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Esen O, Walshe I, Goodall S. Energy intake, hydration status, and sleep of world-class male archers during competition. J Int Soc Sports Nutr 2024; 21:2345358. [PMID: 38708971 DOI: 10.1080/15502783.2024.2345358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/12/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Nutritional intake and sleep, play an important role for recovery and performance in elite sport but little work has been undertaken in archery. The present study aimed to assess energy intake (EI), hydration status, and sleep parameters in world-class male archers over the course of a four-day competition. METHODS Results, Conclusions Six male, elite-standard archers participated in the study and measurements of hydration status, EI, competition load, and sleep were recorded throughout each day of competition. RESULTS Daily energy, carbohydrate, and protein intake ranged between 2,563 and 3,986 kcal, 4 and 7.1 g/kg BM, 2.2 and 3.6 g/kg BM per day, respectively. Thus, archers practiced elements of periodized nutrition such that energy and carbohydrate intake was greater on the high-volume competition days (i.e. days 1 and 3; more numbers of arrows, longer duration, and walking distance) in comparison to low-volume days (days 2 and 4) over the tournament (all p > 0.01). Additionally, urine specific gravity was higher after waking, compared to pre- and post-competition, and before bed (all p < 0.05). This indicates that archers were euhydrated pre- and post-competition and before bedtime, while they were slightly hypohydrated after waking up. Sleep data show that disturbances were kept to a minimum. CONCLUSIONS Collectively, archers appear capable of periodizing their nutritional intake according to daily physical loading during a tournament whilst, staying euhydrated and maintaining sleep quality. In part, such data can help to explain why these archers experience a sustained level of success.
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Affiliation(s)
- Ozcan Esen
- Northumbria University, Department of Sport, Exercise & Rehabilitation, Faculty of Health and Life Sciences, Newcastle upon Tyne, UK
| | - Ian Walshe
- Northumbria University, Department of Sport, Exercise & Rehabilitation, Faculty of Health and Life Sciences, Newcastle upon Tyne, UK
| | - Stuart Goodall
- Northumbria University, Department of Sport, Exercise & Rehabilitation, Faculty of Health and Life Sciences, Newcastle upon Tyne, UK
- North-West University Potchefstroom, Physical Activity, Sport and Recreation Research Focus Area, Faculty of Health Sciences, South Africa
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Hu L, Chen X, Li S, Lei X, Yang Y, Wei J. Attachment and sleep quality in adults: A multilevel meta-analysis of actor and partner effect. Sleep Med 2024; 118:43-58. [PMID: 38608415 DOI: 10.1016/j.sleep.2024.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/14/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024]
Abstract
Within the context of sleep, attachment is hypothesized to play a central role in regulating bedtime affect and arousal. While previous studies have suggested a link between attachment and sleep quality, a meta-analysis specifically examining this association in adults has been lacking. To address this gap, we conducted a series of multilevel meta-analyses of 28 studies on this topic. Our results indicated a correlation between attachment anxiety and an individual's own sleep quality (r = -0.16, p < 0.001), as well as their partner's sleep quality (r = -0.10, p < 0.05). There was also a negative correlation between attachment avoidance and an individual's sleep quality (r = -0.15, p < 0.001) as well as their partner's sleep quality (r = -0.16, p < 0.01). Additionally, the relationships were moderated by several variables, including age, sleep measurement, and gender. Further analysis indicated that attachment anxiety was associated with poorer subjective sleep quality (PSQI) (r = -0.23, p < 0.001), longer sleep latency (r = -0.10, p < 0.05), increased wakefulness after sleep onset (r = -0.09, p < 0.05), and greater daytime sleepiness (r = -0.20, p < 0.01). Attachment avoidance was associated with poorer self-reported sleep quality (PSQI) (r = -0.16, p < 0.001), longer time to fall asleep (r = -0.15, p < 0.05), and increased daytime sleepiness (r = -0.15, p < 0.05). In summary, the findings of the current study supported the association between attachment insecurity and poorer sleep quality in both individuals and their partners. These findings hold important implications for future interventions aimed at improving sleep quality by addressing attachment-related concerns.
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Affiliation(s)
- Liang Hu
- Faculty of Psychology, Southwest University, Tiansheng Road, Beibei, Chongqing, China
| | - Xu Chen
- Faculty of Psychology, Southwest University, Tiansheng Road, Beibei, Chongqing, China.
| | - Song Li
- Faculty of Psychology, Southwest University, Tiansheng Road, Beibei, Chongqing, China
| | - Xu Lei
- Faculty of Psychology, Southwest University, Tiansheng Road, Beibei, Chongqing, China
| | - Yan Yang
- Faculty of Psychology, Southwest University, Tiansheng Road, Beibei, Chongqing, China
| | - Jiahao Wei
- Chongqing University of Posts and Telecommunications, China
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Zeller CJ, Wunderlin M, Wicki K, Teunissen CE, Nissen C, Züst MA, Klöppel S. Multi-night acoustic stimulation is associated with better sleep, amyloid dynamics, and memory in older adults with cognitive impairment. GeroScience 2024:10.1007/s11357-024-01195-z. [PMID: 38744792 DOI: 10.1007/s11357-024-01195-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024] Open
Abstract
Sleep is a potential early, modifiable risk factor for cognitive decline and dementia. Impaired slow wave sleep (SWS) is pronounced in individuals with cognitive impairment (CI). Cognitive decline and impairments of SWS are bi-directionally linked in a vicious cycle. SWS can be enhanced non-invasively using phase-locked acoustic stimulation (PLAS), potentially breaking this vicious cycle. Eighteen healthy older adults (HC, agemean±sd, 68.3 ± 5.1) and 16 older adults (agemean±sd, 71.9 ± 3.9) with CI (Montreal Cognitive Assessment ≤ 25) underwent one baseline (sham-PLAS) night and three consecutive stimulation nights (real-PLAS). EEG responses and blood-plasma amyloid beta Aβ42/Aβ40 ratio were measured pre- and post-intervention, as was episodic memory. The latter was again evaluated 1 week and 3 months after the intervention. In both groups, PLAS induced a significant electrophysiological response in both voltage- and time-frequency analyses, and memory performance improved in association with the magnitude of this response. In the CI group, both electrophysiological and associated memory effects were delayed compared to the healthy group. After 3 intervention nights, electrophysiological response to PLAS was no longer different between CI and HC groups. Only in the CI sample, stronger electrophysiological responses were significantly associated with improving post-intervention Aβ42/Aβ40 ratios. PLAS seems to improve SWS electrophysiology, memory, and amyloid dynamics in older adults with CI. However, effects on memory require more time to unfold compared to healthy older adults. This indicates that PLAS may become a potential tool to ameliorate cognitive decline, but longer interventions are necessary to compensate for declining brain integrity. This study was pre-registered (clinicaltrials.gov: NCT04277104).
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Affiliation(s)
- Céline J Zeller
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Marina Wunderlin
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland
| | - Korian Wicki
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland
- Graduate School for Health Sciences, University of Bern, 3012, Bern, Switzerland
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, Netherlands
| | - Christoph Nissen
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), 1201, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, 1201, Geneva, Switzerland
| | - Marc A Züst
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland.
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, 3000, Bern 60, Switzerland
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Ouellet J, Assaf R, Afzali MH, Nourbakhsh S, Potvin S, Conrod P. Neurocognitive consequences of adolescent sleep disruptions and their relationship to psychosis vulnerability: a longitudinal cohort study. Npj Ment Health Res 2024; 3:18. [PMID: 38714732 PMCID: PMC11076494 DOI: 10.1038/s44184-024-00058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/15/2024] [Indexed: 05/10/2024]
Abstract
Adolescence is a key period for neurocognitive maturation where deviation from normal developmental trajectories may be tied to adverse mental health outcomes. Cognitive disruptions have been noted in populations at risk for psychosis and are known to accompany periods of sleep deprivation. This study aims to assess the role of cognition as a mediator between sleep disruptions and psychosis risk. A cohort of 3801 high school students (51% female, mean age = 12.8, SD = 0.45 years) was recruited from 31 Montreal high schools. Measures of sleep, psychotic-like experiences, inhibition, working memory, perceptual reasoning, and delayed recall were collected from participants on a yearly basis over the five years of their high school education. A multi-level model mediation analysis was performed controlling for sex and time squared. Response inhibition was shown to be associated with, and to mediate (B = -0.005, SD = 0.003, p = 0.005*) the relationship between sleep disruptions (B = -0.011, SD = 0.004, p < 0.001*) and psychotic-like experiences (B = 0.411, SD = 0.170, p = 0.005*). Spatial working memory deficits on a given year were associated with a higher frequency of psychotic-like experiences that same year (B = -0.046, SD = 0.018, p = 0.005*) and the following year (B = -0.051, SD = 0.023, p = 0.010*), but were not associated with sleep disturbances. No significant associations were found between our variables of interest and either delayed recall or perceptual reasoning at the within person level. Findings from this large longitudinal study provide evidence that the association between sleep disruptions and psychosis risk is specifically mediated by inhibitory rather than general cognitive impairments. The association of spatial working memory, response inhibition, and sleep disruptions with psychotic-like experiences suggests that these factors may represent potential targets for preventative interventions.
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Affiliation(s)
- Julien Ouellet
- CHU Sainte-Justine Research Center, Montreal, QC, Canada.
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada.
| | - Roxane Assaf
- CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | | | - Sima Nourbakhsh
- CHU Sainte-Justine Research Center, Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Stéphane Potvin
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
- Institut Universitaire en Santé Mentale de Montréal Research Center, Montreal, QC, Canada
| | - Patricia Conrod
- CHU Sainte-Justine Research Center, Montreal, QC, Canada.
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada.
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada.
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Rollinson R, Cole A, Gee B, Tofan I, Graham A, Hatton J, Lyons J, Reeve S, Wilson J, Beardsworth K, Clarke T. Delivering a sleep intervention across a youth mental health service using non-expert practitioners: A service evaluation. Early Interv Psychiatry 2024. [PMID: 38703076 DOI: 10.1111/eip.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 05/06/2024]
Abstract
AIMS Poor sleep is highly prevalent in young people and increases risk of mental health difficulties, yet access to sleep interventions remains limited. This paper evaluates the use of a sleep intervention delivered by non-expert practitioners in a secondary care youth mental health service. METHOD Assistant psychologists were trained to deliver a six-session 1:1 cognitive-behavioural sleep intervention adapted for use with young people with mental health difficulties. A within-subject design assessed clinical outcomes relating to sleep (Insomnia Severity Index), psychological distress and personal goals (Goal Based Outcome Measures) at four time points. RESULTS High referral, intervention take-up (82.82%) and completion (70%) rates were reported, together with high baseline levels of insomnia (Insomnia Severity Index mean 20.47, SD 3.68) and poor sleep efficiency (56.36%, SD 17.23). Fifty-six young people (average age 19.2 years, SD 3.25) were included in the outcome analysis. Statistically and clinically significant improvements were seen across all outcome measures, with 68% no longer meeting clinical threshold (ISI ≥15) for insomnia at endpoint. CONCLUSIONS This study demonstrates exceptionally high levels of clinical need and engagement with a sleep intervention adapted specifically for young people with mental health difficulties. Whilst limited by the uncontrolled design, large improvements in insomnia and psychological distress support its effectiveness and utility in clinical settings. More robust implementation and evaluation is warranted in broader youth mental health services to promote earlier access.
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Affiliation(s)
- Rebecca Rollinson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Amber Cole
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Ioana Tofan
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Adam Graham
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Jude Hatton
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Jonathan Lyons
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Sarah Reeve
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
- Cambridgeshire and Peterborough NHS FoundationTrust, Cambridge, Cambridgeshire, UK
| | - Jonathan Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | | | - Tim Clarke
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
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Messman BA, Wiley JF, Feldman E, Dietch JR, Taylor DJ, Slavish DC. Irregular sleep is linked to poorer mental health: A pooled analysis of eight studies. Sleep Health 2024:S2352-7218(24)00060-3. [PMID: 38704353 DOI: 10.1016/j.sleh.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES Greater sleep disturbances on average are a risk factor for impaired mental health. Recent research has shown that more intraindividual variability (i.e., inconsistency) in sleep (hereafter called "sleep intraindividual variability") may also be uniquely related to mental health, even above the influence of mean sleep patterns averaged across days. The current study examined associations between sleep intraindividual variability and symptoms of anxiety, depression, and insomnia across different facets of sleep intraindividual variability (sleep duration, efficiency, and timing) and sleep measurement types (sleep diary and actigraphy). METHODS We pooled eight datasets (N = 3053 participants) that assessed repeated measures of sleep diary- and/or actigraphy-determined sleep across multiple days, as well as one-time measures of mental health or sleep disorder symptoms (i.e., anxiety, depression, and insomnia). Multilevel regression analyses were conducted to examine associations between sleep intraindividual variability and mental health or sleep disorder symptoms. RESULTS Greater diary- and actigraphy-determined sleep duration intraindividual variability was associated with more depression symptoms (diary: b=0.02, p < .001; actigraphy: b=0.03, p = .006) and more insomnia symptoms (diary: b=0.02, p < .001; actigraphy: b=0.02, p < .001). Greater diary-determined sleep efficiency intraindividual variability was associated with fewer anxiety symptoms (b=-0.23, p = .019) and fewer insomnia symptoms (b=-0.15, p < .001). Greater diary- and actigraphy-determined sleep midpoint intraindividual variability was associated with more insomnia symptoms (diary: b=0.41, p = .044; actigraphy: b=0.66, p = .021). CONCLUSIONS More inconsistent sleep duration and sleep timing may be a correlate of poorer mental health. Future experimental work should examine whether stabilizing sleep patterns can improve mental health outcomes.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, Texas, USA.
| | - Joshua F Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Emily Feldman
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, Oregon, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, Texas, USA
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Kinoshita S, Hanashiro S, Tsutsumi S, Shiga K, Kitazawa M, Wada Y, Inaishi J, Kashiwagi K, Fukami T, Mashimo Y, Minato K, Kishimoto T. Assessment of Stress and Well-Being of Japanese Employees Using Wearable Devices for Sleep Monitoring Combined With Ecological Momentary Assessment: Pilot Observational Study. JMIR Form Res 2024; 8:e49396. [PMID: 38696237 DOI: 10.2196/49396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 10/01/2023] [Accepted: 03/21/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Poor sleep quality can elevate stress levels and diminish overall well-being. Japanese individuals often experience sleep deprivation, and workers have high levels of stress. Nevertheless, research examining the connection between objective sleep assessments and stress levels, as well as overall well-being, among Japanese workers is lacking. OBJECTIVE This study aims to investigate the correlation between physiological data, including sleep duration and heart rate variability (HRV), objectively measured through wearable devices, and 3 states (sleepiness, mood, and energy) assessed through ecological momentary assessment (EMA) and use of rating scales for stress and well-being. METHODS A total of 40 office workers (female, 20/40, 50%; mean age 40.4 years, SD 11.8 years) participated in the study. Participants were asked to wear a wearable wristband device for 8 consecutive weeks. EMA regarding sleepiness, mood, and energy levels was conducted via email messages sent by participants 4 times daily, with each session spaced 3 hours apart. This assessment occurred on 8 designated days within the 8-week timeframe. Participants' stress levels and perception of well-being were assessed using respective self-rating questionnaires. Subsequently, participants were categorized into quartiles based on their stress and well-being scores, and the sleep patterns and HRV indices recorded by the Fitbit Inspire 2 were compared among these groups. The Mann-Whitney U test was used to assess differences between the quartiles, with adjustments made for multiple comparisons using the Bonferroni correction. Furthermore, EMA results and the sleep and HRV indices were subjected to multilevel analysis for a comprehensive evaluation. RESULTS The EMA achieved a total response rate of 87.3%, while the Fitbit Inspire 2 wear rate reached 88.0%. When participants were grouped based on quartiles of well-being and stress-related scores, significant differences emerged. Specifically, individuals in the lowest stress quartile or highest subjective satisfaction quartile retired to bed earlier (P<.001 and P=.01, respectively), whereas those in the highest stress quartile exhibited greater variation in the midpoint of sleep (P<.001). A multilevel analysis unveiled notable relationships: intraindividual variability analysis indicated that higher energy levels were associated with lower deviation of heart rate during sleep on the preceding day (β=-.12, P<.001), and decreased sleepiness was observed on days following longer sleep durations (β=-.10, P<.001). Furthermore, interindividual variability analysis revealed that individuals with earlier midpoints of sleep tended to exhibit higher energy levels (β=-.26, P=.04). CONCLUSIONS Increased sleep variabilities, characterized by unstable bedtime or midpoint of sleep, were correlated with elevated stress levels and diminished well-being. Conversely, improved sleep indices (eg, lower heart rate during sleep and earlier average bedtime) were associated with heightened daytime energy levels. Further research with a larger sample size using these methodologies, particularly focusing on specific phenomena such as social jet lag, has the potential to yield valuable insights. TRIAL REGISTRATION UMIN-CTR UMIN000046858; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000053392.
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Affiliation(s)
- Shotaro Kinoshita
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
| | - Sayaka Hanashiro
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shiori Tsutsumi
- Graduate School of Health Management, Keio University, Kanagawa, Japan
| | - Kiko Shiga
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Department of Clinical Psychology, Faculty of Human Relations, Shigakukan University, Kagoshima, Japan
| | - Momoko Kitazawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyo Wada
- Center for Preventice Medicine, Keio University Hospital, Tokyo, Japan
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan
| | - Jun Inaishi
- Center for Preventice Medicine, Keio University Hospital, Tokyo, Japan
- Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuhiro Kashiwagi
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
- Center for Preventice Medicine, Keio University Hospital, Tokyo, Japan
| | | | | | | | - Taishiro Kishimoto
- Hills Joint Research Laboratory for Future Preventive Medicine and Wellness, Keio University School of Medicine, Tokyo, Japan
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, New York, NY, United States
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Tsai TC, Mitchell HR, Zeitzer J, Ting A, Laurenceau JP, Spiegel D, Kim Y. Dyadic Investigation of Posttraumatic Stress Symptoms and Daily Sleep Health in Patients With Cancer and Their Caregivers. Psychosom Med 2024; 86:234-243. [PMID: 38345316 PMCID: PMC11081839 DOI: 10.1097/psy.0000000000001283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Cancer can be a traumatic experience affecting multidimensional aspects of sleep among patients and caregivers. This study examined the differential associations of cancer-related posttraumatic stress symptoms (PTSS) with various sleep markers in this population. METHODS Patients newly diagnosed with colorectal cancer ( n = 138, mean age = 56.93 years, 31.88% female, 60.14% Hispanic, 6.53 months after diagnosis) and their sleep-partner caregivers ( n = 138, mean age = 55.32 years, 68.12% female, 57.97% Hispanic) completed questionnaires assessing the four PTSS clusters (intrusion, avoidance, alterations in arousal and reactivity, negative alterations in cognitions and mood). Participants also completed daily sleep diaries for 14 consecutive days, from which sleep onset latency (SOL), wake after sleep onset (WASO), and sleep duration were derived. RESULTS Actor-partner interdependence model revealed that caregivers' greater alterations in arousal and reactivity were associated with their own longer SOL ( b = 15.59, p < .001) and their patients' longer sleep duration ( b = 0.61, p = .014), whereas patients' arousal and reactivity were associated with their caregivers' shorter SOL ( b = -8.47, p = .050). Patients' and caregivers' greater negative alterations in cognitions and mood were associated with patients' longer SOL ( b = 9.15, p = .014) and shorter sleep duration ( b = -0.41, p = .050), respectively. Caregivers' greater intrusion was related to their own shorter SOL ( b = -10.14, p = .004). CONCLUSIONS The four PTSS clusters, particularly arousal and reactivity and negative cognitions and mood, have distinct associations with sleep markers individually and dyadically in patients and caregivers affected by cancer. Investigations of psychosocial and biobehavioral pathways underlying these relations are warranted. Tailored trauma treatments and sleep interventions may improve the well-being of this population.
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Affiliation(s)
- Thomas C. Tsai
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33146, United States
| | | | - Jamie Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University
- Department of Psychiatry and Sleep Medicine, Palo Alto VA Medical Center
| | - Amanda Ting
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33146, United States
| | | | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University
| | - Youngmee Kim
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL, 33146, United States
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Wen JH, Klaiber P, Leger KA, Hill PL, Pfund GN, Slavish DC, DeLongis A, Sin NL. Nightly Sleep Predicts Next-Morning Expectations for Stress and Positive Experiences. Psychosom Med 2024; 86:261-271. [PMID: 38513143 DOI: 10.1097/psy.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Abundant research has linked nightly sleep as an antecedent of daily psychosocial experiences; however, less is known about sleep's influence on daily expectations of these experiences. Therefore, this research examined the day-to-day associations of sleep quality, duration, and efficiency with next-day expectations for stress(ors) and positive experiences, as well as whether these expectations were related to end-of-day reports of physical symptoms. METHODS In Study 1, U.S. adults ( n = 354; ages 19 to 74) completed twice-daily diaries for 10 weekdays about sleep, expectations for encountering daily stressors and positive events, and physical symptoms. In Study 2, adults in Canada ( n = 246; ages 25 to 87) wore a sleep watch for 14 consecutive days and completed mobile surveys 5×/day about sleep, stressfulness and pleasantness expectations, and physical symptoms. RESULTS Multilevel models indicated that self-reported sleep quality and duration, but not efficiency, were associated with lower next-day expectations for stressors (Study 1) and stressfulness (Study 2). Self-reported sleep quality (Study 1) and all sleep indices (Study 2) predicted greater next-day expectations for positive events and pleasantness, respectively. For actigraphy-assessed sleep (Study 2), only longer-than-usual actigraphic sleep duration was associated with lower stressfulness expectations, whereas both sleep duration and efficiency were positively linked with daily pleasantness expectations. Only pleasantness expectations (Study 2)-but not daily stressfulness and event expectations (Study 1)-predicted end-of-day physical symptoms. CONCLUSION Findings suggest the importance of sleep on expectations of next-day stress and positive experiences, of which may have implications for daily physical health.
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Affiliation(s)
- Jin H Wen
- From the Department of Psychology (Wen, DeLongis, Sin), The University of British Columbia, Vancouver, BC, Canada; Department of Developmental Psychology (Klaiber), Tilburg University, Tilburg, the Netherlands; Department of Psychology (Leger), The University of Kentucky, Lexington, Kentucky; Department of Psychological & Brain Sciences (Hill), Washington University in St. Louis, Missouri; Department of Medical Social Sciences (Pfund), Northwestern University, Evanston, Illinois; and Department of Psychology, University of North Texas (Slavish), Denton, Texas
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Verma S, Pinnington DM, Manber R, Bei B. Sleep-wake timing and chronotype in perinatal periods: longitudinal changes and associations with insomnia symptoms, sleep-related impairment, and mood from pregnancy to 2 years postpartum. J Sleep Res 2024; 33:e14021. [PMID: 37608515 DOI: 10.1111/jsr.14021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/27/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
Across the perinatal transition, existing research focuses mainly on significant changes in sleep duration and quality, neglecting sleep timing. This study investigated change trajectories of sleep timing and chronotype from late pregnancy to 2 years postpartum and examined longitudinal associations of chronotype with symptoms of insomnia, daytime sleep-related impairment, and mood. Data were from a two-arm randomised controlled trial testing parent-focused wellbeing interventions. Participants were a community sample of nullipara without severe sleep/mental health conditions. Participants self-reported bedtime, rise-time, chronotype, insomnia symptoms, sleep-related impairment, depression, and anxiety at seven time points: gestation Weeks 30 and 35, and postpartum Months 1.5, 3, 6, 12 and 24. Trajectories were estimated using mixed-effects models with continuous time, quadratic splines, and a knot at childbirth, controlling for age and group allocation. A total of 163 participants (mean [SD] age 33.35 [3.42] years) took part. Bedtime and rise-times delayed during late pregnancy (~8 and ~20 min, respectively) but became progressively earlier (~20 and ~60 min, respectively) over the 2 postpartum years. Chronotype became more eveningness in late pregnancy, and more morningness after childbirth, however changes were small. Controlling for sleep duration and efficiency, greater morningness was associated with significantly less symptoms of insomnia and sleep-related impairment over time (all p < 0.001); longitudinal associations between chronotype and symptoms of depression and anxiety were non-significant (all p > 0.65). Sleep-wake timing and chronotype became progressively earlier from pregnancy to 2 years postpartum. Morningness chronotype may be sleep-protective during the transition from pregnancy to parenthood. Mechanisms underlying these associations require further research.
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Affiliation(s)
- Sumedha Verma
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Donna M Pinnington
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Women's Mental Health Service, Department of Psychiatry, University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Bei Bei
- The Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Women's Mental Health Service, Department of Psychiatry, University of Melbourne, Royal Women's Hospital, Parkville, Victoria, Australia
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11
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Hinrichsen GA, Leipzig RM. Implementation and Effectiveness of Cognitive Behavioral Therapy for Insomnia in Geriatric Primary Care. Clin Gerontol 2024; 47:507-514. [PMID: 35980259 DOI: 10.1080/07317115.2022.2104675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We evaluated a plan for implementation and effectiveness of cognitive behavioral therapy for insomnia (CBT-I) in geriatric primary care by a geropsychologist. METHODS The flow of referrals to a geropsychologist was tracked and, among those eligible and interested in participating, success in deprescribing sleep medications and the effectiveness of CBT-I were documented. RESULTS Seventy patients were referred for evaluation of whom 62 were eligible for CBT-I; 34 began CBT-I and 29 completed a full course of treatment. Almost two-thirds of treatment completers were the "old old" (76-84 years) and "oldest old" (85-93 years) with multiple medical problems. Most treatment completers taking sleep medications had them deprescribed at the beginning of treatment and, one year after treatment, did not have them re-prescribed. After CBT-I, two-thirds of patients met the insomnia severity index criteria for response; and three-fifths for remission from insomnia. Further, most patients had sustained improvement in their target insomnia symptom(s) and sleep efficiency. CONCLUSIONS CBT-I can be implemented in geriatric primary care with successful deprescribing of sleep medications and meaningful improvement in symptoms of insomnia in a group of older adults of advanced age with multiple medical problems. CLINICAL IMPLICATIONS Clinical gerontologists can play an important role in improving late life insomnia.
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Affiliation(s)
- Gregory A Hinrichsen
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rosanne M Leipzig
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
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12
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Gao C, Scullin MK. Objective and Subjective Intraindividual Variability in Sleep: Predisposing Factors and Health Consequences. Psychosom Med 2024; 86:298-306. [PMID: 38439637 DOI: 10.1097/psy.0000000000001301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE We investigated the factors that predispose or precipitate greater intraindividual variability (IIV) in sleep. We further examined the potential consequences of IIV on overall sleep quality and health outcomes, including whether these relationships were found in both self-reported and actigraphy-measured sleep IIV. METHODS In Study 1, 699 US adults completed a Sleep Intra-Individual Variability Questionnaire and self-reported psychosocial, sleep quality, and health outcomes. In Study 2, 100 university students wore actigraphy and completed psychosocial, sleep, and health surveys at multiple timepoints. RESULTS In cross-sectional analyses that controlled for mean sleep duration, predisposing/precipitating factors to greater IIV were being an underrepresented racial/ethnic minority (Study 1: F = 13.95, p < .001; Study 2: F = 7.03, p = .009), having greater stress (Study 2: r values ≥ 0.32, p values ≤ .002) or trait vulnerability to stress (Study 1: r values ≥ 0.15, p values < .001), and showing poorer time management (Study 1: r values ≤ -0.12, p values ≤ .004; Study 2: r values ≤ -0.23, p values ≤ .028). In addition, both studies showed that greater sleep IIV was associated with decreased overall sleep quality, independent of mean sleep duration (Study 1: r values ≥ 0.20, p values < .001; Study 2: r values ≥ 0.33, p values ≤ .001). Concordance across subjective and objective IIV measures was modest ( r values = 0.09-0.35) and similar to concordance observed for subjective-objective mean sleep duration measures. CONCLUSION Risk for irregular sleep patterns is increased in specific demographic groups and may be precipitated by, or contribute to, higher stress and time management inefficiencies. Irregular sleep may lead to poor sleep quality and adverse health outcomes, independent of mean sleep duration, underscoring the importance of addressing sleep consistency.
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Affiliation(s)
- Chenlu Gao
- From the Department of Psychology and Neuroscience (Gao, Scullin), Baylor University, Waco, Texas; Department of Anesthesia, Critical Care and Pain Medicine (Gao), Massachusetts General Hospital; Division of Sleep and Circadian Disorders (Gao), Brigham and Women's Hospital; and Division of Sleep Medicine (Gao), Harvard Medical School, Boston, Massachusetts
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13
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Kaliush PR, Butner JE, Williams PG, Conradt E, Crowell SE. Dynamic Associations Among Sleep, Emotion Dysregulation, and Desire to Live in a Perinatal Sample. Psychosom Med 2024; 86:272-282. [PMID: 38451838 PMCID: PMC11081831 DOI: 10.1097/psy.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE The present study prospectively examined dynamic associations among sleep, emotion dysregulation, and desire to live during the perinatal transition, as it was theorized that these factors may contribute to the emergence of postpartum suicide risk. METHOD Ninety-four women ( Mage = 29.2 years; 23.4% Latina) wore wrist actigraphs and completed twice daily surveys for 7 days during the third trimester of pregnancy, 6 weeks postpartum, and 4 months postpartum. Multilevel, change-as-outcome models were built to examine changes in attractor dynamics among sleep, emotion dysregulation, and desire to live, as well as if sleep-emotion dysregulation dynamics differed based on participants' desires to live. RESULTS From pregnancy to 6 weeks postpartum, emotion dysregulation ( B = -0.09, p = .032) and desire to live ( B = -0.16, p < .001) exhibited more stable temporal patterns around higher emotion dysregulation and lower desire to live. Compared to women who reported consistently high desires to live, those who experienced fluctuations in their desires to live exhibited lower, more stable sleep efficiency during pregnancy ( B = -0.90, p < .001). At 4 months postpartum, those with fluctuating desires to live exhibited a coupling dynamic whereby low sleep efficiency predicted increases in emotion dysregulation ( B = -0.16, p = .020). CONCLUSIONS This study was the first to examine nonlinear dynamics among risk factors for postpartum suicide, which may be evident as early as pregnancy and 6 weeks postpartum. Sleep health, in particular, warrants further exploration as a key susceptibility factor in the emergence of postpartum suicide risk. PREREGISTRATION Open Science Framework ( https://osf.io/qxb75/?view_only=799ffe5c048842dfb89d3ddfebaa420d ).
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Garrido F, González-Caballero JL, García P, Gianni ML, Garrido S, González L, Atance V, Raffaeli G, Cavallaro G. Association between co-sleeping in the first year of life and preschoolers´ sleep patterns. Eur J Pediatr 2024; 183:2111-2119. [PMID: 38351212 PMCID: PMC11035441 DOI: 10.1007/s00431-024-05429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 03/27/2024]
Abstract
This study aimed to investigate the association between co-sleeping practiced during the first year of life and preschoolers' sleep patterns. A cross-sectional study including toddlers was designed to analyze their sleep patterns. The Brief Infant Sleep Questionnaire, validated in Spanish, was used to measure sleep quality. A latent class analysis was performed to identify qualitative subgroups in the sample and explore the effects of co-sleeping. The sleep patterns of 276 children were analyzed. A total of 181 (65%) parents reported having practiced co-sleeping with their children. The latent class analysis identified a two-class solution with two different sleep patterns. One of them showed a worse quality sleep pattern, which had a significant association with having practiced co-sleeping during the first year of life, and with the fact that they were still sleeping in the parents' room, among other characteristics related to co-sleeping and parental concerns. Breastfeeding also showed association with a worse quality sleep pattern. Conclusion: Based on the present findings, co-sleeping during the first year of life appears to be associated with poor sleep patterns in young preschoolers. What is Known: • Co-sleeping shows benefits for infants and parents, mainly facilitating successful breastfeeding. • Literature on the effect of co-sleeping in lately sleep quality in children and their parents is very limited. What is New: • Co-sleeping practiced during the first year of life could be associated with a worse sleep pattern measured with BISQ-E tool. • A balance between the correct practice of co-sleeping and the achievement of a healthy sleep routine in preschool should probably be part of parents' health education.
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Affiliation(s)
- Felipe Garrido
- Department of Pediatrics, Clínica Universidad de Navarra. Calle Marquesado de Santa Marta, 1, Madrid (28227), Spain.
| | | | | | - Maria-Lorella Gianni
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
- Neonatal Intensive Care Unit. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. 20122, Milan, Italy
| | - Silvia Garrido
- Department of Pediatrics, Clínica Universidad de Navarra, Madrid (28227), Spain
| | - Lucía González
- Department of Pediatrics, Clínica Universidad de Navarra, Madrid (28227), Spain
| | - Verónica Atance
- Department of Pediatrics, Clínica Universidad de Navarra, Madrid (28227), Spain
| | - Genny Raffaeli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
- Neonatal Intensive Care Unit. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. 20122, Milan, Italy
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit. Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico. 20122, Milan, Italy
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15
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Quaedflieg CWEM, Bossi C, Bruijel J. The moderating role of conscientiousness in the temporal association of stress on sleep. J Sleep Res 2024:e14224. [PMID: 38685740 DOI: 10.1111/jsr.14224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 03/25/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
Personality traits have been associated with sleep problems and stress experience. However, their impact on objective sleep and the temporal relationship of stress on sleep has remained elusive. This study examined whether daytime stress predicts sleep the following night, and the moderating role of neuroticism and conscientiousness in this relationship. To introduce stress variability in natural daily stressors, we measured college students (N = 92) during exams (e.g. high academic stress) and at the start of new course period (e.g. low academic stress). Both objective (actigraphy) and subjective sleep, and daily self-reported stress, were measured for 14 days and personality traits once. Reported daily stress was significantly higher in the exam period compared with baseline, suggesting that our natural manipulation did indeed result in variation in stress levels. Intra-individual daily variations in stress were not associated with the following night's sleep timing, duration or fragmentation, implying that more stress during the day did not affect sleep the following night. Higher levels of neuroticism were associated with poorer daily subjective sleep quality and higher stress levels over the complete period. Neuroticism did not moderate the temporal association of stress on sleep. Conscientiousness moderated the association between intra-individual stress and sleep fragmentation, and intra-individual stress and wake-up time. This implied that highly conscientious participants experienced less sleep fragmentation and woke-up earlier after more stressful days. These results suggest an interconnected relationship among stress, sleep and personality. Focusing on one aspect, like handling stress or enhancing sleep quality, might yield positive effects on the rest.
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Affiliation(s)
- Conny W E M Quaedflieg
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Camilla Bossi
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Jessica Bruijel
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Centre, Maastricht, The Netherlands
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16
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Arring N, Barton DL, Lafferty C, Cox B, Conroy DA, An L. Mi Sleep Coach Mobile App to Address Insomnia Symptoms Among Cancer Survivors: Single-Arm Feasibility Study. JMIR Form Res 2024; 8:e55402. [PMID: 38669678 PMCID: PMC11087861 DOI: 10.2196/55402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Rates of sleep disturbance among survivors of cancer are more than 3 times higher than the general population. Causes of sleep disturbance among survivors are many and multifaceted, including anxiety and fear related to cancer diagnosis and treatments. Cognitive behavioral therapy for insomnia (CBT-I) is considered a first-line treatment for insomnia; However, a lack of access to trained professionals and limited insurance coverage for CBT-I services has limited patient access to these effective treatments. Evidence supports digital delivery of CBT-I (dCBT-I), but there is only limited evidence to support its use among survivors of cancer. Broad adoption of smartphone technology provides a new channel to deliver dCBT-I, but no prior studies have evaluated mobile dCBT-I interventions for survivors. To address the need for accessible and efficacious CBT-I for survivors of cancer, the Mi Sleep Coach program was developed to adapt CBT-I for delivery to survivors of cancer as a self-directed mobile health app. OBJECTIVE This single-arm feasibility study assessed the adherence, attrition, usefulness, and satisfaction of the Mi Sleep Coach app for insomnia. METHODS A 7-week, single-arm study was conducted, enrolling adult survivors of breast, prostate, or colon cancer reporting sleep disturbances. RESULTS In total, 30 participants were enrolled, with 100% completing the study and providing data through week 7. Further, 9 out of 10 app features were found to be useful by 80% (n=24) to 93% (n=28) of the 30 participants. Furthermore, 27 (90%) participants were satisfied with the Mi Sleep Coach app and 28 (93%) would recommend the use of the Mi Sleep Coach app for those with insomnia. The Insomnia Severity Index showed a decrease from baseline (18.5, SD 4.6) to week 7 (10.4, SD 4.2) of 8.1 (P<.001; Cohen d=1.5). At baseline, 25 (83%) participants scored in the moderate (n=19; 15-21) or severe (n=6; 22-28) insomnia range. At week 7, a total of 4 (13%) patients scored in the moderate (n=4) or severe (n=0) range. The number of patients taking prescription sleep medications decreased from 7 (23%) at baseline to 1 (3%; P<.001) at week 7. The number of patients taking over-the-counter sleep medications decreased from 14 (47%) at baseline to 9 (30%; P=.03) at week 7. CONCLUSIONS The Mi Sleep Coach app demonstrated high levels of program adherence and user satisfaction and had large effects on the severity of insomnia among survivors of cancer. The Mi Sleep Coach app is a promising intervention for cancer-related insomnia, and further clinical trials are warranted. If proven to significantly decrease insomnia in survivors of cancer in future randomized controlled clinical trials, this intervention would provide more survivors of cancer with easy access to evidence-based CBT-I treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT04827459; https://clinicaltrials.gov/study/NCT04827459.
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Affiliation(s)
- Noel Arring
- College of Nursing, University of Tennessee, Knoxville, TN, United States
| | - Debra L Barton
- College of Nursing, University of Tennessee, Knoxville, TN, United States
| | - Carolyn Lafferty
- College of Nursing, University of Tennessee, Knoxville, TN, United States
| | - Bryana Cox
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Deirdre A Conroy
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Lawrence An
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
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McCallum C, Campbell M, Vines J, Rapley T, Ellis J, Deary V, Hackett K. A Smartphone App to Support Self-Management for People Living With Sjögren's Syndrome: Qualitative Co-Design Workshops. JMIR Hum Factors 2024; 11:e54172. [PMID: 38630530 PMCID: PMC11063884 DOI: 10.2196/54172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Sjögren's syndrome (SS) is the second most common autoimmune rheumatic disease, and the range of symptoms includes fatigue, dryness, sleep disturbances, and pain. Smartphone apps may help deliver a variety of cognitive and behavioral techniques to support self-management in SS. However, app-based interventions must be carefully designed to promote engagement and motivate behavior change. OBJECTIVE We aimed to explore self-management approaches and challenges experienced by people living with SS and produce a corresponding set of design recommendations that inform the design of an engaging, motivating, and evidence-based self-management app for those living with SS. METHODS We conducted a series of 8 co-design workshops and an additional 3 interviews with participants who were unable to attend a workshop. These were audio recorded, transcribed, and initially thematically analyzed using an inductive approach. Then, the themes were mapped to the Self-Determination Theory domains of competency, autonomy, and relatedness. RESULTS Participants experienced a considerable demand in the daily work required in self-managing their SS. The condition demanded unrelenting, fluctuating, and unpredictable mental, physical, and social efforts. Participants used a wide variety of techniques to self-manage their symptoms; however, their sense of competency was undermined by the complexity and interconnected nature of their symptoms and affected by interactions with others. The daily contexts in which this labor was occurring revealed ample opportunities to use digital health aids. The lived experience of participants showed that the constructs of competency, autonomy, and relatedness existed in a complex equilibrium with each other. Sometimes, they were disrupted by tensions, whereas on other occasions, they worked together harmoniously. CONCLUSIONS An SS self-management app needs to recognize the complexity and overlap of symptoms and the complexities of managing the condition in daily life. Identifying techniques that target several symptoms simultaneously may prevent users from becoming overwhelmed. Including techniques that support assertiveness and communication with others about the condition, its symptoms, and users' limitations may support users in their interactions with others and improve engagement in symptom management strategies. For digital health aids (such as self-management apps) to provide meaningful support, they should be designed according to human needs such as competence, autonomy, and relatedness. However, the complexities among the 3 Self-Determination Theory constructs should be carefully considered, as they present both design difficulties and opportunities.
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Affiliation(s)
- Claire McCallum
- Faculty of Engineering, University of Bristol, Bristol, United Kingdom
| | - Miglena Campbell
- Institute for Collective Place Leadership, Teesside University, Middlesbrough, United Kingdom
| | - John Vines
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Jason Ellis
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Vincent Deary
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Katie Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
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Chan K, Tseng CC, Milarachi E, Goldrich DY, King TS, Fernandez-Mendoza J, Saadi RA, Saunders B, Boltz M, Goldenberg D. Actigraphy measures show sleep improvement after parathyroidectomy for primary hyperparathyroidism. Am J Otolaryngol 2024; 45:104297. [PMID: 38692072 DOI: 10.1016/j.amjoto.2024.104297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
IMPORTANCE The symptoms of primary hyperparathyroidism are often subtle, such as fatigue, mood changes, and sleep disturbances. After parathyroidectomy, patients often report improvement in sleep and mood; however, objective data supporting these improvements is lacking. OBJECTIVE This prospective study uses standard measures to objectively and subjectively assess sleep in patients with primary hyperparathyroidism before and after parathyroidectomy. DESIGN A longitudinal prospective study was conducted over three one-week-long periods: pre-parathyroidectomy, 1-week post-parathyroidectomy, and three months post-parathyroidectomy. During each time point, patients wore an actigraphy device, recorded a sleep diary, and completed the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Depression Anxiety Stress Scale (DASS). Statistical analysis was performed using repeated measures models to compare the average measures among the three time points and test for trends over time. SETTING Single institution, tertiary care center. PARTICIPANTS Patients with primary hyperparathyroidism from ages 18 to 89 years old. EXPOSURE Parathyroidectomy between September 2020 and January 2024. MAIN OUTCOMES AND MEASURES Actigraphy data, consensus sleep diary, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Depression Anxiety Stress Scales - 21 Items (DASS). RESULTS Thirty-six patients were enrolled, and 34 patients completed the study. Actigraphy data showed a significant negative trend in average sleep latency (p = 0.045) and average time in bed (p = 0.046). Sleep diary data showed additional differences in the number of awakenings (p = 0.002), wake after sleep onset (p < 0.001), sleep quality (p < 0.001), and sleep efficiency (p = 0.02) among the three time points and/or as a significant negative trend. PSQI and ISI scores were significantly different among the three time points (p = 0.002 and p < 0.001, respectively) and also declined significantly over time (p = 0.008 and p = 0.007, respectively). DASS depression, anxiety, and stress scores were significantly different among the three time points (p < 0.001, p = 0.01, and p < 0.001, respectively), and stress also declined significantly over time (p = 0.005). CONCLUSION AND RELEVANCE This study represents the most extensive prospective study demonstrating objective and subjective sleep and mood improvement in patients with primary hyperparathyroidism after parathyroidectomy.
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Affiliation(s)
- Kimberly Chan
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Emily Milarachi
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - David Y Goldrich
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Tonya S King
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry and Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Robert A Saadi
- University of Arkansas for Medical Sciences, Department of Otolaryngology-Head and Neck Surgery, Little Rock, AR, USA
| | - Brian Saunders
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Melissa Boltz
- Department of Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - David Goldenberg
- Department of Otolaryngology-Head and Neck Surgery, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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19
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Boyle JT, Morales KH, Muench A, Ellis J, Vargas I, Grandner MA, Posner D, Perlis ML. The natural history of insomnia: evaluating illness severity from acute to chronic insomnia; is the first the worst? Sleep 2024; 47:zsae034. [PMID: 38310641 PMCID: PMC11009029 DOI: 10.1093/sleep/zsae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/20/2024] [Indexed: 02/06/2024] Open
Abstract
STUDY OBJECTIVES The 3P and 4P models represent illness severity over the course of insomnia disorder. The 3P model suggests that illness severity is worst during acute onset. The 4P model suggests that illness severity crescendos with chronicity. The present analysis from an archival dataset assesses illness severity with new onset illness (i.e. from good sleep [GS] to acute insomnia [AI] to chronic insomnia [CI]). Illness severity is quantified in terms of total wake time (TWT). METHODS GSs (N = 934) were followed up to 1 year with digital sleep diaries, and classified as GS, AI, or CI. Data for CIs were anchored to the first of 14 days with insomnia so that day-to-day TWT was represented prior to and following AI onset. A similar graphic (+/-acute onset) was constructed for number of days per week with insomnia. GS data were temporally matched to CI data. Segmented linear mixed regression models were applied to examine the change in slopes in the AI-to-CI period compared to GS-to-AI period. RESULTS Twenty-three individuals transitioned to AI and then CI. Average TWT rose during the first 2 weeks of AI onset (b = 1.8, SE = 0.57, p = 0.001) and was then stable for 3 months (b = -0.02, SE = 0.04, p = 0.53). Average number of affected days was stable from AI to CI (b = 0.0005, SE = 0.002, p = 0.81). That is, while there was week-to-week variability in the number of days affected, no linear trend was evident. CONCLUSIONS In our sample of CIs, primarily with middle insomnia, the average severity and number of affected days were worst with the onset of AI (worst is first) and stable thereafter.
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Affiliation(s)
- Julia T Boyle
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandria Muench
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Chronobiology and Sleep Institute Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jason Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle, UK
| | - Ivan Vargas
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - Michael A Grandner
- Sleep & Health Research Program, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Donn Posner
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Sleepwell Consultants, Newtonville, MA, USA
| | - Michael L Perlis
- Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Chronobiology and Sleep Institute Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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20
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Holmelid Ø, Pallesen S, Bjorvatn B, Sunde E, Waage S, Vedaa Ø, Nielsen MB, Djupedal ILR, Harris A. Simulated quick returns in a laboratory context and effects on sleep and pre-sleep arousal between shifts: a crossover controlled trial. Ergonomics 2024:1-11. [PMID: 38587121 DOI: 10.1080/00140139.2024.2335545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
This trial presents a laboratory model investigating the effect of quick returns (QRs, <11 h time off between shifts) on sleep and pre-sleep arousal. Using a crossover design, 63 participants worked a simulated QR condition (8 h time off between consecutive evening- and day shifts) and a day-day (DD) condition (16 h time off between consecutive day shifts). Participants slept at home and sleep was measured using a sleep diary and sleep radar. Compared to the DD condition, the QR condition reduced subjective and objective total sleep time by approximately one hour (both p < .001), reduced time in light- (p < .001), deep- (p = .004), rapid eye movement (REM, p < .001), percentage of REM sleep (p = .023), and subjective sleep quality (p < .001). Remaining sleep parameters and subjective pre-sleep arousal showed no differences between conditions. Results corroborate previous field studies, validating the QR model and indicating causal effects of short rest between shifts on common sleep parameters and sleep architecture.
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Affiliation(s)
- Øystein Holmelid
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Erlend Sunde
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Siri Waage
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Øystein Vedaa
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Department of Health Promotion, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Ingebjørg Louise Rockwell Djupedal
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
- Department of Health Promotion, Norwegian Institute of Public Health, Oslo, Norway
| | - Anette Harris
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
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21
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Mehra LM, Hajcak G, Meyer A. The associations among sleep-related difficulties, anxiety, and error-related brain activity in youth. Biol Psychol 2024; 188:108790. [PMID: 38580098 DOI: 10.1016/j.biopsycho.2024.108790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
Given the high prevalence of anxiety disorders and their associated impairment, elucidating neural mechanisms related to these disorders has been increasingly prioritized. The error-related negativity (ERN) has been identified as a neural marker that indexes risk for anxiety across development. The ERN seems to confer risk for developing anxiety, especially in the context of stressful life events. The present study sought to examine sleep-related difficulties as another stressful factor that might impact the ERN. In a sample of 221 girls, aged 8 to 15 years old, we first examined the relationship between longer-term (i.e., over the past month) and shorter-term (i.e., over the past week) sleep difficulties and the ERN. We then investigated whether specific sleep difficulties uniquely predict the ERN. In exploratory analyses, we assessed whether sleep difficulties moderate the relationship between the ERN and anxiety. Results indicated that youth who report longer-term lower sleep duration, longer-term worse sleep, and shorter-term lower sleep duration on school days over the past week have a larger (i.e., more negative) ERN. Additionally, only shorter-term sleep duration on school days over the past week uniquely predicted the ERN. Finally, an elevated ERN predicted greater clinical anxiety in the context of longer-term sleep difficulties. Future studies should clarify the direction of these associations via longitudinal designs.
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Affiliation(s)
- Lushna M Mehra
- Department of Psychology, Florida State University, 1107 W Call St, Tallahassee, FL 32304, USA.
| | - Greg Hajcak
- School of Education and Counseling, Santa Clara University, 455 El Camino Real, Guadalupe Hall, Santa Clara, CA 95053, USA
| | - Alexandria Meyer
- School of Education and Counseling, Santa Clara University, 455 El Camino Real, Guadalupe Hall, Santa Clara, CA 95053, USA
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22
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Kim Y, Ting A, Tsai TC, Carver CS. Dyadic sleep intervention for adult patients with cancer and their sleep-partner caregivers: A feasibility study. Palliat Support Care 2024; 22:226-235. [PMID: 37312582 PMCID: PMC10719417 DOI: 10.1017/s1478951523000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Sleep disturbances are common among adult patients with cancer and their caregivers. To our knowledge, no sleep intervention to date has been designed to be provided to both patients with cancer and their caregivers simultaneously. This single-arm study aimed to pilot test the feasibility and acceptability, and to illustrate the preliminary efficacy on sleep efficiency of the newly developed dyadic sleep intervention, My Sleep Our Sleep (MSOS: NCT04712604). METHODS Adult patients who were newly diagnosed with a gastrointestinal (GI) cancer and their sleep-partner caregivers (n = 20 persons: 10 dyads, 64 years old, 60% female patients, 20% Hispanic, 28 years relationship duration), both of whom had at least mild levels of sleep disturbance (Pittsburgh Sleep Quality Index [PSQI] ≥ 5) participated in this study. MSOS intervention consists of four 1-hour weekly sessions delivered using Zoom to the patient-caregiver dyad together. RESULTS We were able to enroll 92.9% of the eligible and screened patient-caregiver dyads within 4 months. Participants reported high satisfaction in 8 domains (average 4.76 on a 1-5 rating). All participants agreed that the number of sessions, interval (weekly), and delivery mode (Zoom) were optimal. Participants also preferred attending the intervention with their partners. Both patients and caregivers showed improvement in sleep efficiency after completing the MSOS intervention: Cohen's d = 1.04 and 1.47, respectively. SIGNIFICANCE OF RESULTS Results support the feasibility and acceptability, as well as provide the preliminary efficacy of MSOS for adult patients with GI cancer and their sleep-partner caregivers. Findings suggest the need for more rigorous controlled trial designs for further efficacy testing of MSOS intervention.
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Affiliation(s)
| | - Amanda Ting
- Department of Psychology, Palo Alto VA, Palo Alto
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23
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McAlpine T, Mullan B, Clarke PJF. Assessing the daily association of sleep hygiene behaviours with sleep: A between and within persons approach. J Behav Med 2024; 47:255-270. [PMID: 37702911 PMCID: PMC10944446 DOI: 10.1007/s10865-023-00448-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/19/2023] [Indexed: 09/14/2023]
Abstract
Sleep hygiene behaviours are recommendations given to both clinical and non-clinical populations with a focus on modifying behaviours to maximise sleep outcomes. However, methodological issues present in sleep hygiene research make it difficult to conclusively determine the impact of each behaviour. This study aimed to address these issues by adopting a two-week, repeated measures design which incorporated objective sleep measures and used linear mixed effect modelling to assess the daily association of a wide range of sleep hygiene behaviours on sleep in a non-clinical, university sample. Between-persons effects revealed that bedtime and frequency of daytime napping, alcohol use, and social media use were negatively related to sleep duration while waketime and frequency of too much water consumption were positively related to sleep duration. Within-person effects revealed that later than usual bedtime, earlier than usual waketime, no sunlight exposure, poor ventilation, having an unpleasant conversation before bed were negatively associated with sleep duration whereas using alcohol to deliberately help full asleep was positively related to sleep duration. In contrast, disproportionately more behaviours were not significantly related to either sleep outcome, only some of which could be explained by individual differences, which suggests that more research is needed to determine the conditions under which these behaviours affect sleep, if at all.
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Affiliation(s)
- Thomas McAlpine
- enAble Institute, Curtin University, Bentley, WA, 6102, Australia
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia
| | - Barbara Mullan
- enAble Institute, Curtin University, Bentley, WA, 6102, Australia.
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia.
| | - Patrick J F Clarke
- enAble Institute, Curtin University, Bentley, WA, 6102, Australia
- School of Population Health, Curtin University, Bentley, WA, 6102, Australia
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24
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Miller MB, Freeman LK, Helle AC, Hall NA, DiBello AM, McCrae CS. Comparative feasibility and preliminary efficacy of CBT for insomnia among adults seeking and not seeking addiction treatment. J Sleep Res 2024; 33:e13969. [PMID: 37423902 DOI: 10.1111/jsr.13969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/02/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023]
Abstract
Two out of three adults seeking treatment for alcohol or other substance use disorders report co-occurring symptoms of insomnia. This study compared the feasibility, acceptability, and preliminary efficacy of cognitive behavioural therapy for insomnia (CBT-I) among adults seeking and not seeking treatment for substance use. Adults with alcohol or other substance use disorders (n = 22, 32% female, 82% White; Mage = 39.5) completed assessments at baseline, post-treatment, and at 6 week follow-up. Of those, 11 were and 11 were not enrolled in substance use treatment. All received CBT-I. Multiple imputation was used for missing data. Data were analysed using repeated measures analyses of variance. In the substance use treatment group, 6/11 completed post and 5/11 completed follow-up. In the non-treatment group, 9/11 completed post and 7/11 completed follow-up. Participants in both groups reported improvements in insomnia severity, sleep onset latency, and dysfunctional beliefs about sleep, with most effects evident at post and follow-up. There was a marginal group-by-time interaction in the change in frequency of substance use, with only participants not in substance use treatment reporting decreases at follow-up. Participants in substance use treatment reported significant reductions in substance-related problems and symptoms of post-traumatic stress disorder over time; however, they also reported more symptoms at baseline. CBT-I produces similar reductions in insomnia but is relatively less feasible among individuals in (versus not in) treatment for substance use disorder. This may be due to the more complex logistics of accessing CBT-I among those in treatment. We speculate that integrating CBT-I into treatment for addictions may improve feasibility in this population. clinicaltrials.gov NCT04198311.
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, Missouri, USA
| | - Lindsey K Freeman
- Department of Psychiatry, University of Missouri, Columbia, Missouri, USA
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Ashley C Helle
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Nicole A Hall
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Angelo M DiBello
- Center of Alcohol & Substance Use Studies, Rutgers University, Piscataway, New Jersey, USA
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25
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Palagini L, Manni R, Liguori C, De Gennaro L, Gemignani A, Fanfulla F, Ferri R, Nobili L, Ferini-Strambi L. Evaluation and management of insomnia in the clinical practice in Italy: a 2023 update from the Insomnia Expert Consensus Group. J Neurol 2024; 271:1668-1679. [PMID: 38063870 DOI: 10.1007/s00415-023-12112-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Insomnia is the most reported sleep disorder in industrialized countries, affecting, in the chronic form, around 10% of the European population. In Italy, such a percentage seems to be even higher. Although insomnia can be an independent disorder, it is frequently described as comorbid condition and may precipitate, exacerbate, or prolong a broad range of physical and mental disorders. Evaluating and targeting insomnia in the Italian clinical practice should be a priority. METHODS The present expert opinions and recommendations represent an update from 2020 and insights from Insomnia Expert Consensus Group, based on systematic reviews according to PRISMA on available options in Italy from January 2020 to March 2023. RESULTS We evaluated 28 papers among international guidelines, expert opinions, systematic reviews, and meta-analysis produced during the last 26 months. CONCLUSIONS Our findings suggest that symptoms of insomnia must be assessed in the Italian clinical practice by evaluating nocturnal and daytime symptoms, comorbid conditions, and lifestyle. Cognitive behavioral therapy for insomnia should be the first option according to availability. The choice of the drug should be based on different factors including type of insomnia, age, comorbidities, and potential side effects. If the choice would be a Z-drug or a short-acting benzodiazepine (in subjects < 65 years old), the use should be in the short term (≤ 4 weeks). Indeed, eszopiclone, as a new option in Italy, may present a different profile and may be used for up to 6 months, also in the elderly. If the choice is melatonin, it should be used melatonin 2 mg prolonged release in adults ≥ 55 years for up to 13 weeks. A new dual orexin antagonist, daridorexant, is available in Italy; it has been shown to be effective in adults and elderly and it can be used for at least 3 months and up to 1 year.
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Affiliation(s)
- Laura Palagini
- Unit of Psychiatry, Department of Neuroscience, Azienda Ospedaliero Universitaria Pisana AUOP, Pisa, Italy.
| | - Raffaele Manni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Neurology Unit, Sleep Medicine Centre, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, 00185, Rome, Italy
- Body and Action Lab, IRCSS Fondazione Santa Lucia, 00179, Rome, Italy
| | - Angelo Gemignani
- Psychology Unit, Department of Neuroscience, University of Pisa, Pisa, Italy
| | - Francesco Fanfulla
- Respiratory Function and Sleep Medicine Unit, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy
| | - Lino Nobili
- Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology Sleep Disorders Centre, RCCS San Raffaele Scientific Institute, Milan, Italy
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26
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Marmis R, McGoldrick-Ruth L, Kelly MR, Haynes PL. Comparing actigraphy and diary to measure daily and average sleep in firefighters: a Bland-Altman analysis. J Clin Sleep Med 2024; 20:497-503. [PMID: 37950454 PMCID: PMC10985296 DOI: 10.5664/jcsm.10916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 11/12/2023]
Abstract
STUDY OBJECTIVES This study sought to examine the relationship between actigraphy and the Consensus Sleep Diary to contribute information on their concurrent validity in a sample of career firefighters. METHODS Sixty firefighters were recruited from a large, urban fire department in the southwest United States that utilizes a fire-based emergency medical services system and a 5/6 shift schedule. A total of 329 differences were recorded during participants' 6-day between-shift recovery period. Data was collected utilizing the two most common forms of sleep analysis in an outpatient setting, wrist actigraphy (Actiwatch-2) and the Consensus Sleep Diary. Nine major sleep indices were computed: wake time after sleep onset, total sleep time, sleep onset latency, sleep offset, in-bed time, lights-off time, out-of-bed time, wake time, and sleep efficiency. RESULTS Firefighters overestimated sleep efficiency and underestimated wake after sleep onset by values that were greater than the American Academy of Sleep Medicine a priori clinical significance thresholds. All indices showed very broad limits of agreement. For example, the 95% confidence interval for diary and actigraphic total sleep time estimates fell within a 4.7-hour range. CONCLUSIONS Firefighters receiving recovery sleep between tours demonstrated significantly large disagreements between their daily self-reported sleep and measured actigraphic sleep. Sleep findings from actigraphic and Consensus Sleep Diary sleep assessments in this population should be interpreted cautiously until each method is compared against other reliable sleep analysis methods. Currently it is unclear if clinicians are using properly validated tools when diagnosing shift work disorder or other sleep disorders in firefighters. CITATION Marmis R, McGoldrick-Ruth L, Kelly MR, Haynes PL. Comparing actigraphy and diary to measure daily and average sleep in firefighters: a Bland-Altman analysis. J Clin Sleep Med. 2024;20(4):497-503.
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Affiliation(s)
- Ryan Marmis
- Department of Physiology, University of Arizona, Tucson, Arizona
| | | | - Monica R. Kelly
- Department of Psychology, University of Arizona, Tucson, Arizona
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Patricia L. Haynes
- Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona
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27
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Mangini C, Zarantonello L, Formentin C, Giusti G, Domenie ED, Ruggerini D, Costa R, Skene DJ, Basso D, Battagliarin L, Di Bella A, Angeli P, Montagnese S. Managing Circadian Disruption due to Hospitalization: A Pilot Randomized Controlled Trial of the CircadianCare Inpatient Management System. J Biol Rhythms 2024; 39:183-199. [PMID: 38153134 DOI: 10.1177/07487304231213916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
The objective of the present study was to test the effects of an inpatient management system (CircadianCare) aimed at limiting the negative impact of hospitalization on sleep by enhancing circadian rhythmicity. Fifty inpatients were randomized to either CircadianCare (n = 25; 18 males, 62.4 ± 1.9 years) or standard of care (n = 25; 14 males, 64.5 ± 2.3 years). On admission, all underwent a full sleep-wake evaluation; they then completed daily sleep diaries and wore an actigraph for the whole length of hospitalization. On days 1 (T0), 7 (T1), and 14 (T2, if still hospitalized), salivary melatonin for dim light melatonin onset (DLMO) and 24-h skin temperature were recorded. In addition, environmental noise, temperature, and illuminance were monitored. Patients in the CircadianCare arm followed 1 of 3 schedules for light/dark, meal, and physical activity timings, based on their diurnal preference/habits. They wore short-wavelength-enriched light-emitting glasses for 45 min after awakening and short-wavelength light filter shades from 18:00 h until sleep onset. While the first, primary registered outcome (reduced sleep-onset latency on actigraphy or diary) was not met, based on sleep diaries, there was a trend (0.05 < p < 0.1) toward an advance in bedtime for CircadianCare compared to standard of care patients between T0 and T1. Similarly, DLMO time significantly advanced in the small group of patients for whom it could be computed on both occasions, with untreated ones starting from earlier baseline values. Patients sleeping near the window had significantly higher sleep efficiency, regardless of treatment arm. As noise fluctuation increased, so did the number of night awakenings, regardless of treatment arm. In conclusion, the CircadianCare management system showed positive results in terms of advancing sleep timing and the circadian rhythm of melatonin. Furthermore, our study identified a combination of environmental noise and lighting indices, which could be easily modulated to prevent hospitalization-related insomnia.
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Affiliation(s)
- Chiara Mangini
- Department of Medicine, University of Padova, Padova, Italy
| | | | | | - Gianluca Giusti
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | | | - Rodolfo Costa
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Department of Biomedical Sciences, University of Padova, Padova, Italy
- Institute of Neuroscience, National Research Council, Padova, Italy
| | - Debra J Skene
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Daniela Basso
- Department of Medicine, University of Padova, Padova, Italy
| | - Lisa Battagliarin
- Department of Industrial Engineering, University of Padova, Padova, Italy
- Iuav University of Venice, Venice, Italy
| | - Antonino Di Bella
- Department of Industrial Engineering, University of Padova, Padova, Italy
| | - Paolo Angeli
- Department of Medicine, University of Padova, Padova, Italy
| | - Sara Montagnese
- Department of Medicine, University of Padova, Padova, Italy
- Chronobiology Section, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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28
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Kadura S, Poulakis A, Roberts DE, Arora VM, Darrow SN, Eisner L, Ibarra M, Lin J, Wang L, Pigeon WR. Sleeping with one cerebrum open: patient and staff perceptions of sleep quality and quantity on an inpatient neurology unit. J Clin Sleep Med 2024; 20:619-629. [PMID: 38063214 PMCID: PMC10985310 DOI: 10.5664/jcsm.10958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 04/04/2024]
Abstract
STUDY OBJECTIVES This study sought to investigate perceptions of sleep disruptions among patients and staff in the inpatient neurology setting. The objectives were to explore the differences between these groups regarding factors that impact sleep, identify the most significant sleep disruptions, and examine the barriers and opportunities suggested to improve inpatient sleep. METHODS A survey-based observational study was conducted on a 25-bed inpatient neurology unit at an academic medical center. Staff and patients completed the Potential Hospital Sleep Disruptions and Noises Questionnaire, and focus groups were held to gather qualitative data. Patient-reported sleep measures were collected for additional assessment. Responses were dichotomized for comparison. Regression models were used to assess associations between disruptors and patient-reported sleep measures. Qualitative thematic analyses were performed. RESULTS Forty-nine inpatient staff and 247 patients completed sleep surveys. Top primary patient diagnoses included stroke, epilepsy, autoimmune diseases, and psychogenic nonepileptic attacks. Medical interventions, environmental factors, patient-related factors, and unit workflows emerged as key themes related to sleep disruptions. Patient-reported sleep efficiency was significantly reduced when pain, anxiety, stress, temperature, and medication administration disrupted sleep. Staff perspectives highlighted medical interventions as most disruptive to sleep, while patients did not find them as disruptive as expected. CONCLUSIONS Differing perspectives on sleep disruption exist between staff and patients in the inpatient neurology setting. Medical interventions may be overstated in staff perceptions and inpatient sleep research, as pain, anxiety, and stress had the most significant impact on patient-reported sleep efficiency. CITATION Kadura S, Poulakis A, Roberts DE, et al. Sleeping with one cerebrum open: patient and staff perceptions of sleep quality and quantity on an inpatient neurology unit. J Clin Sleep Med. 2024;20(4):619-629.
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Affiliation(s)
- Sullafa Kadura
- Department of Medicine, Pulmonary Diseases and Critical Care, University of Rochester Medical Center, Rochester, New York
| | - Alexander Poulakis
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Debra E. Roberts
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Vineet M. Arora
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Stephanie N. Darrow
- Department of Operations Excellence, University of Rochester Medical Center, Rochester, New York
| | - Lauren Eisner
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Michael Ibarra
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Jennifer Lin
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Lu Wang
- Department of Biostatistics, University of Rochester Medical Center, Rochester, New York
| | - Wilfred R. Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
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29
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Herrero Babiloni A, Brazeau D, Jodoin M, Theis-Mahon N, Martel MO, Lavigne GJ, Moana-Filho EJ. The Impact of Sleep Disturbances on Endogenous Pain Modulation: A Systematic Review and Meta-Analysis. J Pain 2024; 25:875-901. [PMID: 37914093 DOI: 10.1016/j.jpain.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
The bidirectional relationship between sleep and pain problems has been extensively demonstrated but despite all the accumulating evidence, their shared mechanisms are currently not fully understood. This review examined the association between sleep disturbances, defined as a broad array of sleep-related outcomes (eg, poor quality, short duration, insomnia), and endogenous pain modulation (EPM) in healthy and clinical populations. Our search yielded 6,151 references, and 37 studies met the eligibility criteria. Qualitative results showed mixed findings regarding the association between sleep disturbances and temporal summation of pain (TSP) and conditioned pain modulation (CPM), with poor sleep more commonly associated with decreased pain inhibition in both populations. Quantitative results indicated that such associations were not statistically significant, neither in healthy populations when EPM outcomes were assessed for changes pre-/post-sleep intervention (TSP: .31 [95%CI: -.30 to .92]; P = .321; CPM: .40 [95%CI: -.06 to .85] P = .088) nor in clinical populations when such association was assessed via correlation (TSP: -.00 [95%CI: -.22 to .21] P = .970; CPM: .12 [95%CI: -.05 to .29]; P = .181). For studies that reported results by sex, meta-analysis showed that experimental sleep disturbances impaired pain inhibition in females (1.43 [95%CI: .98-1.88]; P < .001) but not in males (-.30 [95%CI: -2.69 to 1.60]; P = .760). Only one study investigating the association between sleep disturbances and offset analgesia was identified, while no studies assessing spatial summation of pain were found. Overall, this review provides a comprehensive overview of the association between sleep disturbances and EPM function, emphasizing the need for further investigation to clarify specific mechanisms and phenotypic subtypes. PERSPECTIVE: This review shines a light on the association between sleep disturbances and endogenous pain modulation function. Qualitatively, we found a frequent association between reduced sleep quality and impaired pain inhibition. However, quantitatively such an association was not corroborated. Sex-specific effects were observed, with females presenting sleep-related impaired pain inhibition but not males.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Sacre-Coeur Hospital, University of Montreal, Quebec, Canada
| | - Daphnée Brazeau
- Sacre-Coeur Hospital, University of Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Marianne Jodoin
- Sacre-Coeur Hospital, University of Montreal, Quebec, Canada; Department of Psychology, University of Montreal, Montreal, Quebec, Canada
| | - Nicole Theis-Mahon
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, United States
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Faculty of Dentistry, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada; Sacre-Coeur Hospital, University of Montreal, Quebec, Canada; Faculty of Dental Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Estephan J Moana-Filho
- Division of TMD and Orofacial Pain, School of Dentistry, University of Minnesota, Minneapolis, Minnesota
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Yu L, Peng W, Lin W, Luo Y, Hu D, Zhao G, Xu H, Dou Z, Zhang Q, Hong X, Yu S. Electroencephalography connectome changes in chronic insomnia disorder are correlated with neurochemical signatures. Sleep 2024:zsae080. [PMID: 38520362 DOI: 10.1093/sleep/zsae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Indexed: 03/25/2024] Open
Abstract
STUDY OBJECTIVES This study aimed to investigate the alterations in resting-state electroencephalography (EEG) global brain connectivity (GBC) in patients with chronic insomnia disorder (CID) and to explore the correlation between macroscale connectomic variances and microscale neurotransmitter distributions. METHODS We acquired 64-channel EEG from 35 female CID patients and 34 healthy females. EEG signals were source-localized using individual brain anatomy and orthogonalized to mitigate volume conduction. Correlation coefficients between band-limited source-space power envelopes of the DK 68 atlas were computed and averaged across regions to determine specific GBC values. A support vector machine (SVM) classifier utilizing GBC features was employed to differentiate CID patients from controls. We further used Neurosynth and a 3D atlas of neurotransmitter receptors/transporters to assess the cognitive functions and neurotransmitter landscape associated with CID cortical abnormality maps, respectively. RESULTS CID patients exhibited elevated GBC within the medial prefrontal cortex and limbic cortex, particularly at the gamma carrier frequency, compared to controls (pFDR<0.05). GBC patterns were found to effectively distinguish CID patients from controls with a precision of 90.8% in the SVM model. The cortical abnormality maps were significantly correlated with meta-analytic terms like "cognitive control" and "emotion regulation." Notably, GBC patterns were associated with neurotransmitter profiles (pspin<0.05), with neurotransmitter systems such as norepinephrine, dopamine, and serotonin making significant contributions. CONCLUSIONS This work characterizes the EEG connectomic profile of CID, facilitating the cost-effective clinical translation of EEG-derived markers. Additionally, the linkage between GBC patterns and neurotransmitter distribution offers promising avenues for developing targeted treatment strategies for CID.
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Affiliation(s)
- Liyong Yu
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei Peng
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Wenting Lin
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yucai Luo
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Daijie Hu
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Guangli Zhao
- School of Rehabilitation and Health Preservation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hao Xu
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zeyang Dou
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qi Zhang
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Xiaojuan Hong
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Siyi Yu
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Gabb VG, Blackman J, Morrison HD, Biswas B, Li H, Turner N, Russell GM, Greenwood R, Jolly A, Trender W, Hampshire A, Whone A, Coulthard E. Remote Evaluation of Sleep and Circadian Rhythms in Older Adults With Mild Cognitive Impairment and Dementia: Protocol for a Feasibility and Acceptability Mixed Methods Study. JMIR Res Protoc 2024; 13:e52652. [PMID: 38517469 PMCID: PMC10998181 DOI: 10.2196/52652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Sleep disturbances are a potentially modifiable risk factor for neurodegenerative dementia secondary to Alzheimer disease (AD) and Lewy body disease (LBD). Therefore, we need to identify the best methods to study sleep in this population. OBJECTIVE This study will assess the feasibility and acceptability of various wearable devices, smart devices, and remote study tasks in sleep and cognition research for people with AD and LBD. METHODS We will deliver a feasibility and acceptability study alongside a prospective observational cohort study assessing sleep and cognition longitudinally in the home environment. Adults aged older than 50 years who were diagnosed with mild to moderate dementia or mild cognitive impairment (MCI) due to probable AD or LBD and age-matched controls will be eligible. Exclusion criteria include lack of capacity to consent to research, other causes of MCI or dementia, and clinically significant sleep disorders. Participants will complete a cognitive assessment and questionnaires with a researcher and receive training and instructions for at-home study tasks across 8 weeks. At-home study tasks include remote sleep assessments using wearable devices (electroencephalography headband and actigraphy watch), app-based sleep diaries, online cognitive assessments, and saliva samples for melatonin- and cortisol-derived circadian markers. Feasibility outcomes will be assessed relating to recruitment and retention, data completeness, data quality, and support required. Feedback on acceptability and usability will be collected throughout the study period and end-of-study interviews will be analyzed using thematic analysis. RESULTS Recruitment started in February 2022. Data collection is ongoing, with final data expected in February 2024 and data analysis and publication of findings scheduled for the summer of 2024. CONCLUSIONS This study will allow us to assess if remote testing using smart devices and wearable technology is a viable alternative to traditional sleep measurements, such as polysomnography and questionnaires, in older adults with and without MCI or dementia due to AD or LBD. Understanding participant experience and the barriers and facilitators to technology use for research purposes and remote research in this population will assist with the development of, recruitment to, and retention within future research projects studying sleep and cognition outside of the clinic or laboratory. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52652.
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Affiliation(s)
- Victoria Grace Gabb
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Jonathan Blackman
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hamish Duncan Morrison
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Bijetri Biswas
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Haoxuan Li
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
- King's College Hospital, King's College Hospital NHS Foundation Trust, London, United Kingdom
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Nicholas Turner
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Rosemary Greenwood
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Research & Innovation, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Amy Jolly
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - William Trender
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Adam Hampshire
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Alan Whone
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
| | - Elizabeth Coulthard
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Neurology Department, Bristol Brain Centre, North Bristol NHS Trust, Bristol, United Kingdom
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Cai Y, Zheng YJ, Cheng CM, Strohl KP, Mason AE, Chang JL. Impact of Hypoglossal Nerve Stimulation on Consumer Sleep Technology Metrics and Patient Symptoms. Laryngoscope 2024. [PMID: 38516821 DOI: 10.1002/lary.31398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Obstructive sleep apnea (OSA) is usually assessed at discrete and infrequent timepoints. Wearable consumer sleep technologies (CST) may allow for more granular and longitudinal assessments of OSA therapy responses and OSA-related symptoms. METHODS In this case series, we enrolled hypoglossal nerve stimulator (HGNS) patients who had an effective treatment response for an 8-week study using a wearable CST. Participants started with "HGNS-on," were randomized to turn off HGNS therapy during either week 4 or 5 ("HGNS-off"), followed by a return to therapy, "HGNS-resume." Participants completed validated symptom questionnaires assessing sleepiness, insomnia symptoms, functional status, and overall sleep health (Satisfaction, Alertness, Timing, Efficiency, and Duration, SATED) each week. CST metrics and survey scores were compared between HGNS treatment phases. Associations between CST metrics and survey scores were assessed. RESULTS Seven participants with a total of 304 nights of CST data showed no statistically significant changes in total sleep time (TST), wake time after sleep onset, or sleep efficiency (SE) across the study periods. During HGNS-off, survey scores indicated significantly worsened OSA-related symptom scores. Two participants had significantly higher heart rate variability (HRV) during HGNS-off (by 3.3 and 6.3 ms) when compared to HGNS active therapy periods. Amongst CST metrics, SATED scores correlated with TST (r = 0.434, p < 0.0001), HRV (r = -0.486, p < 0.0001), and SE (r = 0.320, = 0.0014). In addition, FOSQ-10 scores correlated with average HR during sleep (r = -0.489, p < 0.001). CONCLUSION A 1-week HGNS therapy withdrawal period impacted OSA-related sleep symptoms. Sleep-related metrics measured by a wearable CST correlated with symptom scores indicating potental value in the use of CSTs for longitudinal sleep-tracking in OSA patients. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- Yi Cai
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Yixuan James Zheng
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Chloe M Cheng
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Kingman P Strohl
- Division of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, U.S.A
| | - Ashley E Mason
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, California, U.S.A
- Department of Psychiatry, University of California, San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, U.S.A
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Acheson LS, Gordon C, McKetin R, Brett J, Christmass M, Rodgers C, Lintzeris N, Dunlop A, Farrell M, Shoptaw S, Ezard N, Siefried KJ. Measuring Objective and Subjective Sleep during Lisdexamfetamine Treatment of Acute Methamphetamine Withdrawal: A Feasibility Study. Eur Addict Res 2024; 30:121-125. [PMID: 38498995 DOI: 10.1159/000536328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/21/2023] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Sleep disturbance is common during methamphetamine (MA) use and withdrawal; however, the feasibility of combined subjective-objective measurement of sleep-wake has not been shown in this population. Actigraphy is a well-established, non-invasive measure of sleep-wake cycles with good concordance with polysomnography. This study aimed to investigate the feasibility and utility of using actigraphy and sleep diaries to investigate sleep during MA withdrawal. METHODS We conducted a feasibility and utility study of actigraphy and sleep diaries during a clinical trial of lisdexamfetamine for MA withdrawal. Participants were inpatients for 7 days, wore an actigraph (Philips Actiwatch 2) and completed a modified Consensus Sleep Diary each morning. Participants were interviewed between days 3-5. RESULTS Ten participants (mean age 37 years, 90% male) were enrolled. No participant removed the device prematurely. Participants interviewed (n = 8) reported that the actigraph was not difficult or distracting to wear or completion of daily sleep diary onerous. Actigraphic average daily sleep duration over 7 days was 568 min, sleep onset latency 22.4 min, wake after sleep onset (WASO) 75.2 min, and sleep efficiency 83.6%. Sleep diaries underreported daily sleep compared with actigraphy (sleep duration was 56 min (p = 0.008) and WASO 47 min (p < 0.001) less). Overall sleep quality was 4.4 on a nine-point Likert scale within the diary. CONCLUSIONS Continuous actigraphy is feasible to measure sleep-wake in people withdrawing from MA, with low participant burden. We found important differences in self-reported and actigraphic sleep, which need to be explored in more detail.
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Affiliation(s)
- Liam S Acheson
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Gordon
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca McKetin
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
| | - Jonathan Brett
- Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Christmass
- Next Step Drug and Alcohol Services, Perth, Washington, Australia
- National Drug Research Institute, Curtin University, Perth, Washington, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
- Drug and Alcohol Services, Sydney, New South Wales, Australia
- Specialty of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrian Dunlop
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
- Drug and Alcohol Clinical Services, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Michael Farrell
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
| | - Steven Shoptaw
- Department of Family Medicine, The University of California Los Angeles, Los Angeles, California, USA
| | - Nadine Ezard
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, New South Wales, Australia
- New South Wales Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, New South Wales, Australia
| | - Krista J Siefried
- The National Drug and Alcohol Research Centre (NDARC), The University of New South Wales, Sydney, New South Wales, Australia
- Alcohol and Drug Service, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
- The National Centre for Clinical Research on Emerging Drugs (NCCRED), c/o the University of New South Wales, Sydney, New South Wales, Australia
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Idalino SCC, Cândido LM, Wagner KJP, de Souza Moreira B, de Carvalho Bastone A, Danielewicz AL, de Avelar NCP. Association between sleep problems and functional disability in community-dwelling older adults. BMC Geriatr 2024; 24:253. [PMID: 38481136 PMCID: PMC10938775 DOI: 10.1186/s12877-024-04822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 02/17/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Sleep problems are frequently observed in older adults. They can lead to changes in the individual's physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults. METHODS This was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest. RESULTS Older adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems. CONCLUSIONS Older adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.
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Affiliation(s)
- Stefany Cristina Claudino Idalino
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Santa Catarina, 88906-072, Brazil
| | - Letícia Martins Cândido
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Santa Catarina, 88906-072, Brazil
| | - Katia Jakovljevic Pudla Wagner
- Federal University of Santa Catarina, Campus Curitibanos, Rod. Ulysses Gaboardi, 300, Curitibanos, Santa Catarina, 89520-000, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Federal University of Minas Gerais and Oswaldo Cruz Foundation - Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Ana Lúcia Danielewicz
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Santa Catarina, 88906-072, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina, Campus Araranguá, Rod. Governador Jorge Lacerda, 3201, Urussanguinha, Araranguá, Santa Catarina, 88906-072, Brazil.
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Vallières A, Pappathomas A, Garnier SDB, Mérette C, Carrier J, Paquette T, Bastien CH. Behavioural therapy for shift work disorder improves shift workers' sleep, sleepiness and mental health: A pilot randomised control trial. J Sleep Res 2024:e14162. [PMID: 38443322 DOI: 10.1111/jsr.14162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 03/07/2024]
Abstract
The present study evaluates the efficacy of behavioural therapy adapted for shift work disorder with a randomised control design in a healthcare population. Forty-three night shift workers (m. age: 34 years; 77% women) experiencing shift work disorder were randomised to either the behavioural therapy for shift work disorder (BT-SWD) or a waiting-list control group offered after the waiting period. Participants completed questionnaires on insomnia, sleepiness and mental health pre- and post-treatment, pre- and post-waiting, and at follow-up, and a sleep diary. As night shift workers alternate between sleeping during the day after their night shifts and transitioning to nighttime sleep on days off, insomnia severity and sleep variables were analysed for daytime and nighttime sleep. The BT-SWD involved sleep restriction therapy, stimulus control and fixed sleep periods in the dark. Statistical analyses were performed under intent-to-treat and per-protocol approaches. Repeated-measures two-way ANCOVA analysis, controlling for age, sex and pre-treatment daytime total sleep time, was performed with Bonferroni corrections, and between-group effect sizes computed. Fourteen participants dropped out after randomisation. Under the intent-to-treat analysis, BT-SWD participants had a significant greater decrease in daytime insomnia severity and an increase in daytime total sleep time at post-treatment than the control group, with large between-group effect sizes (-1.25 and 0.89). These corresponding results were also significant with large effect sizes under the per-protocol analysis. Sleepiness, anxiety and depression levels improved at post-treatment and maintained at follow-up when the BT-SWD treated controls were added to the BT-SWD group. The behavioural therapy for shift work disorder can be used to improve the sleep and mental health of healthcare night workers.
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Affiliation(s)
- Annie Vallières
- École de psychologie, Université Laval, Québec, Québec, Canada
- Centre de recherche CERVO, Québec, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec, Québec, Canada
| | - Alric Pappathomas
- École de psychologie, Université Laval, Québec, Québec, Canada
- Centre de recherche CERVO, Québec, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec, Québec, Canada
| | | | - Chantal Mérette
- Centre de recherche CERVO, Québec, Québec, Canada
- Département de psychiatrie et de neurosciences, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Julie Carrier
- Département de psychologie, Université de Montréal, Montréal, Québec, Canada
- Centre d'étude avancée en médecine du sommeil, CIUSSS-NIM, Montréal, Québec, Canada
| | - Tyna Paquette
- Centre d'étude avancée en médecine du sommeil, CIUSSS-NIM, Montréal, Québec, Canada
| | - Célyne H Bastien
- École de psychologie, Université Laval, Québec, Québec, Canada
- Centre de recherche CERVO, Québec, Québec, Canada
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Loughan AR, Lanoye A, Willis KD, Fox A, Ravyts SG, Zukas A, Kim Y. Telehealth group Cognitive-Behavioral Therapy for Insomnia (CBT-I) in primary brain tumor: Primary outcomes from a single-arm phase II feasibility and proof-of-concept trial. Neuro Oncol 2024; 26:516-527. [PMID: 37796017 PMCID: PMC10911999 DOI: 10.1093/neuonc/noad193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Cognitive-Behavioral Therapy for Insomnia (CBT-I), the frontline treatment for insomnia, has yet to be evaluated among patients with primary brain tumors (PwPBT) despite high prevalence of sleep disturbance in this population. This study aimed to be the first to evaluate the feasibility, safety, and acceptability of implementing telehealth group CBT-I as well as assessing preliminary changes in subjective sleep metrics in PwPBT from baseline to follow-up. METHODS Adult PwPBT were recruited to participate in six 90-min telehealth group CBT-I sessions. Feasibility was assessed by rates of screening, eligibility, enrollment, and data completion. Safety was measured by participant-reported adverse events. Acceptability was assessed by retention, session attendance, satisfaction, recommendation of program to others, and qualitative feedback. Participant subjective insomnia severity, sleep quality, and fatigue were assessed at baseline, post intervention, and 3-month follow-up. RESULTS Telehealth group CBT-I was deemed safe. Following the 76% screening rate, 85% of interested individuals met study eligibility and 98% enrolled (N = 44). Ninety-one percent of enrolled participants completed measures at baseline, 79% at post intervention, and 73% at 3-month follow-up. Overall, there was an 80% retention rate for the 6-session telehealth group CBT-I intervention. All participants endorsed moderate-to-strong treatment adherence and 97% reported improved sleep. Preliminary pre-post intervention effects demonstrated improvements in subjective insomnia severity, sleep quality, and fatigue with large effect sizes. These effects were maintained at follow-up. CONCLUSIONS Results of this proof-of-concept trial indicate that telehealth group CBT-I is feasible, safe, and acceptable among PwPBT, providing support for future randomized controlled pilot trials.
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Affiliation(s)
- Ashlee R Loughan
- Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Autumn Lanoye
- Massey Comprehensive Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kelcie D Willis
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Amber Fox
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Scott G Ravyts
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alicia Zukas
- Department of Neurosurgery, Medical College of South Carolina, Charleston, South Carolina, USA
| | - Youngdeok Kim
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
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Lau PH, Marway OS, Carmona NE, Starick E, Iskenderova I, Carney CE. An Investigation of Further Strategies to Optimize Early Treatment Gains in Brief Therapies for Insomnia. Behav Sleep Med 2024; 22:140-149. [PMID: 37232142 DOI: 10.1080/15402002.2023.2217311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Identifying those who are most (and least) likely to benefit from a stepped-care approach to cognitive behavioral therapy for insomnia (CBT-I) increases access to insomnia therapies while minimizing resource consumption. The present study investigates non-targeted factors in a single-session of CBT-I that may act as barriers to early response and remission. METHODS Participants (N = 303) received four sessions of CBT-I and completed measures of subjective insomnia severity, fatigue, sleep-related beliefs, treatment expectations, and sleep diaries. Subjective insomnia severity and sleep diaries were completed between each treatment session. Early response was defined as a 50% reduction in Insomnia Severity Index (ISI) scores and early remission was defined by < 10 on the ISI after the first session. RESULTS A single-session of CBT-I significantly reduced subjective insomnia severity scores and diary total wake time. Logistic regression models indicated that lower baseline fatigue was associated with increased odds of early remission (B = -.05, p = .02), and lower subjective insomnia severity (B = -.13, p = .049). Only fatigue was a significant predictor of early treatment response (B = -.06, p = .003). CONCLUSIONS Fatigue appeared to be an important construct that dictates early changes in perceived insomnia severity. Beliefs about the relationship between sleep and daytime performance may hinder perceived improvements in insomnia symptoms. Incorporating fatigue management strategies and psychoeducation about the relationship between sleep and fatigue may target non-early responders. Future research would benefit from further profiling potential early insomnia responders/remitters.
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Affiliation(s)
- Parky H Lau
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Onkar S Marway
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Nicole E Carmona
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Elisha Starick
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Irene Iskenderova
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Colleen E Carney
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
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Lunsford-Avery JR, Bidopia T, Jackson L, Sloan JS. Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents. Psychiatr Clin North Am 2024; 47:103-120. [PMID: 38302200 DOI: 10.1016/j.psc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Insomnia and related sleep disturbances are prevalent among youth and are associated with adverse consequences, including poorer psychiatric functioning. Behavioral sleep interventions, ranging from brief educational interventions to behavioral therapies (cognitive behavior therapy-insomnia), are associated with positive outcomes for pediatric sleep health. In addition, sleep interventions may improve psychiatric health for children and adolescents with neurodevelopmental and internalizing disorders. Additional research is necessary to clarify the efficacy of these interventions over the long-term and across demographic groups; however, evidence suggests incorporating behavioral sleep strategies may prove beneficial to pediatric patients with sleep disturbances and related psychiatric complaints.
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Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychiatry, Duke University School of Medicine, 2400 Pratt Street, Office 7036, 7th Floor, North Pavilion, Durham, NC 27705, USA.
| | - Tatyana Bidopia
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Leah Jackson
- HRC Behavioral Health & Psychiatry, PA, Chapel Hill, NC, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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.
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Hu S, Chen Y, Chen J, Guo Y, Li Y, Shao Y, Yao P, Lu L, Tang X, Sun H. The insensitivity of sleep to an unfamiliar sleeping environment in patients with insomnia disorder. Sleep Breath 2024; 28:467-473. [PMID: 37747601 DOI: 10.1007/s11325-023-02914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/14/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Sleeping in an unfamiliar environment, such as a sleep laboratory, is thought to disturb sleep in healthy individuals and could express a hyperarousal state called the first night effect. Insomnia disorder (ID) is a highly prevalent health problem characterized by increased arousal during the night and daytime. Whether or not a similar phenomenon occurs in patients with ID is unclear. This study aimed to investigate the effect of an unfamiliar environment on the sleep of patients with ID. METHODS In an unfamiliar sleep laboratory, polysomnographic recording testing was performed for two consecutive nights in patients with ID and age- and sex-matched healthy control subjects (HC). We collected sleep diaries and questionnaires regarding sleep, medical conditions, psychological status, and health history. Sleep continuity and architecture in both groups were compared and analyzed for two consecutive nights. RESULTS Participants with ID (n = 39) and HC (n = 35) demonstrated differentially poor sleep on laboratory adaptation after exposure to the sleep laboratory. Patients with ID had longer rapid eye movement (REM) latency on the first night than on the second sleep night. HC showed increased duration and percentage of N1, decreased duration and percentage of N3, and decreased REM percentage during initial nights compared to subsequent nights. The other sleep variables showed no differences between the first and second sleep nights in patients with ID and HC. CONCLUSIONS An unfamiliar sleep environment does not aggravate the disruption of sleep continuity and sleep architecture but only affects the REM latency in patients with ID compared with HC.
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Affiliation(s)
- Sifan Hu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Yun Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Jie Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Yupeng Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Yuezhen Li
- Department of Neuropsychiatry, Behavioral Neurology and Sleep Center, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yan Shao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Ping Yao
- Mental Health Institute of Inner Mongolia Autonomous Region, The Third Hospital of Inner Mongolia Autonomous Region, Hohhot, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China.
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41
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Baddam SKR, Canapari CA, Van de Grift J, McGirr C, Nasser AY, Crowley MJ. Screening and Evaluation of Sleep Disturbances and Sleep Disorders in Children and Adolescents. Psychiatr Clin North Am 2024; 47:65-86. [PMID: 38302214 DOI: 10.1016/j.psc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sleep disturbances and sleep disorders are prevalent in children/adolescents and have a bidirectional relationship with pediatric medical and mental health disorders. Screening tools and mechanisms for the evaluation and treatment of sleep disturbances and sleep disorders in the pediatric mental health clinic are less well-known; hence, sleep disturbances and disorders are under-recognized in the pediatric clinics. We present specific, validated screening and evaluation tools to identify sleep disturbances and sleep disorders in children/adolescents. We offer guidance related to the use of consumer wearables for sleep assessments and use of sleep telemedicine in pediatric mental health and primary care clinics.
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Affiliation(s)
- Suman K R Baddam
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA.
| | - Craig A Canapari
- Pediatric Pulmonology, Allergy, Immunology & Sleep Medicine, PO Box 208064, New Haven, CT, 06520-8064, USA
| | - Jenna Van de Grift
- Yale University School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | - Christopher McGirr
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
| | | | - Michael J Crowley
- Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT 06519, USA
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Abstract
Insomnia is the most common sleep disorder among all ages; unfortunately, however, child and adolescent insomnia is infrequently addressed. Given the importance of adequate sleep for proper brain development, pediatric populations are particularly vulnerable to the negative effects of insomnia. Therefore, proper clinical assessment and treatment of pediatric insomnia is crucial. This article is the result of a comprehensive literature review and serves as a guide to the disorder and how it presents differently across child development.
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Affiliation(s)
- Madeline Himelfarb
- Department of Child & Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Jess P Shatkin
- Department of Child & Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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Phillips-Beyer A, Kawata AK, Kleinman L, Seboek Kinter D, Flamion B. Meaningful Within-Patient Change in Subjective Total Sleep Time in Patients with Insomnia Disorder: An Analysis of the Sleep Diary Questionnaire Using Data from Open-Label and Phase III Clinical Trials. Pharmaceut Med 2024; 38:133-144. [PMID: 38302765 PMCID: PMC10948516 DOI: 10.1007/s40290-023-00512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND The Sleep Diary Questionnaire (SDQ), a modified version of the Consensus Sleep Diary, is a 17-item sleep diary for assessing subjective total sleep time (sTST: total time spent asleep at night) and other sleep parameters in insomnia trials. sTST is a key parameter of efficacy in insomnia trials; however, the magnitude of improvement in this parameter that people with insomnia disorder consider clinically meaningful is unclear. OBJECTIVE The aim of this study was to estimate meaningful within-patient change for sTST using clinical trial data. METHODS Data were from an open-label trial of zolpidem and pooled data from a phase III placebo-controlled trial of daridorexant. In both trials, adults with moderate to severe insomnia completed the SDQ daily. Meaningful change in sTST was estimated in an anchor-based analysis using outcome measures that were correlated with change in weekly average sTST (Spearman correlation coefficient ≥ 0.30): the Insomnia Severity Index, patient global assessments and impressions of severity and change in daytime and night-time symptoms (PGA-S, PGI-S, PGI-C), and clinician global impressions of severity and change in patients' daytime symptoms (CGI-S, CGI-C). Meaningful within-patient change estimates were 'triangulated' to identify a value where they converged. RESULTS In the open-label trial (N = 114), subjects with a 1-point or 1-step improvement on the anchors had mean increases in sTST of 60.1-83.2 min at day 8 and 55.5-68.2 min at day 15. For subjects with a 2-point or 2-step improvement on the anchors, mean increases in sTST were 79.6-81.4 min at day 8 and 80.1-93.5 min at day 15. In the phase III trial (N = 930), weekly average increases in sTST for subjects with a 1-point or 1-step improvement on the anchors were 39.3-46.7 min at month 1 and 47.3-58.3 min at month 3. For subjects with a 2-point or 2-step improvement on the anchors, mean increases in sTST were 60.7-76.2 min at month 1 and 70.1-87.7 min at month 3. Triangulation of these values supported a meaningful within-patient change threshold starting at 55 min. CONCLUSION Increasing sTST is an important treatment outcome for people with insomnia. An increase in sleep time of approximately 55 min is meaningful to patients. CLINICAL TRIALS REGISTRATION NCT03056053 (17 February 2017) and NCT03545191 (4 June 2018).
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Affiliation(s)
- Andrea Phillips-Beyer
- Innovus Consulting Ltd, 8a Wingbury Courtyard, Business Village, Wingrave, Buckinghamshire, HP22 4LW, UK.
| | | | | | | | - Bruno Flamion
- Clinical Development, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
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Filardi M, Gnoni V, Tamburrino L, Nigro S, Urso D, Vilella D, Tafuri B, Giugno A, De Blasi R, Zoccolella S, Logroscino G. Sleep and circadian rhythm disruptions in behavioral variant frontotemporal dementia. Alzheimers Dement 2024; 20:1966-1977. [PMID: 38183333 PMCID: PMC10984421 DOI: 10.1002/alz.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Sleep and rest-activity rhythm alterations are common in neurodegenerative diseases. However, their characterization in patients with behavioral variant frontotemporal dementia (bvFTD) has proven elusive. We investigated rest-activity rhythm alterations, sleep disturbances, and their neural correlates in bvFTD. METHODS Twenty-seven bvFTD patients and 25 healthy controls completed sleep questionnaires and underwent 7 days of actigraphy while concurrently maintaining a sleep diary. Cortical complexity and thickness were calculated from T1-weighted magnetic resonance (MR) images. RESULTS Compared to controls, bvFTD patients showed longer time in bed (95% confidence interval [CI]: 79.31, 321.83) and total sleep time (95% CI: 24.38, 321.88), lower sleep efficiency (95% CI: -12.58, -95.54), and rest-activity rhythm alterations in the morning and early afternoon. Increased sleep duration was associated with reduced cortical thickness in frontal regions. DISCUSSION Patients with bvFTD showed longer sleep duration, lower sleep quality, and rest-activity rhythm alterations. Actigraphy could serve as a cost-effective and accessible tool for ecologically monitoring changes in sleep duration in bvFTD patients. HIGHLIGHTS We assessed sleep and circadian rhythms in behavioral variant frontotemporal dementia (bvFTD) using actigraphy. Patients with bvFTD show increased sleep duration and reduced sleep quality. Patients with bvFTD show rest-activity alterations in the morning and early afternoon. Sleep duration is associated with reduced cortical thickness in frontal regions. These alterations may represent an early sign of neurodegeneration.
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Affiliation(s)
- Marco Filardi
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Valentina Gnoni
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Ludovica Tamburrino
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Salvatore Nigro
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Davide Vilella
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Benedetta Tafuri
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Alessia Giugno
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
| | - Roberto De Blasi
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
- Department of Diagnostic ImagingPia Fondazione “Card. G. Panico”TricaseItaly
| | - Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
- Neurology Unit, San Paolo HospitalAzienda Sanitaria Locale (ASL) BariBariItaly
| | - Giancarlo Logroscino
- Department of Translational Biomedicine and Neurosciences (DiBraiN)University of Bari Aldo MoroBariItaly
- Center for Neurodegenerative Diseases and the Aging BrainUniversity of Bari Aldo Moro at Pia Fondazione “Card. G. Panico”TricaseItaly
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Vestergaard CL, Skogen JC, Hysing M, Harvey AG, Vedaa Ø, Sivertsen B. Sleep duration and mental health in young adults. Sleep Med 2024; 115:30-38. [PMID: 38330693 DOI: 10.1016/j.sleep.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/10/2024] [Accepted: 01/21/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND The association between sleep duration and mental illness has been established in middle-aged and older populations, yet remains less explored in younger adults. Additionally, a common limitation to existing studies is the lack of statistical power to explore less common disorders. The purpose of this study was to examine sleep duration as a predictor for a range of mental disorders and well-being in a longitudinal sample of young adults. METHODS Data were derived from two waves (w1, w2) of the SHoT survey, which invited all full-time university and college students in Norway. The response rates were 34.4 % (n = 62,498) in 2021 (w1) and 35.1 % (n = 59,554) 2022 (w2). This study utilized a nested longitudinal sample from both w1 and w2, encompassing 21,289 students. Demographics, sleep duration (w1), and mental health (w2) were measured by self-report questionnaires. Sex-stratified linear regression models and log-link binomial regression analyses were employed to determine the proportion and calculate the risk ratios, respectively, for mental illness across different sleep duration categories. RESULTS The mean age of the sample was 24.8 years ± 4.5 years (w1). Students with shorter sleep durations, and to some degree longer sleep durations (illustrating a ᒐ-shaped association), exhibited a higher risk for all assessed mental disorders and well-being outcomes one year later, compared to students sleeping 8-9 h. The ᒐ-shaped trend was consistent for both female and male students. CONCLUSION Sleep duration appears to be a transdiagnostic marker for mental health in young adults.
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Affiliation(s)
- Cecilie L Vestergaard
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway.
| | - Jens C Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Alcohol & Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway; Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Mari Hysing
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, USA
| | - Øystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research and Innovation, Helse-Fonna HF, Haugesund, Norway
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Saifeldin H, Negm IM. Assessing the immediate impact of Twin-block appliance insertion on adolescents' sleep using a wearable device. Orthod Craniofac Res 2024. [PMID: 38426595 DOI: 10.1111/ocr.12773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE This prospective clinical study aimed to evaluate the immediate impact of Twin-block appliance insertion on the sleep of adolescents using a wearable device. MATERIALS AND METHODS A total of 24 girls, aged 11-13 years, with Class II division 1 molar relationship, skeletal class 2 malocclusion (ANB ≥5) and overjet measuring ≥5 mm were selected. Exclusion criteria included a history of previous orthodontic treatment, systemic disease, irregular sleep pattern, obstructive sleep apnea, medical history of breathing disorders, or concurrent use of medications. Participants wore a wearable device to measure sleep parameters, including deep sleep, light sleep, minutes awake during sleep, wake-up times, bedtimes and total sleep times. The participants wore the device for 10 days prior to Twin-block insertion and sleep data were collected for another 10 days after insertion. RESULTS Following the insertion of the Twin-block appliance, there was a highly statistically significant shift in bedtime and wake-up time to later hours (P < .001). All participants experienced a highly significant delay in bedtime compared to the recommended 10 pm time (P < .001). Additionally, there was a significant increase in the duration of light sleep (P < .05). However, the effect on deep sleep, minutes awake during sleep and sleep duration was not statistically significant. None of the sleep parameters tested showed statistically significant changes between the first 5 days after Twin-block insertion with the subsequent 5 days. CONCLUSION The immediate insertion of the Twin-block appliance disrupts sleep onset, wake-up time and light sleep during the specified period of 10 days.
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Affiliation(s)
- Hatem Saifeldin
- Orthodontic Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Ibrahim M Negm
- Orthodontic Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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47
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Guerrera CS, Boccaccio FM, Varrasi S, Platania GA, Coco M, Pirrone C, Castellano S, Caraci F, Ferri R, Lanza G. A narrative review on insomnia and hypersomnolence within Major Depressive Disorder and bipolar disorder: A proposal for a novel psychometric protocol. Neurosci Biobehav Rev 2024; 158:105575. [PMID: 38331126 DOI: 10.1016/j.neubiorev.2024.105575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/27/2024] [Accepted: 02/03/2024] [Indexed: 02/10/2024]
Abstract
Sleep disorders have become increasingly prevalent, with many adults worldwide reporting sleep dissatisfaction. Major Depressive Disorder (MDD) and Bipolar Disorder (BD) are common conditions associated with disrupted sleep patterns such as insomnia and hypersomnolence. These sleep disorders significantly affect the progression, severity, treatment, and outcome of unipolar and bipolar depression. While there is evidence of a connection between sleep disorders and depression, it remains unclear if sleep features differ between MDD and BD. In light of this, this narrative review aims to: (1) summarize findings on common sleep disorders like insomnia and hypersomnolence, strongly linked to MDD and BD; (2) propose a novel psychometric approach to assess sleep in individuals with depressive disorders. Despite insomnia seems to be more influent in unipolar depression, while hypersomnolence in bipolar one, there is no common agreement. So, it is essential adopting a comprehensive psychometric protocol for try to fill this gap. Understanding the relationship between sleep and MDD and BD disorders are crucial for effective management and better quality of life for those affected.
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Affiliation(s)
- Claudia Savia Guerrera
- Department of Educational Sciences, University of Catania, Via Biblioteca, 4, 95124 Catania, Italy; Department of Biomedical and Biotechnological Sciences, University of Catania, Torre Biologica, Via Santa Sofia, 97, 95123 Catania, Italy.
| | | | - Simone Varrasi
- Department of Educational Sciences, University of Catania, Via Biblioteca, 4, 95124 Catania, Italy
| | | | - Marinella Coco
- Department of Educational Sciences, University of Catania, Via Biblioteca, 4, 95124 Catania, Italy
| | - Concetta Pirrone
- Department of Educational Sciences, University of Catania, Via Biblioteca, 4, 95124 Catania, Italy
| | - Sabrina Castellano
- Department of Educational Sciences, University of Catania, Via Biblioteca, 4, 95124 Catania, Italy
| | - Filippo Caraci
- Department of Drug and Health Sciences, University of Catania, Cittadella Universitaria, Via Santa Sofia, 95123 Catania, Italy; Unit of Neuropharmacology and Translation Neurosciences, Oasi Research Institute - IRCCS, Via Conte Ruggero 73, 94018 Troina, En, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology IC, Oasi Research Institute - IRCCS, Via Conte Ruggero 73, 94018 Troina, En, Italy
| | - Giuseppe Lanza
- Unit of Neuropharmacology and Translation Neurosciences, Oasi Research Institute - IRCCS, Via Conte Ruggero 73, 94018 Troina, En, Italy; Department of Surgery and Medical-Surgical Specialties, University of Catania, A.O.U. "Policlinico - San Marco", Via Santa Sofia, 78, 95123 Catania, Italy
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48
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Della Monica C, Ravindran KKG, Atzori G, Lambert DJ, Rodriguez T, Mahvash-Mohammadi S, Bartsch U, Skeldon AC, Wells K, Hampshire A, Nilforooshan R, Hassanin H, The Uk Dementia Research Institute Care Research Amp Technology Research Group, Revell VL, Dijk DJ. A Protocol for Evaluating Digital Technology for Monitoring Sleep and Circadian Rhythms in Older People and People Living with Dementia in the Community. Clocks Sleep 2024; 6:129-155. [PMID: 38534798 DOI: 10.3390/clockssleep6010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/12/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Sleep and circadian rhythm disturbance are predictors of poor physical and mental health, including dementia. Long-term digital technology-enabled monitoring of sleep and circadian rhythms in the community has great potential for early diagnosis, monitoring of disease progression, and assessing the effectiveness of interventions. Before novel digital technology-based monitoring can be implemented at scale, its performance and acceptability need to be evaluated and compared to gold-standard methodology in relevant populations. Here, we describe our protocol for the evaluation of novel sleep and circadian technology which we have applied in cognitively intact older adults and are currently using in people living with dementia (PLWD). In this protocol, we test a range of technologies simultaneously at home (7-14 days) and subsequently in a clinical research facility in which gold standard methodology for assessing sleep and circadian physiology is implemented. We emphasize the importance of assessing both nocturnal and diurnal sleep (naps), valid markers of circadian physiology, and that evaluation of technology is best achieved in protocols in which sleep is mildly disturbed and in populations that are relevant to the intended use-case. We provide details on the design, implementation, challenges, and advantages of this protocol, along with examples of datasets.
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Affiliation(s)
- Ciro Della Monica
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Kiran K G Ravindran
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Giuseppe Atzori
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Damion J Lambert
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Thalia Rodriguez
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- School of Mathematics & Physics, University of Surrey, Guildford GU2 7XH, UK
| | - Sara Mahvash-Mohammadi
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford GU2 7XH, UK
| | - Ullrich Bartsch
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Anne C Skeldon
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- School of Mathematics & Physics, University of Surrey, Guildford GU2 7XH, UK
| | - Kevin Wells
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford GU2 7XH, UK
| | - Adam Hampshire
- Department of Brain Sciences, Imperial College, London W12 0NN, UK
| | - Ramin Nilforooshan
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- Surrey and Borders Partnership NHS Foundation Trust Surrey, Chertsey KT16 9AU, UK
| | - Hana Hassanin
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
- Surrey Clinical Research Facility, University of Surrey, Guildford GU2 7XP, UK
- NIHR Royal Surrey CRF, Royal Surrey Foundation Trust, Guildford GU2 7XX, UK
| | | | - Victoria L Revell
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford GU2 7XP, UK
- UK Dementia Research Institute Care Research & Technology Centre (CR&T), Imperial College London and the University of Surrey, London W12 0NN, UK
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49
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Hertenstein E, Trinca E, Schneider CL, Fehér KD, Johann AF, Nissen C. Acceptance and Commitment Therapy, Combined with Bedtime Restriction, versus Cognitive Behavioral Therapy for Insomnia: A Randomized Controlled Pilot Trial. Psychother Psychosom 2024; 93:114-128. [PMID: 38417415 DOI: 10.1159/000535834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/08/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Cognitive behavioral therapy for insomnia (CBT-I) is the current first-line treatment for insomnia. However, rates of nonresponse and nonremission are high and effects on quality of life are only small to moderate, indicating a need for novel treatment developments. We propose that Acceptance and Commitment Therapy (ACT) addresses core pathophysiological pathways of insomnia. ACT therefore has the potential to improve treatment efficacy when combined with bedtime restriction, the most effective component of CBT-I. The aim of this study was to compare the efficacy of ACT for insomnia combined with bedtime restriction (ACT-I) and CBT-I in improving insomnia severity and sleep-related quality of life. METHODS Sixty-three patients with insomnia disorder (mean age 52 years, 65% female, 35% male) were randomly assigned to receive either ACT-I or CBT-I in a group format. The primary outcomes were insomnia severity (Insomnia Severity Index) and sleep-related quality of life (Glasgow Sleep Impact Index). Outcomes were assessed before randomization (T0), directly after treatment (T1), and at 6-month follow-up (T2). RESULTS The results indicated significant, large pre-to-post improvements in both groups, for both primary and secondary outcomes. Improvements were maintained at the 6-month follow-up. However, there was no significant group by time interactions in linear mixed models, indicating an absence of differential efficacy. On a subjective treatment satisfaction scale, patients in the ACT-I group indicated significantly greater satisfaction with their improvement of several aspects of health including their energy level and work productivity. CONCLUSIONS The results suggest that ACT-I is feasible and effective, but not more effective than CBT-I for the improvement of insomnia severity and sleep-related quality of life. Future studies are needed to assess whether ACT-I is noninferior to CBT-I and to shed light on mechanisms of change in both treatments.
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Affiliation(s)
- Elisabeth Hertenstein
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ersilia Trinca
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carlotta L Schneider
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kristoffer D Fehér
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anna F Johann
- Clinic for Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
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50
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Lam YC, Li C, Hsiao JHW, Lau EYY. A sleepless night disrupts the resolution of emotional conflicts: Behavioural and neural evidence. J Sleep Res 2024:e14176. [PMID: 38404186 DOI: 10.1111/jsr.14176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
The present study aims to investigate the influence of 24-hr sleep deprivation on implicit emotion regulation using the emotional conflict task. Twenty-five healthy young adults completed a repeated-measures study protocol involving a night of at-home normal sleep control and a night of in-laboratory sleep deprivation. Prior to the experimental session, all participants wore an actigraph watch and completed the sleep diary. Following each condition, participants performed an emotional conflict task with electroencephalographic recordings. Emotional faces (fearful or happy) overlaid with words ("fear" or "happy") were used as stimuli creating congruent or incongruent trials, and participants were instructed to indicate whether the facial expression was happy or fearful. We measured the accuracy and reaction time on the emotional conflict task, as well as the mean amplitude of the P300 component of the event-related potential at CPz. At the behavioural level, sleep-deprived participants showed reduced alertness with overall longer reaction times and higher error rates. In addition, participants in the sleep deprivation condition made more errors when the current trial followed congruent trials compared with when it followed incongruent trials. At the neural level, P300 amplitude evoked under the sleep-deprived condition was significantly more positive compared with the normal sleep condition, and this effect interacted with previous-trial and current-trial congruency conditions, suggesting that participants used more attentional resources to resolve emotional conflicts when sleep deprived. Our study provided pioneering data demonstrating that sleep deprivation may impair the regulation of emotional processing in the absence of explicit instruction among emerging adults.
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Affiliation(s)
- Yeuk Ching Lam
- Sleep Laboratory, Department of Psychology, The Education University of Hong Kong, Hong Kong, Hong Kong SAR
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Cheng Li
- Centre for Special Educational Needs and Inclusive Education, The Education University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Janet Hui-Wen Hsiao
- Division of Social Science, Hong Kong University of Science & Technology, Hong Kong, Hong Kong SAR
| | - Esther Yuet Ying Lau
- Sleep Laboratory, Department of Psychology, The Education University of Hong Kong, Hong Kong, Hong Kong SAR
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, Hong Kong SAR
- Centre for Religious and Spirituality Education, The Education University of Hong, Hong Kong, Hong Kong SAR
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