleep quality, anxiety, and depression levels. In the last years, due to COVID-19 pandemic, there was a reduction in sleep quality, an increase in anxiety and depressive symptoms as well as an impairment in emotional episodic memory encoding, especially in young adults. Taking into account the profound impact of sleep quality in daily life a series of rules has been developed that are conducive to consistently achieving good sleep, known as sleep hygiene education. These interventions have been shown to be effective in improving sleep quality and duration and reducing depressive and anxiety symptoms. Here we propose the implementation of a brief sleep hygiene education to improve sleep quality and memory performance as well as to diminish anxiety and depressive scores. For that, participants were divided into two groups: Sleep hygiene education and control group. After that, they were evaluated for anxiety, depression, and sleep quality levels and trained on an episodic memory task. They were tested immediately after (short-term test) and also 1 week later (long-term test). This procedure was also performed before the sleep hygiene education and was taken as baseline level. We found that episodic memory performance for young adults improved for the SHE group after intervention but not for older adults, and no improvements in emotional variables were observed. Despite not observing a significant effect of the intervention for young and older adults regarding the sleep quality scores, we consider that there may be an improvement in sleep physiology that is not subjectively perceived, but would also have a positive impact on memory processes. These results show that even a sleep hygiene education of 1 week could improve cognition in young adults when acute memory and sleep impairment occurs, in this case, due to the isolation by COVID-19 pandemic. However, we suggest that longer interventions should be implemented for older adults who already experience a natural decline in cognitive processes such as episodic memory formation.
Collapse
Affiliation(s)
- Leonela Magali Tassone
- Laboratorio de Sueño y Memoria, Departamento de Ciencias de la Vida, Instituto Tecnológico de Buenos Aires (ITBA), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Malen Daiana Moyano
- Laboratorio de Sueño y Memoria, Departamento de Ciencias de la Vida, Instituto Tecnológico de Buenos Aires (ITBA), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| | - Fernando Laiño
- Fundación Instituto Superior de Ciencias de la Salud, Buenos Aires, Argentina
| | - Luis Ignacio Brusco
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
- CENECON, Centro de Neuropsiquiatría y Neurología de la Conducta (CENECON), Buenos Aires, Argentina
| | - Rodrigo Ezequiel Ramele
- Centro de Inteligencia Computacional, Instituto Tecnológico de Buenos Aires (ITBA), Buenos Aires, Argentina
| | - Cecilia Forcato
- Laboratorio de Sueño y Memoria, Departamento de Ciencias de la Vida, Instituto Tecnológico de Buenos Aires (ITBA), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
| |
Collapse
|
16
|
Inoue Y, Nishida M, Kubota N, Koebis M, Taninaga T, Muramoto K, Ishikawa K, Moline M. Comparison of the treatment effectiveness between lemborexant and zolpidem tartrate extended-release for insomnia disorder subtypes defined based on polysomnographic findings. J Clin Sleep Med 2023; 19:519-528. [PMID: 36472134 PMCID: PMC9978424 DOI: 10.5664/jcsm.10378] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
STUDY OBJECTIVES Patients with chronic insomnia may respond differently to therapeutic modalities. This study examined differences in response of individuals with 2 insomnia phenotypes-short sleep duration (I-SSD; < 6 hours) and normal sleep duration (I-NSD; ≥ 6 hours) determined by polysomnography-to treatment with lemborexant and zolpidem tartrate extended-release 6.25 mg (zolpidem ER), compared with placebo. METHODS Study E2006-G000-304 (Study 304; SUNRISE-1; NCT02783729) was a global, randomized, double-blind, placebo, and active comparator-controlled, parallel-group study comparing lemborexant 5 and 10 mg in individuals aged ≥ 55 years with insomnia disorder. In this analysis, changes in subjective (self-reported) variables based on sleep diaries and objective variables based on polysomnographs were assessed after 1-month administration of study drugs. Data from participants with I-SSD and I-NSD were compared. RESULTS In the I-SSD subgroup, both lemborexant doses provided significant benefit for sleep-onset latency (SOL), total sleep time (TST), and wake after sleep onset (WASO) vs placebo; zolpidem ER also provided significant benefit for TST and WASO, but not SOL, on both measures vs placebo. In the I-NSD subgroup, lemborexant and zolpidem ER provided significant benefit for TST and WASO vs placebo objectively but not subjectively; both doses of lemborexant provided significant benefit for SOL vs placebo subjectively, but not objectively. CONCLUSIONS Both drugs, but lemborexant more consistently, showed subjective and objective benefits compared with placebo in participants with insomnia with objective short sleep duration. However, neither lemborexant nor zolpidem provided consistent benefits for participants with normal sleep duration on sleep-onset and sleep maintenance variables. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Study of the Efficacy and Safety of Lemborexant in Subjects 55 Years and Older With Insomnia Disorder (SUNRISE 1); URL: https://clinicaltrials.gov/ct2/show/record/NCT02783729; Identifier: NCT02783729. CITATION Inoue Y, Nishida M, Kubota N, et al. Comparison of the treatment effectiveness between lemborexant and zolpidem tartrate extended-release for insomnia disorder subtypes defined based on polysomnographic findings. J Clin Sleep Med. 2023;19(3):519-528.
Collapse
Affiliation(s)
- Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Institute of Neuropsychiatry, Tokyo, Japan
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Kutzer Y, Whitehead L, Quigley E, Fu SC, Stanley M. Subjective versus objective sleep outcomes in older adults with and without uncoupled sleep following online cognitive behavioural therapy for insomnia. Psychogeriatrics 2023; 23:298-310. [PMID: 36653914 DOI: 10.1111/psyg.12931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/15/2022] [Accepted: 12/26/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Uncoupled sleep is a phenomenon characterised by a disconnect between sleep pattern and sleep complaint. This study examined the impact of uncoupled sleep on dysfunctional sleep beliefs and objective and subjective sleep outcomes in community-dwelling older adults following digitally delivered Cognitive Behavioural Therapy for Insomnia (CBT-I) to assess how these groups respond to CBT-I. METHODS Objective sleep was measured using wrist actigraphy, subjective sleep quality via sleep diaries and the Pittsburgh Sleep Quality Index (PSQI). Dysfunctional sleep beliefs were assessed by the Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16). All measurements were taken prior to and following a 4-week online CBT-I program. Linear mixed model and generalised linear mixed model analyses were conducted to examine objective and subjective sleep onset latency, total sleep time, wake after sleep onset and number of awakenings as well as PSQI and DBAS-16 scores, respectively. RESULTS Out of 80 enrolled participants, 62 participants (55 females, 89%; 16 complaining good sleepers, 26 complaining poor sleepers, 11 non-complaining good sleepers, and nine non-complaining poor sleepers) completed the study. CBT-I reduced dysfunctional sleep beliefs across all sleeper classifications. Objective and self-reported changes in sleep parameters were demonstrated in complaining poor sleepers without uncoupled sleep. Complaining good sleepers with uncoupled sleep only reported a decrease in the number of subjective sleep awakenings. There were no changes in sleep outcomes in non-complaining good and non-complaining poor sleepers. CONCLUSIONS Online CBT-I was effective in improving the sleep outcomes of individuals who had both subjective and objective poor sleep. However, as the online CBT-I reduced dysfunctional sleep beliefs in all sleep groups, further examination of dysfunctional sleep beliefs and whether they mediate the outcomes of digital CBT-I in older adults will need to be conducted.
Collapse
Affiliation(s)
| | | | | | - Shih Ching Fu
- Edith Cowan University, Perth, Australia.,Curtin University, Perth, Australia
| | | |
Collapse
|
18
|
Conte F, Malloggi S, De Rosa O, Di Iorio I, Romano F, Giganti F, Ficca G. Sleep Continuity, Stability and Cyclic Organization Are Impaired in Insomniacs: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1240. [PMID: 36673991 PMCID: PMC9859102 DOI: 10.3390/ijerph20021240] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
The possibility of distinguishing insomniacs from good sleepers based on polysomnography (PSG) remains an open question. While these groups show modest differences in traditional PSG parameters, some studies suggest that finer measures may be more useful. Here we assess differences between good sleepers (GS), poor sleepers (PS) and insomniacs (IN) in classical PSG measures as well as in sleep continuity, stability and cyclic organization. PSG-monitored sleep (two nights) of 17 IN (diagnosed through a standard clinical interview; Pittsburgh Sleep Quality Index (PSQI) ≥ 5, Insomnia Severity Index (ISI) > 14) was compared to that of 33 GS (PSQI < 5) and 20 PS (PSQI ≥ 5, ISI ≤ 14). Compared to GS, IN were impaired in sleep macrostructure (sleep latency, sleep efficiency, WASO%) and in continuity, stability and organization, whereas PS only showed disrupted continuity and stability. Spindle parameters were comparable between IN and GS, but the former displayed enhanced power in fast frequency bands. Our findings support the hypothesis of a continuum between individuals with self-reported poor sleep and insomniacs. Further, they add to extant data on impaired sleep continuity, stability and organization in poor sleepers and elderly individuals, underlining the utility of including these measures in standard sleep assessments.
Collapse
Affiliation(s)
- Francesca Conte
- Department of Psychology, University of Campania L. Vanvitelli, Viale Ellittico 31, 81100 Caserta, Italy
| | - Serena Malloggi
- Department NEUROFARBA, University of Firenze, Via di San Salvi 12, 50135 Firenze, Italy
| | - Oreste De Rosa
- Department of Psychology, University of Campania L. Vanvitelli, Viale Ellittico 31, 81100 Caserta, Italy
| | - Ilaria Di Iorio
- Department NEUROFARBA, University of Firenze, Via di San Salvi 12, 50135 Firenze, Italy
| | - Federica Romano
- Department of Psychology, University of Campania L. Vanvitelli, Viale Ellittico 31, 81100 Caserta, Italy
| | - Fiorenza Giganti
- Department NEUROFARBA, University of Firenze, Via di San Salvi 12, 50135 Firenze, Italy
| | - Gianluca Ficca
- Department of Psychology, University of Campania L. Vanvitelli, Viale Ellittico 31, 81100 Caserta, Italy
| |
Collapse
|
19
|
Scott H, Lechat B, Manners J, Lovato N, Vakulin A, Catcheside P, Eckert DJ, Reynolds AC. Emerging applications of objective sleep assessments towards the improved management of insomnia. Sleep Med 2023; 101:138-145. [PMID: 36379084 DOI: 10.1016/j.sleep.2022.10.030] [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: 06/30/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Self-reported sleep difficulties are the primary concern associated with diagnosis and treatment of chronic insomnia. This said, in-home sleep monitoring technology in combination with self-reported sleep outcomes may usefully assist with the management of insomnia. The rapid acceleration in consumer sleep technology capabilities together with their growing use by consumers means that the implementation of clinically useful techniques to more precisely diagnose and better treat insomnia are now possible. This review describes emerging techniques which may facilitate better identification and management of insomnia through objective sleep monitoring. Diagnostic techniques covered include insomnia phenotyping, better detection of comorbid sleep disorders, and identification of patients potentially at greatest risk of adverse outcomes. Treatment techniques reviewed include the administration of therapies (e.g., Intensive Sleep Retraining, digital treatment programs), methods to assess and improve treatment adherence, and sleep feedback to address concerns about sleep and sleep loss. Gaps in sleep device capabilities are also discussed, such as the practical assessment of circadian rhythms. Proof-of-concept studies remain needed to test these sleep monitoring-supported techniques in insomnia patient populations, with the goal to progress towards more precise diagnoses and efficacious treatments for individuals with insomnia.
Collapse
Affiliation(s)
- Hannah Scott
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia.
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Jack Manners
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Peter Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| |
Collapse
|
20
|
Utsumi T, Yoshiike T, Kaneita Y, Aritake-Okada S, Matsui K, Nagao K, Saitoh K, Otsuki R, Shigeta M, Suzuki M, Kuriyama K. The association between subjective-objective discrepancies in sleep duration and mortality in older men. Sci Rep 2022; 12:18650. [PMID: 36333394 PMCID: PMC9636161 DOI: 10.1038/s41598-022-22065-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
A discrepancy in subjective and objective estimations of sleep duration, which often diverge, could have long-term adverse effects on health outcomes in older adults. Using data from 2674 older adult men (≥ 65 years of age) of the Osteoporotic Fractures in Men Sleep Study, we assessed the longitudinal association between misperception index (MI), calculated as MI = (objective sleep duration - subjective sleep duration)/objective sleep duration, and all-cause mortality. During the follow-up with a mean (standard deviation) of 10.8 (4.2) years, 1596 deaths were observed. As a continuous variable, MI showed a linear relationship with all-cause mortality after adjusting for multiple covariates, including polysomnography-measured objective sleep duration [fully adjusted hazard ratio (HR), 0.69; 95% confidence interval [CI], 0.56-0.84]. As a categorical variable, the lowest MI quartile (vs. the interquartile MI range) was associated with increased mortality (fully adjusted HR, 1.28; 95% CI, 1.12-1.46), whereas the highest MI quartile was not associated with mortality (fully adjusted HR, 0.97; 95% CI, 0.85-1.11). The subjective overestimation of sleep duration may be a risk factor for all-cause mortality in older men. Future studies should examine why subjective overestimation of sleep duration is associated with all-cause mortality from a physiological perspective.
Collapse
Affiliation(s)
- Tomohiro Utsumi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Yoshiike
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Yoshitaka Kaneita
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
- 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, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
- Department of Health Sciences, Saitama Prefectural University, Saitama, Japan
| | - Kentaro Matsui
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kentaro Nagao
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
- Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kaori Saitoh
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Rei Otsuki
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
- Department of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Masahiro Shigeta
- Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Suzuki
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
- Department of Psychiatry, Nihon University School of Medicine, Tokyo, Japan
| | - Kenichi Kuriyama
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
| |
Collapse
|
21
|
Perlis ML, Posner D, Riemann D, Bastien CH, Teel J, Thase M. Insomnia. Lancet 2022; 400:1047-1060. [PMID: 36115372 DOI: 10.1016/s0140-6736(22)00879-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/03/2022] [Accepted: 05/05/2022] [Indexed: 12/30/2022]
Abstract
Insomnia is highly prevalent in clinical practice, occurring in up to 50% of primary care patients. Insomnia can present independently or alongside other medical conditions or mental health disorders and is a risk factor for the development and exacerbation of these other disorders if not treated. In 2016, the American College of Physicians recommended that insomnia be specifically targeted for treatment. The recommended first-line treatment for insomnia, whether the underlying cause has been identified or not, is cognitive behavioural therapy for insomnia (CBT-I). Currently, there is no global consensus regarding which pharmacological treatment has the best efficacy or risk-benefit ratio. Both CBT-I and pharmacological intervention are thought to have similar acute effects, but only CBT-I has shown durable long-term effects after treatment discontinuation. Administering a combined treatment of CBT-I and medication could decrease the latency to treatment response, but might diminish the durability of the positive treatment effects of CBT-I.
Collapse
Affiliation(s)
- Michael L Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Donn Posner
- Department of Psychiatry and Behavioral Science, Stanford University, Stanford, CA, USA
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | | | - Joseph Teel
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
22
|
Kawada T. Comment on "Smartphone Addiction Proneness is Associated With Subjective-Objective Sleep Discrepancy in Patients With Insomnia Disorder". Psychiatry Investig 2022; 19:595-596. [PMID: 35903062 PMCID: PMC9334804 DOI: 10.30773/pi.2022.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/11/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
23
|
Kundu K, Sharma G, Saini L, Gupta R. Polysomnographic Characteristics of the Patients Having Chronic Insomnia and Obstructive Sleep Apnea: Evidence for Paradoxical Insomnia and Comorbid Insomnia with OSA (COMISA). Indian J Psychol Med 2022; 44:384-391. [PMID: 35949627 PMCID: PMC9301755 DOI: 10.1177/02537176211048322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sleep state misperception (SSM) is seen among patients with obstructive sleep apnea (OSA) as well as those having insomnia. Moreover, OSA and insomnia can also be comorbid. This study aims at finding the proportion of SSM and "Comorbid Insomnia with OSA" (COMISA) among patients of OSA and chronic insomnia. Macroachitecture of sleep was also compared across groups. METHODS This study utilized the retrospective laboratory and medical records of two groups of patients: chronic insomnia and OSA. Sleep disorders were diagnosed according to standard criteria. Daytime sleepiness was examined using the Epworth Sleepiness Scale. Diagnosis of SSM was based on the difference between subjective and objective sleep onset latency (Subjective SOL > 1.5 × Objective SOL). RESULTS Sixteen adult subjects were included in each group. Based on the difference between subjective and objective sleep onset latency, SSM was reported by 62.5% subjects of chronic insomnia and 56.25% subjects having OSA (OR = 1.29; 95% CI = 0.31-5.33; P = 0.79). The proportion of COMISA in subjects with chronic insomnia was 18% and among subjects with OSA, it was 43%. Effect size for the proportion was calculated as odds ratio (33.96; 95% CI = 7.48-154.01; P < 0.0002). Thus, the odds for COMISA were higher among subjects with OSA than those with chronic Insomnia. The three groups (OSA, COMISA and Chronic Insomnia) were comparable with regard to the macro-architecture of sleep. CONCLUSION SSM is common among subjects with OSA and chronic insomnia. COMISA was commoner among patients with OSA compared to those with chronic insomnia. Macro-architecture of sleep is comparable among groups.
Collapse
Affiliation(s)
- Kaustav Kundu
- Dept. of Psychiatry, Division of Sleep Medicine, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Gaurav Sharma
- Dept. of Psychiatry, Division of Sleep Medicine, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| | - Lokesh Saini
- Dept. of Pulmonary Medicine and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ravi Gupta
- Dept. of Psychiatry, Division of Sleep Medicine, All India Institute of Medical Sciences Rishikesh, Uttarakhand, India
| |
Collapse
|
24
|
Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition. Sleep Med 2022; 97:13-26. [DOI: 10.1016/j.sleep.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/02/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
|
25
|
Yoon G, Lee MH, Oh SM, Choi JW, Yoon SY, Lee YJ. Negative and positive sleep state misperception in patients with insomnia: factors associated with sleep perception. J Clin Sleep Med 2022; 18:1789-1795. [PMID: 35383568 DOI: 10.5664/jcsm.9974] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES In the present study, factors associated with sleep perception were identified by comparing clinical characteristics and polysomnographic variables between insomnia patients with negative and positive sleep state misperception (NSSM and PSSM, respectively). METHODS Subjective and objective sleep measures were retrospectively collected, including the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and a questionnaire on "morning feeling" after nocturnal polysomnography (PSG) in 150 patients with insomnia. Based on the misperception index (MI), participants were classified into NSSM (MI > 0, n = 115) and PSSM (MI < 0, n = 35) groups. RESULTS The PSSM group had more N3 sleep on nocturnal PSG than the NSSM group (p=0.002). The NSSM group showed a higher PSQI score (p<0.001), longer subjective sleep onset latency (SOL) (p=0.001), and a greater SOL discrepancy (p=0.001). Subjective feelings of tiredness and morning awakenings in the morning were higher in the NSSM group (p=0.029 and p=0.038). The MI negatively correlated with a proportion of N3 sleep (p=0.005) and positively correlated with PSQI (p<0.001), morning awakenings (p=0.01), subjective SOL (p<0.001), and SOL discrepancy (p<0.001) in insomnia patients. Multiple regression analysis showed that N3 sleep, PSQI, and morning awakenings were significantly associated with MI in insomnia patients. CONCLUSIONS The proportion of slow-wave sleep and subjective measures may be associated with perception of sleep in insomnia patients. Objective and subjective characteristics of insomnia patients should be carefully evaluated and managed because they may influence the perception of sleep.
Collapse
Affiliation(s)
- Gahui Yoon
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Mi Hyun Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Seong Min Oh
- Department of Psychiatry, Dongguk University Ilsan Hospital, Ilsan, Republic of Korea
| | - Jae-Won Choi
- Department of Neuropsychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Republic of Korea
| | - So Young Yoon
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University, College of Medicine and Hospital, Seoul, Republic of Korea
| |
Collapse
|
26
|
Milinski L, Nodal FR, Vyazovskiy VV, Bajo VM. Tinnitus: at a crossroad between phantom perception and sleep. Brain Commun 2022; 4:fcac089. [PMID: 35620170 PMCID: PMC9128384 DOI: 10.1093/braincomms/fcac089] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/31/2021] [Accepted: 03/31/2022] [Indexed: 11/25/2022] Open
Abstract
Sensory disconnection from the environment is a hallmark of sleep and is crucial
for sleep maintenance. It remains unclear, however, whether internally generated
percepts—phantom percepts—may overcome such disconnection and, in
turn, how sleep and its effect on sensory processing and brain plasticity may
affect the function of the specific neural networks underlying such phenomena. A
major hurdle in addressing this relationship is the methodological difficulty to
study sensory phantoms, due to their subjective nature and lack of control over
the parameters or neural activity underlying that percept. Here, we explore the
most prevalent phantom percept, subjective tinnitus—or tinnitus for
short—as a model to investigate this. Tinnitus is the permanent
perception of a sound with no identifiable corresponding acoustic source. This
review offers a novel perspective on the functional interaction between brain
activity across the sleep–wake cycle and tinnitus. We discuss
characteristic features of brain activity during tinnitus in the awake and the
sleeping brain and explore its effect on sleep functions and homeostasis. We ask
whether local changes in cortical activity in tinnitus may overcome sensory
disconnection and prevent the occurrence of global restorative sleep and, in
turn, how accumulating sleep pressure may temporarily alleviate the persistence
of a phantom sound. Beyond an acute interaction between sleep and neural
activity, we discuss how the effects of sleep on brain plasticity may contribute
to aberrant neural circuit activity and promote tinnitus consolidation. Tinnitus
represents a unique window into understanding the role of sleep in sensory
processing. Clarification of the underlying relationship may offer novel
insights into therapeutic interventions in tinnitus management.
Collapse
Affiliation(s)
- Linus Milinski
- University of Oxford, Department of Physiology, Anatomy and Genetics, Sherrington Building, Parks Road, Oxford OX1 3PT, UK
| | - Fernando R. Nodal
- University of Oxford, Department of Physiology, Anatomy and Genetics, Sherrington Building, Parks Road, Oxford OX1 3PT, UK
| | - Vladyslav V. Vyazovskiy
- University of Oxford, Department of Physiology, Anatomy and Genetics, Sherrington Building, Parks Road, Oxford OX1 3PT, UK
| | - Victoria M. Bajo
- University of Oxford, Department of Physiology, Anatomy and Genetics, Sherrington Building, Parks Road, Oxford OX1 3PT, UK
| |
Collapse
|
27
|
Wang J, Chen Y, Zhai X, Chu Y, Liu X, Ma X. Visualizing Research Trends and Identifying Hotspots of Traditional Chinese Medicine (TCM) Nursing Technology for Insomnia: A 18-Years Bibliometric Analysis of Web of Science Core Collection. Front Neurol 2022; 13:816031. [PMID: 35432182 PMCID: PMC9009417 DOI: 10.3389/fneur.2022.816031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/04/2022] [Indexed: 12/11/2022] Open
Abstract
Objective To explore the research hotspot and frontier direction of TCM nursing of insomnia and provide reference for the follow-up study of the optimal scheme of TCM nursing of insomnia. Background Insomnia is a common sleep-wake disorder, affects 6–10% of adults and was associated with independent higher risks of cardiovascular disease and diabetes. TCM Nursing Techniques of insomnia has a long history and has shown a definite impact. However, it's still lack of analysis in the field of the most commonly used and effective techniques, as well as the co-morbidities associated with insomnia. Therefore, the database was searched and analyzed to find effective TCM Nursing Techniques for insomnia and related diseases related to insomnia. Method Randomized controlled trials on the intervention of TCM Nursing Techniques in insomnia were retrieved from Web of Science Core Collection and imported into CiteSpace 5.6.R5 visualization software. The works of literature were co-cited by keywords authors and institutions for visual analysis, and the co-morbidities associated with insomnia of TCM Nursing Techniques in literature was extracted manually. The symptoms of co-morbidities associated with insomnia were imported into Cytoscape 3.9.0 software and clustered by CytoHubba. Result As of October 20, 2021, the literature published in the last 20 years from Web of Science Core Collection was screened, and the publication period of the included literature was from 2004 to 2021. From 2016 to now, the total number of articles has been increasing. A total of 146 articles were included, and the highest production year was 2020. There is little cooperation between states, institutions, and authors. China (including Hong Kong and Taiwan) and Hong Kong Polytech University are leading countries and institutions in this area. MYUNGHAENG HUR is the most cited author, and J ALTERN COMPLEM MED is the most cited journal. According to cluster analysis and keyword frequency, auricular therapy, aromatherapy, and acupressure are the three most commonly used techniques. While the top five co-morbidities are fatigue, anxiety, depression, pain and hemodialysis. The three frontier topics and the main research directions are sleep quality, comorbid insomnia and clinical trial design. Conclusion We found that acupressure, aromatherapy, and auricular acupoint therapy are the most commonly used nursing methods of TCM to intervene in insomnia. However, these studies have limitations such as small sample size, lack of objectivity in evaluating sleep quality, and high heterogeneity of intervention measures, which are not conducive to forming TCM clinical nursing guidelines. Therefore, it is necessary to adopt objectified sleep quality evaluation methods, select suitable acupoints according to TCM theories, and design multi-center large-sample clinical trials based on the safety principle of randomized blind control. This study provides an in-depth perspective for insomnia research on TCM Nursing Techniques and includes information for follow-up research on TCM Nursing Techniques of insomnia.
Collapse
Affiliation(s)
- Junxin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Yufeng Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Xing Zhai
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Yupeng Chu
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Xiangdi Liu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Xiangdi Liu
| | - Xueling Ma
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- Xueling Ma
| |
Collapse
|
28
|
The disintegrated theory of consciousness: Sleep, waking, and meta-awareness. Behav Brain Sci 2022; 45:e64. [PMID: 35319408 DOI: 10.1017/s0140525x21001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The study of sleep and wakefulness can inform debates about the nature of consciousness. We argue that sleep and wakefulness fall along a multidimensional continuum and that inconsistencies and paradoxes with the accounts put forth by Merker et al. and Tononi can be understood in terms of a pervasive false dichotomy between these two states.
Collapse
|
29
|
Castelnovo A, Lividini A, Bernardi G, Pezzoli V, Foderaro G, Ramelli GP, Manconi M, Miano S. Sleep Power Topography in Children with Attention Deficit Hyperactivity Disorder (ADHD). CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020197. [PMID: 35204918 PMCID: PMC8870029 DOI: 10.3390/children9020197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Recent years saw an increasing interest towards sleep microstructure abnormalities in attention-deficit/hyperactivity disorder (ADHD). However, the existing literature on sleep electroencephalographic (EEG) power in ADHD is still controversial, often based on single electrode recordings, and mainly focused on slow wave activity (SWA) during NREM sleep. This study aimed to systematically investigate sleep power topography in all traditional frequency bands, in all sleep stages and across sleep cycles using high-density EEG (HD-EEG). METHOD Thirty drug-naïve children with ADHD (10.5 ± 2.1 years, 21 male) and 23 typically developing (TD) control participants (mean age: 10.2 ± 1.6 years, 13 male) were included in the current analysis. Signal power topography was computed in classical frequency bands during sleep, contrasted between groups and sleep cycles, and correlated with measures of ADHD severity, cognitive functioning and estimated total sleep time. RESULTS Compared to TD subjects, patients with ADHD consistently displayed a widespread increase in low-frequency activity (between 3 and 10 Hz) during NREM sleep, but not during REM sleep and wake before sleep onset. Such a difference involved a wide centro-posterior cluster of channels in the upper SWA range, in Theta, and low-Alpha. Between-group difference was maximal in sleep stage N3 in the first sleep cycle, and positively correlated with average total sleep time. CONCLUSIONS These results support the concept that children with ADHD, compared to TD peers, have a higher sleep pressure and altered sleep homeostasis, which possibly interfere with (and delay) cortical maturation.
Collapse
Affiliation(s)
- Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, 6900 Lugano, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, 3011 Bern, Switzerland
- Correspondence: (A.C.); (S.M.)
| | - Althea Lividini
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
| | - Giulio Bernardi
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, 55100 Lucca, Italy;
| | - Valdo Pezzoli
- Department of Pediatrics, Ospedale Civico, 6900 Lugano, Switzerland; (V.P.); (G.F.)
| | - Giuseppe Foderaro
- Department of Pediatrics, Ospedale Civico, 6900 Lugano, Switzerland; (V.P.); (G.F.)
| | - Gian Paolo Ramelli
- Department of Pediatrics, San Giovanni Hospital, 6500 Bellinzona, Switzerland;
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, 6900 Lugano, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Department of Neurology, University Hospital, Inselspital, 3010 Bern, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, 6900 Lugano, Switzerland;
- Correspondence: (A.C.); (S.M.)
| |
Collapse
|
30
|
Xu B, Cai Q, Mai R, Liang H, Huang J, Yang Z. Sleep EEG characteristics associated with total sleep time misperception in young adults: an exploratory study. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2022; 18:2. [PMID: 35073948 PMCID: PMC8788124 DOI: 10.1186/s12993-022-00188-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022]
Abstract
Background Power spectral analysis (PSA) is one of the most commonly-used EEG markers of cortical hyperarousal, and can help to understand subjective–objective sleep discrepancy (SOD). Age is associated with decreased sleep EEG activity; however, the PSA of young adults is currently limited. Thus, this study aimed to examine the correlation of spectral EEG power with total sleep time (TST) misperception in young patients. Methods Forty-seven young adults were recruited and underwent a polysomnography recording in a sleep laboratory. Clinical records and self-report questionnaires of all patients were collected, and were used to categorize patients into a good sleeper (GS) group (n = 10), insomnia with a low mismatch group (IWLM, n = 19) or participant with a high mismatch group (IWHM, n = 18). PSA was applied to the first 6 h of sleep. Results IWHM patients exhibited a higher absolute power and relative beta/delta ratio in the frontal region compared to the GS group. No significant difference was observed between the IWLM and GS groups. No significant difference in the above parameters was observed between the IWHM and IWLM groups. Moreover, The SOD of TST was positively correlated with frontal absolute power and the relative beta/delta ratio (r = 0.363, P = 0.012; r = 0.363, P = 0.012), and absolute beta EEG spectral power (r = 0.313, P = 0.032) as well as the number of arousals. Conclusions Increased frontal beta/delta ratio EEG power was found in young patients with a high mismatch but not in those with a low mismatch, compared with good sleepers. This suggests that there exists increased cortical activity in IWHM patients. In addition, the frontal beta/delta ratio and the number of arousals was positively correlated with the SOD of TST.
Collapse
Affiliation(s)
- Biyun Xu
- Department of Fangcun Sleep-Disorder, the Second Clinical College of Guangzhou University of Chinese Medicine (Guangdong Provincial Hopsital of Chinese Medicine), Guangzhou, 510120, China. .,Applicants for Doctoral Degree with an Equivalent Educational Level in Guangzhou University of Chinese Medicine, Guangzhou, 510006, China. .,, 111 Dade Road, Yuexiu District, Guangzhou, 510120, China.
| | - Qinghao Cai
- Department of Fangcun Sleep-Disorder, the Second Clinical College of Guangzhou University of Chinese Medicine (Guangdong Provincial Hopsital of Chinese Medicine), Guangzhou, 510120, China
| | - Runru Mai
- Department of Fangcun Sleep-Disorder, the Second Clinical College of Guangzhou University of Chinese Medicine (Guangdong Provincial Hopsital of Chinese Medicine), Guangzhou, 510120, China
| | - Hailong Liang
- Department of Fangcun Sleep-Disorder, the Second Clinical College of Guangzhou University of Chinese Medicine (Guangdong Provincial Hopsital of Chinese Medicine), Guangzhou, 510120, China
| | - Jiayu Huang
- Department of Fangcun Sleep-Disorder, the Second Clinical College of Guangzhou University of Chinese Medicine (Guangdong Provincial Hopsital of Chinese Medicine), Guangzhou, 510120, China
| | - Zhimin Yang
- Department of Fangcun Sleep-Disorder, the Second Clinical College of Guangzhou University of Chinese Medicine (Guangdong Provincial Hopsital of Chinese Medicine), Guangzhou, 510120, China
| |
Collapse
|
31
|
Cho E, Song J, Lee J, Cho IK, Lee D, Choi H, Kim H, Chung S. Discrepancy between desired time in bed and desired total sleep time in patients with cancer: The DBST index and its relationship with insomnia severity and sleep onset latency. Front Psychiatry 2022; 13:978001. [PMID: 36713894 PMCID: PMC9874099 DOI: 10.3389/fpsyt.2022.978001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/19/2022] [Indexed: 01/13/2023] Open
Abstract
Patients with cancer can often experience insomnia or sleep disturbances. This study aimed to explore whether the discrepancy between a patient's desired time in bed and desired total sleep time (DBST index) can be used as a measurement tool for insomnia severity or sleep onset latency [SOL] in patients with cancer. This retrospective medical records review study gathered clinical information and scores from scales and indices such as the Insomnia Severity Index (ISI), Cancer-related Dysfunctional Beliefs about Sleep (C-DBS) scale, Patient Health Questionnaire-9 items (PHQ-9), State subcategory of State and Trait Anxiety Inventory, and the short form of the Fear of Progression Questionnaire. Sleep indices of time variables (bedtime, sleep onset time, and wake-up time), duration variables [SOL, time in bed (TIB), time in bed over 24 hours (TIB/d), and duration from wake-up time to bedtime (WTB)], and DBST index were calculated. ISI scores were predicted by the PHQ-9 (β = 0.34, P < 0.001), C-DBS scale (β = 0.17, P = 0.034), and DBST indices (β = 0.22, P = 0.004). Long SOL value was predicted by early bedtimes (β = -0.18, P = 0.045), short WTB durations (β = -0.26, P = 0.004), and high DBST index values (β = 0.19, P = 0.013). The DBST index was significantly correlated with both insomnia severity and SOL in patients with cancer.
Collapse
Affiliation(s)
- Eulah Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jaeeun Song
- University of Ulsan College of Medicine, Seoul, South Korea
| | - Joohee Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Inn-Kyu Cho
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dongin Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hayun Choi
- Department of Psychiatry, Veteran Health Service Medical Center, Seoul, South Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
32
|
Kawai K, Iwamoto K, Miyata S, Okada I, Ando M, Fujishiro H, Noda A, Ozaki N. A Study of Factors Causing Sleep State Misperception in Patients with Depression. Nat Sci Sleep 2022; 14:1273-1283. [PMID: 35873712 PMCID: PMC9296877 DOI: 10.2147/nss.s366774] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Sleep state misperception, which is the discrepancy between subjective and objective sleep, is often observed in patients with depression. This phenomenon may delay the remission of depression. Previous studies have focused on the total sleep time (TST) misperception, with many of these studies using actigraphy. Thus, our study investigated depressed patients with the exploratory aim of clarifying factors associated with the sleep state misperception including the wake after sleep onset (WASO) misperception, with their objective sleep additionally evaluated by polysomnography (PSG). PATIENTS AND METHODS We conducted a cross-sectional study. Before undergoing overnight PSG monitoring, 40 patients with depression completed questionnaires that included the Beck Depression Inventory (BDI), Epworth sleepiness scale, Temperament and Character Inventory, and the Pittsburgh sleep quality index. Patients were also asked to estimate their subjective sleep duration after they woke up in the morning. Based on this data, we calculated the misperception using the following formula: subjective sleep duration minus objective sleep duration. We compared each factor between negative and positive misperception groups and the multiple regression analysis was performed for TST and WASO misperception, respectively. RESULTS Although sleep architectures, age, severity of depression and obstructive sleep apnea (OSA) exhibited differences in underestimating or overestimating the WASO, only sex differences were associated with underestimating or overestimating their total sleep time (TST). Moreover, BDI, the severity of OSA, sleep architectures (N1% and N2%), and benzodiazepine (BZD) use were significantly correlated with WASO misperception, whereas only OSA severity was significantly correlated with TST misperception. A subsequent multiple regression analysis demonstrated the BDI was independently correlated with the WASO misperception (β=0.341, p=0.049). CONCLUSION In clinical practice, interventions especially for OSA, and the reduction of depressive symptoms are an important method for improving patient sleep perception. Moreover, current results suggest that BZD prescriptions should be avoided as well.
Collapse
Affiliation(s)
- Keita Kawai
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiko Miyata
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ippei Okada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Motoo Ando
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshige Fujishiro
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akiko Noda
- Department of Biomedical Sciences, Chubu University Graduate School of Life and Health Sciences, Kasugai, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
33
|
Diagnosis of Insomnia Disorder. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
34
|
Lee J, Jung HY, Lee SI, Youn H, Kim SG. Smartphone Addiction Proneness Is Associated With Subjective-Objective Sleep Discrepancy in Patients With Insomnia Disorder. Psychiatry Investig 2021; 18:1035-1043. [PMID: 34732032 PMCID: PMC8600213 DOI: 10.30773/pi.2020.0360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/09/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Subjective reports of patients with insomnia often show a discrepancy with their objective assessments of sleep. We aimed to assess subjective-objective sleep discrepancy in subjects with insomnia disorder as well as the psychological factors associated with the discrepancy. METHODS This study is a secondary analysis of the baseline data of a randomized controlled study on 110 adults aged 18 years to 59 years with insomnia disorder. Subjective reports on sleep and the objective measures acquired by an overnight polysomnography were used to measure the sleep discrepancy. Smartphone Addiction Proneness Scale (SAPS), Center for Epidemiologic Studies Depression Scale (CES-D), beck anxiety inventory (BAI), and Global Assessment of Recent Stress (GARS) were used to evaluate the psychological factors associated with the sleep discrepancy. RESULTS Mean total sleep time (TST) discrepancy of the participants was -81.65±97.41 minutes. Multivariable logistic regression analyses revealed that age (adjusted OR=1.07, 95% CI=1.01-1.13, p=0.027), years of education (adjusted OR=0.69, 95% CI=0.48-0.91, p=0.017), and smartphone addiction proneness (adjusted OR=1.14, 95% CI=1.04-1.27, p=0.008) were independent predictors of TST misperception. Mean sleep onset latency (SOL) discrepancy of the participants was 41.28±45.01 minutes. Only anxiety was an independent predictor of SOL misperception (adjusted OR=1.16, 95% CI=1.05-1.31, p=0.006). CONCLUSION The present study provides empirical evidence to increase our understanding of the various factors that are associated with subjective-objective sleep discrepancy. Screening insomnia patients with smartphone addiction proneness may help predict the potential discrepancy between the patients' subjective reports and objective measures of sleep duration.
Collapse
Affiliation(s)
- Jeewon Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Han-Yong Jung
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - HyunChul Youn
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Shin-Gyeom Kim
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| |
Collapse
|
35
|
Ma Y, Goldstein MR, Davis RB, Yeh GY. Profile of subjective-objective sleep discrepancy in patients with insomnia and sleep apnea. J Clin Sleep Med 2021; 17:2155-2163. [PMID: 34666882 PMCID: PMC8636379 DOI: 10.5664/jcsm.9348] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/20/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although subjective-objective sleep discrepancy has long been observed in patients with insomnia, the profiles of this discrepancy are poorly understood. Further, sleep discrepancy in insomnia with sleep comorbidities remains underexplored. We sought to better characterize sleep discrepancy among patient groups with and without insomnia and comorbid conditions such as obstructive sleep apnea (OSA). METHODS Using data from the Sleep Heart Health Study, we conducted a secondary analysis describing (1) the profile of self-reported and objective sleep measures in patients with insomnia (IS group; n = 73) and comorbid OSA (IS + OSA group; n = 143), compared with individuals with OSA only (OSA group; n = 296) and normal sleep control patients (NSC group; n = 126); (2) the comparative magnitude of sleep misperception between these 4 groups; and (3) the self-reported quality of life (QOL) in the 4 groups. RESULTS Subjective-objective sleep discrepancy existed in all 4 groups, including the NSC group. Controlling for age, sex, mental health conditions, sleep apnea severity, and objectively measured sleep time, the presence of self-reported insomnia had the strongest association with sleep discrepancy. In patients with insomnia, sleep onset latency was overestimated (7.8 ± 36.8 min in the IS group; P < .001 when compared to the NSC and OSA groups), with the largest differences seen in the comorbid IS + OSA group (15.0 ± 56.8 min). Insomnia conferred the most negative impact on QOL, with the combined IS + OSA group reporting the lowest QOL. CONCLUSIONS Self-reported insomnia is associated with sleep discrepancy and negative QOL. Those with comorbid OSA reported the greatest sleep discrepancy and the lowest QOL. Future research is warranted to further understand individual profiles of misperception and insomnia phenotypes. CITATION Ma Y, Goldstein MR, Davis RB, Yeh GY. Profile of subjective-objective sleep discrepancy in patients with insomnia and sleep apnea. J Clin Sleep Med. 2021;17(11):2155-2163.
Collapse
Affiliation(s)
- Yan Ma
- Division of Interdisciplinary Medicine and Biotechnology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Michael R. Goldstein
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Roger B. Davis
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Gloria Y. Yeh
- Osher Center for Integrative Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
36
|
Stephan AM, Lecci S, Cataldi J, Siclari F. Conscious experiences and high-density EEG patterns predicting subjective sleep depth. Curr Biol 2021; 31:5487-5500.e3. [PMID: 34710350 DOI: 10.1016/j.cub.2021.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/06/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
What accounts for feeling deeply asleep? Standard sleep recordings only incompletely reflect subjective aspects of sleep and some individuals with so-called sleep misperception frequently feel awake although sleep recordings indicate clear-cut sleep. To identify the determinants of sleep perception, we performed 787 awakenings in 20 good sleepers and 10 individuals with sleep misperception and interviewed them about their subjective sleep depth while they underwent high-density EEG sleep recordings. Surprisingly, in good sleepers, sleep was subjectively lightest in the first 2 h of non-rapid eye movement (NREM) sleep, generally considered the deepest sleep, and deepest in rapid eye movement (REM) sleep. Compared to good sleepers, sleep misperceptors felt more frequently awake during sleep and reported lighter REM sleep. At the EEG level, spatially widespread high-frequency power was inversely related to subjective sleep depth in NREM sleep in both groups and in REM sleep in misperceptors. Subjective sleep depth positively correlated with dream-like qualities of reports of mental activity. These findings challenge the widely held notion that slow wave sleep best accounts for feeling deeply asleep. Instead, they indicate that subjective sleep depth is inversely related to a neurophysiological process that predominates in early NREM sleep, becomes quiescent in REM sleep, and is reflected in high-frequency EEG activity. In sleep misperceptors, this process is more frequently active, more spatially widespread, and abnormally persists into REM sleep. These findings help identify the neuromodulatory systems involved in subjective sleep depth and are relevant for studies aiming to improve subjective sleep quality.
Collapse
Affiliation(s)
- Aurélie M Stephan
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1010 Lausanne, Switzerland
| | - Sandro Lecci
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1010 Lausanne, Switzerland
| | - Jacinthe Cataldi
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1010 Lausanne, Switzerland
| | - Francesca Siclari
- Center for Investigation and Research on Sleep, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1010 Lausanne, Switzerland; Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1010 Lausanne, Switzerland.
| |
Collapse
|
37
|
Bastien CH, Cote KA. Insomnia: A magnifying glass to measure hyperarousal in REM. Sleep 2021; 44:6331313. [PMID: 34329476 DOI: 10.1093/sleep/zsab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Célyne H Bastien
- École de psychologie, Université Laval, Québec, QC, Canada
- Centre de Recherche CERVO, Québec, QC, Canada
| | - Kimberly A Cote
- Psychology Department, Brock University, St. Catharines, ON, Canada
| |
Collapse
|
38
|
Benbir Şenel G, Aydın Ö, Tanrıöver Aydın E, Bayar MR, Karadeniz D. Changes in sleep structure and sleep spindles are associated with the neuropsychiatric profile in paradoxical insomnia. Int J Psychophysiol 2021; 168:27-32. [PMID: 34331959 DOI: 10.1016/j.ijpsycho.2021.07.626] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/01/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
AIM Sleep spindles have an important role in the pathophysiology and perception of sleep. We aimed to investigate the link between sleep spindles and microstructural architecture of sleep in regard to psychiatric characteristics in paradoxical insomnia. METHOD A total of 40 participants (20 with paradoxical insomnia, 20 healthy controls) were included in the study. All participants were evaluated by somnologists and undergone a full-night polysomnography at sleep laboratory. In addition, psychiatric interview was made by the same psychiatrist, and questionnaires were performed to assess the dimensions of the personality such as the neuroticism or extroversion (Eysenck Personality Questionnaire, EPQR-A); to evaluate the tendency to exaggerate somatic perceptions (Somatosensory Amplification Scale, SSAS), somatic parts of dissociation (Somatoform Dissociation Questionnaire, SDQ-20), and somatization (Somatization Scale, SS); to measure participants' feelings about their health and disease anxiety (Health Anxiety Inventory, HAI-18), and the level of uncontrollable and persistent anxiety (Penn State Worry Questionnaire, PSWQ); to investigate the tendency to ruminative thinking (Ruminative Thought Style Questionnaire, RTSQ), alexithymia (Toronto Alexithymia Scale, TAS-20); and to define the presence and the severity of depressive symptoms (Beck Depression Inventory, BDI). RESULTS The duration and frequency of the sleep spindles were similar between two groups, while the density was significantly decreased in paradoxical insomnia. The duration of sleep spindles, on the other hand, showed positive correlations with the extroversion dimension scores of EPQR-A and PSWQ scores. DISCUSSION Sleep protective mechanisms are disturbed in paradoxical insomnia as shown by the lower density of sleep spindles. In addition, fast spindle activity is associated with the personality traits, characterized by an increase in the expression of feelings and the level of anxiety.
Collapse
Affiliation(s)
- Gülçin Benbir Şenel
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology, Sleep and Disorders Unit, Istanbul 34098, Turkey
| | - Ömer Aydın
- Bakirkoy Prof Mazhar Osman Training and Research Hospital for Psychiatry, Neurology, and Neurosurgery, Department of Psychiatry, Istanbul 34147, Turkey.
| | - Ezgi Tanrıöver Aydın
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Psychiatry, Istanbul 34098, Turkey
| | - Mahmut Reha Bayar
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Psychiatry, Istanbul 34098, Turkey
| | - Derya Karadeniz
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology, Sleep and Disorders Unit, Istanbul 34098, Turkey
| |
Collapse
|
39
|
Castelnovo A, Ferri R, Galbiati A, Rossi A, Zucconi M, Castronovo V, Strambi LF, Manconi M. Extreme sleep state misperception: From psychopathology to objective-subjective sleep measures. Int J Psychophysiol 2021; 167:77-85. [PMID: 34216692 DOI: 10.1016/j.ijpsycho.2021.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVES We tested the hypothesis that patients with extreme sleep state misperception display higher levels of psychopathology and reduced quantitative estimation abilities compared to other patients with insomnia. Secondary aims included the evaluation of group differences in subjective self-reported quality of life and sleep quality and objective sleep parameters. METHODS In this cross-sectional, observational study, 249 patients with insomnia underwent a video-polysomnography with a subsequent morning interview to assess self-reported sleep estimates and filled in a large battery of questionnaires. Patients were classified into High Misperception (HM) and Moderate Misperception (MM) groups, according to the complement of the ratio between self-reported total sleep time and objective total sleep time (Misperception Index). RESULTS No significant differences emerged in any of the psychopathological measures considered between the HM and the MM group. Similarly, no effect was observed in quantitative estimation abilities. HM patients displayed a significantly increased number of awakenings per hour of sleep and a reduced dream recall rate. Their overall sleep quality and quality of life was significantly impaired. CONCLUSIONS Future research on sleep misperception should focus on factors other than the level of psychopathology and estimation abilities, in particular sleep microstructure and quantitative EEG studies in both REM and NREM sleep.
Collapse
Affiliation(s)
- Anna Castelnovo
- Sleep Medicine, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | | | - Andrea Galbiati
- Division of Neuroscience, Sleep Disorders Center-Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Marco Zucconi
- Division of Neuroscience, Sleep Disorders Center-Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenza Castronovo
- Division of Neuroscience, Sleep Disorders Center-Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi-Ferini Strambi
- Division of Neuroscience, Sleep Disorders Center-Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Mauro Manconi
- Sleep Medicine, Neurocenter of Southern Switzerland, Regional Hospital of Lugano, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| |
Collapse
|
40
|
Emamian F, Mahdipour M, Noori K, Rostampour M, Mousavi SB, Khazaie H, Khodaie-Ardakani M, Tahmasian M, Zarei M. Alterations of Subcortical Brain Structures in Paradoxical and Psychophysiological Insomnia Disorder. Front Psychiatry 2021; 12:661286. [PMID: 34025484 PMCID: PMC8139557 DOI: 10.3389/fpsyt.2021.661286] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/07/2021] [Indexed: 12/29/2022] Open
Abstract
Insomnia disorder (ID) is a common illness associated with mood and cognitive impairments. Subtyping ID is an ongoing debate in sleep medicine, but the underlying mechanisms of each subtype is poorly understood. Growing evidence suggests that subcortical brain structures play the key roles in pathophysiology of ID and its subtypes. Here, we aimed to investigate structural alteration of subcortical regions in patients with two common ID subtypes i.e., paradoxical and psychophysiological insomnia. Fifty-five patients and 49 healthy controls were recruited for this study and T1-weighted images and subjective and objective sleep parameters (i.e., Pittsburgh Sleep Quality Index and polysomnography) were collected from participants. Subcortical structures including the hippocampus, amygdala, caudate, putamen, globus pallidus, nucleus accumbens, and thalamus were automatically segmented in FSL. Volume and shape (using surface vertices) of each structure were compared between the groups, controlled for covariates, and corrected for multiple comparisons. In addition, correlations of sleep parameters and surface vertices or volumes were calculated. The caudate's volume was smaller in patients than controls. Compared with controls, we found regional shrinkage in the caudate, nucleus accumbens, posterior putamen, hippocampus, thalamus, and amygdala in paradoxical insomnia and shrinkage in the amygdala, caudate, hippocampus, and putamen in psychophysiological insomnia. Interestingly, comparing two patients groups, shape alteration in the caudate, putamen, and nucleus accumbens in paradoxical insomnia and shrinkage in the thalamus, amygdala, and hippocampus in psychophysiological insomnia were observed. Both subjective and objective sleep parameters were associated with these regional shape alterations in patients. Our results support the differential role of subcortical brain structures in pathophysiology of paradoxical and psychophysiological insomnia.
Collapse
Affiliation(s)
- Farnoosh Emamian
- Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mostafa Mahdipour
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Khadijeh Noori
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoumeh Rostampour
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - S Bentolhoda Mousavi
- Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Masoud Tahmasian
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Mojtaba Zarei
- Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| |
Collapse
|
41
|
Perogamvros L, Castelnovo A, Samson D, Dang-Vu TT. Failure of fear extinction in insomnia: An evolutionary perspective. Sleep Med Rev 2020; 51:101277. [DOI: 10.1016/j.smrv.2020.101277] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/07/2020] [Accepted: 01/13/2020] [Indexed: 12/22/2022]
|
42
|
van der Zweerde T, Lancee J, Ida Luik A, van Straten A. Internet-Delivered Cognitive Behavioral Therapy for Insomnia. Sleep Med Clin 2020; 15:117-131. [DOI: 10.1016/j.jsmc.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
43
|
Janků K, Šmotek M, Fárková E, Kopřivová J. Subjective–objective sleep discrepancy in patients with insomnia during and after cognitive behavioural therapy: An actigraphy study. J Sleep Res 2020; 29:e13064. [DOI: 10.1111/jsr.13064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/06/2020] [Accepted: 04/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Karolina Janků
- National Institute of Mental Health Klecany Czech Republic
- Third Faculty of Medicine Charles University Prague Czech Republic
| | - Michal Šmotek
- National Institute of Mental Health Klecany Czech Republic
- Third Faculty of Medicine Charles University Prague Czech Republic
| | - Eva Fárková
- National Institute of Mental Health Klecany Czech Republic
- Third Faculty of Medicine Charles University Prague Czech Republic
| | - Jana Kopřivová
- National Institute of Mental Health Klecany Czech Republic
- Third Faculty of Medicine Charles University Prague Czech Republic
| |
Collapse
|
44
|
Lecci S, Cataldi J, Betta M, Bernardi G, Heinzer R, Siclari F. Electroencephalographic changes associated with subjective under- and overestimation of sleep duration. Sleep 2020; 43:5837410. [DOI: 10.1093/sleep/zsaa094] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/18/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Feeling awake although sleep recordings indicate clear-cut sleep sometimes occurs in good sleepers and to an extreme degree in patients with so-called paradoxical insomnia. It is unknown what underlies sleep misperception, as standard polysomnographic (PSG) parameters are often normal in these cases. Here we asked whether regional changes in brain activity could account for the mismatch between objective and subjective total sleep times (TST). To set cutoffs and define the norm, we first evaluated sleep perception in a population-based sample, consisting of 2,092 individuals who underwent a full PSG at home and estimated TST the next day. We then compared participants with a low mismatch (normoestimators, n = 1,147, ±0.5 SD of mean) with those who severely underestimated (n = 52, <2.5th percentile) or overestimated TST (n = 53, >97.5th percentile). Compared with normoestimators, underestimators displayed higher electroencephalographic (EEG) activation (beta/delta power ratio) in both rapid eye movement (REM) and non-rapid eye movement (NREM) sleep, while overestimators showed lower EEG activation (significant in REM sleep). To spatially map these changes, we performed a second experiment, in which 24 healthy subjects and 10 insomnia patients underwent high-density sleep EEG recordings. Similarly to underestimators, patients displayed increased EEG activation during NREM sleep, which we localized to central-posterior brain areas. Our results indicate that a relative shift from low- to high-frequency spectral power in central-posterior brain regions, not readily apparent in conventional PSG parameters, is associated with underestimation of sleep duration. This challenges the concept of sleep misperception, and suggests that instead of misperceiving sleep, insomnia patients may correctly perceive subtle shifts toward wake-like brain activity.
Collapse
Affiliation(s)
- Sandro Lecci
- Center for Investigation and Research in Sleep, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jacinthe Cataldi
- Center for Investigation and Research in Sleep, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Monica Betta
- MoMiLab Research Unit, IMT School for Advanced Studies, Lucca, Italy
| | - Giulio Bernardi
- MoMiLab Research Unit, IMT School for Advanced Studies, Lucca, Italy
| | - Raphaël Heinzer
- Center for Investigation and Research in Sleep, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Francesca Siclari
- Center for Investigation and Research in Sleep, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| |
Collapse
|
45
|
Sleep onset (mis)perception in relation to sleep fragmentation, time estimation and pre-sleep arousal. Sleep Med X 2020; 2:100014. [PMID: 33870171 PMCID: PMC8041114 DOI: 10.1016/j.sleepx.2020.100014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 11/21/2022] Open
Abstract
Study objective To elucidate the contribution of time estimation and pre sleep arousal to the component of sleep onset misperception not explained by sleep fragmentation. Methods At-home ambulatory polysomnograms (PSGs) of 31 people with insomnia were recorded. Participants performed a time estimation task and completed the Pre Sleep Arousal Scale (PSAS). Based on previous modelling of the relationship between objectively measured sleep fragmentation and sleep onset misperception, the subjective sleep onset was estimated for each participant as the start of the first uninterrupted sleep bout longer than 30 min. Subsequently, the component of misperception not explained by sleep fragmentation was calculated as the residual error between estimated sleep onset and perceived sleep onset. This residual error was correlated with individual time estimation task results and PSAS scores. Results A negative correlation between time estimation task results and the residual error of the sleep onset model was found, indicating that participants who overestimated a time interval during the day also overestimated their sleep onset latency (SOL). No correlation was found between PSAS scores and residual error. Conclusions Interindividual variations of sleep architecture possibly obscure the correlation of sleep onset misperception with time estimation and pre sleep arousal, especially in small groups. Therefore, we used a previously proposed model to account for the influence of sleep fragmentation. Results indicate that time estimation is associated with sleep onset misperception. Since sleep onset misperception appears to be a general characteristic of insomnia, understanding the underlying mechanisms is probably important for understanding and treating insomnia. Sleep onset misperception is probably a multifactorial process. We identify the part of misperception not explained by fragmentation. This metric was correlated with the time estimation and pre sleep arousal. Results indicate that time estimation is involved in sleep onset misperception.
Collapse
|
46
|
Abstract
The relationship between objective and subjective sleep quality is still debated. Here, we investigate differences in objective sleep parameters in habitual subjective good sleepers and bad sleepers with the aim of evaluating sleep continuity, stability and organization as possible determinants of subjective sleep quality. In total, 38 subjects (good sleepers, N = 18; bad sleepers, N = 20) underwent two nights of sleep recording. Traditional sleep parameters displayed no between-groups differences. Conversely, bad sleepers showed lower sleep continuity (awakenings frequency), stability (e.g. arousals and state transitions frequency) and organization (e.g. number of sleep cycles and time spent in cycles). Our findings point to the involvement of these measures in determining habitual sleep quality perception and suggest the possibility to include them in standard sleep assessments.
Collapse
|
47
|
van der Zweerde T, Lancee J, Ida Luik A, van Straten A. Internet-Delivered Cognitive Behavioral Therapy for Insomnia: Tailoring Cognitive Behavioral Therapy for Insomnia for Patients with Chronic Insomnia. Sleep Med Clin 2019; 14:301-315. [PMID: 31375200 DOI: 10.1016/j.jsmc.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic insomnia is preferably treated with cognitive behavioral therapy for insomnia (CBTI), but many insomnia sufferers receive medication instead, likely because of high costs, lack of knowledge about optimal insomnia treatment among physicians, and lack of CBTI-trained professionals in mental health care. A possible solution is to offer CBTI through the Internet: I-CBTI. I-CBTI is generally acceptable to patients and greatly improves insomnia symptoms. We review the state of knowledge around I-CBTI and its effects. CBTI's effectiveness is influenced by treatment characteristics and patient-specific factors. We review potential factors that help identify which patients may benefit from I-CBTI.
Collapse
Affiliation(s)
- Tanja van der Zweerde
- Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands.
| | - Jaap Lancee
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129, Amsterdam 1018 WS, the Netherlands; PsyQ Amsterdam, Amsterdam, the Netherlands
| | - Annemarie Ida Luik
- Department of Epidemiology, Erasmus MC University Medical Center, Dr. Molewaterplein 40, Rotterdam 3015 GD, the Netherlands
| | - Annemieke van Straten
- Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University, Van der Boechorststraat 7, Amsterdam 1081 BT, the Netherlands
| |
Collapse
|
48
|
Ferini-Strambi L, Fossati A, Sforza M, Galbiati A. Subtyping insomnia disorder. Lancet Psychiatry 2019; 6:284. [PMID: 30904120 DOI: 10.1016/s2215-0366(19)30098-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Luigi Ferini-Strambi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology, Sleep Disorders Center, Milan, Italy; Vita-Salute San Raffaele University, Faculty of Psychology, Milan, Italy.
| | - Andrea Fossati
- Vita-Salute San Raffaele University, Faculty of Psychology, Milan, Italy
| | - Marco Sforza
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology, Sleep Disorders Center, Milan, Italy; Vita-Salute San Raffaele University, Faculty of Psychology, Milan, Italy
| | - Andrea Galbiati
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Neurology, Sleep Disorders Center, Milan, Italy; Vita-Salute San Raffaele University, Faculty of Psychology, Milan, Italy
| |
Collapse
|