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Chen IY, Radom-Aizik S, Stehli A, Palmer JR, Lui KK, Dave A, Chappel-Farley MG, Vinces KG, Gealer D, Lim A, Mander BA, Benca RM, Neikrug AB. Cardiorespiratory fitness and circadian rhythms in adolescents: a pilot study. J Appl Physiol (1985) 2024; 136:372-384. [PMID: 38126092 DOI: 10.1152/japplphysiol.00291.2023] [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: 05/08/2023] [Revised: 11/07/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
Although cardiorespiratory fitness (CRF), an important marker of youth health, is associated with earlier sleep/wake schedule, its relationship with circadian rhythms is unclear. This study examined the associations between CRF and rhythm variables in adolescents. Eighteen healthy adolescents (10 females and 8 males; Mage = 14.6 ± 2.3 yr) completed two study visits on weekdays bracketing an ambulatory assessment during summer vacation. Visit 1 included in-laboratory CRF assessment (peak V̇o2) using a ramp-type progressive cycle ergometry protocol and gas exchange measurement, which was followed by 7-14 days of actigraphy to assess sleep/wake patterns and 24-h activity rhythms. During Visit 2, chronotype, social jetlag (i.e., the difference in midsleep time between weekdays and weekends), and phase preference were assessed using a questionnaire, and hourly saliva samples were collected to determine the dim light melatonin onset (DLMO) phase. All analyses were adjusted for sex, pubertal status, and physical activity. Greater peak V̇o2 was associated with earlier sleep/wake times and circadian phase measures, including acrophase, UP time, DOWN time, last activity peak (LAP) time, and chronotype (all P < 0.05). Peak V̇o2 was negatively associated with social jetlag (P = 0.02). In addition, the mixed-model analysis revealed a significant interaction effect between peak V̇o2 and actigraphy-estimated hour-by-hour activity patterns (P < 0.001), with the strongest effects observed at around the time of waking (0600-1000). In healthy adolescents, better CRF was associated with an earlier circadian phase and increased activity levels notably during the morning. Future studies are needed to investigate the longitudinal effects of the interactions between CRF and advanced rhythms on health outcomes.NEW & NOTEWORTHY In healthy adolescents, better cardiorespiratory fitness, as assessed by the gold standard measure [laboratory-based assessment of peak oxygen consumption (V̇o2)], was associated with earlier circadian timing of sleep/wake patterns, rest-activity rhythms and chronotype, and less social jetlag. These findings highlight the close interrelationships between fitness and rhythms and raise the possibility that maintaining higher cardiorespiratory fitness levels alongside earlier sleep/wake schedule and activity rhythms may be important behavioral intervention targets to promote health in adolescents.
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Affiliation(s)
- Ivy Y Chen
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, United States
| | - Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center, University of California, Irvine, Irvine, California, United States
| | - Annamarie Stehli
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, United States
- Pediatric Exercise and Genomics Research Center, University of California, Irvine, Irvine, California, United States
| | - Jake R Palmer
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kitty K Lui
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, United States
| | - Abhishek Dave
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, United States
| | - Miranda G Chappel-Farley
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, California, United States
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, California, United States
| | - Karla G Vinces
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, United States
| | - Daniel Gealer
- Pediatric Exercise and Genomics Research Center, University of California, Irvine, Irvine, California, United States
| | - Alexandra Lim
- Pediatric Exercise and Genomics Research Center, University of California, Irvine, Irvine, California, United States
| | - Bryce A Mander
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, United States
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, California, United States
| | - Ruth M Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, United States
| | - Ariel B Neikrug
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, California, United States
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2
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Berisha DE, Rizvi B, Chappel-Farley MG, Tustison N, Taylor L, Dave A, Sattari NS, Chen IY, Lui KK, Janecek JC, Keator D, Neikrug AB, Benca RM, Yassa MA, Mander BA. Cerebrovascular pathology mediates associations between hypoxemia during rapid eye movement sleep and medial temporal lobe structure and function in older adults. bioRxiv 2024:2024.01.28.577469. [PMID: 38328085 PMCID: PMC10849660 DOI: 10.1101/2024.01.28.577469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Obstructive sleep apnea (OSA) is common in older adults and is associated with medial temporal lobe (MTL) degeneration and memory decline in aging and Alzheimer's disease (AD). However, the underlying mechanisms linking OSA to MTL degeneration and impaired memory remains unclear. By combining magnetic resonance imaging (MRI) assessments of cerebrovascular pathology and MTL structure with clinical polysomnography and assessment of overnight emotional memory retention in older adults at risk for AD, cerebrovascular pathology in fronto-parietal brain regions was shown to statistically mediate the relationship between OSA-related hypoxemia, particularly during rapid eye movement (REM) sleep, and entorhinal cortical thickness. Reduced entorhinal cortical thickness was, in turn, associated with impaired overnight retention in mnemonic discrimination ability across emotional valences for high similarity lures. These findings identify cerebrovascular pathology as a contributing mechanism linking hypoxemia to MTL degeneration and impaired sleep-dependent memory in older adults.
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Affiliation(s)
- Destiny E. Berisha
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Batool Rizvi
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Miranda G. Chappel-Farley
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Nicholas Tustison
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Lisa Taylor
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Abhishek Dave
- Department of Cognitive Sciences, University of California Irvine, Irvine CA, 92697, USA
| | - Negin S. Sattari
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ivy Y. Chen
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Kitty K. Lui
- San Diego State University/University of California San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92093, USA
| | - John C. Janecek
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - David Keator
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ariel B. Neikrug
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ruth M. Benca
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, 53706, WI, USA
- Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, NC, 27109, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
| | - Michael A. Yassa
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
- Department of Neurology, University of California Irvine, Irvine CA, 92697, USA
| | - Bryce A. Mander
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Department of Cognitive Sciences, University of California Irvine, Irvine CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine CA, 92697, USA
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Huo S, Bruckner TA, Xiong GL, Cooper E, Wade A, Neikrug AB, Gagliardi JP, McCarron R. Antidepressant Prescription Behavior Among Primary Care Clinician Providers After an Interprofessional Primary Care Psychiatric Training Program. Adm Policy Ment Health 2023; 50:926-935. [PMID: 37598371 PMCID: PMC10543424 DOI: 10.1007/s10488-023-01290-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 08/22/2023]
Abstract
Primary care providers (PCPs) are increasingly called upon to screen for and treat depression. However, PCPs often lack the training to diagnose and treat depression. We designed an innovative 12-month evidence and mentorship-based primary care psychiatric training program entitled the University of California, Irvine (UCI) School of Medicine Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship and examined whether this training impacted clinician prescription rates for antidepressants. We retrieved information on 18,844 patients and 192 PCPs from a publicly insured health program in Southern California receiving care between 2017 and 2021. Of the 192 PCPs, 42 received TNT training and 150 did not. We considered a patient as exposed to the provider's TNT treatment if they received care from a provider after the provider completed the 1-year fellowship. We utilized the number of antidepressant prescriptions per patient, per quarter-year as the dependent variable. Linear regression models controlled for provider characteristics and time trends. Robustness checks included clustering patients by provider identification. After PCPs completed TNT training, "exposed" patients received 0.154 more antidepressant prescriptions per quarter-year relative to expected levels (p < 0.01). Clustering of standard errors by provider characteristics reduced precision of the estimate (p < 0.10) but the direction and magnitude of the results were unchanged. Early results from the UCI TNT PCP Fellowship demonstrate enhanced antidepressant prescription behavior in PCPs who have undergone TNT training. A novel, and relatively low-cost, clinician training program holds the potential to empower PCPs to optimally deliver depression treatment.
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Affiliation(s)
- Shutong Huo
- University of California Irvine, Program in Public Health, Irvine, CA USA
| | - Tim A. Bruckner
- University of California Irvine, Program in Public Health, Irvine, CA USA
- Public Health & Planning, Policy and Design, University of California, Irvine, CA USA
| | - Glen L. Xiong
- University of California, Davis, Psychiatry and Behavioral Sciences, Sacramento, CA USA
| | - Emma Cooper
- University of California Irvine Department of Psychiatry and Human Behavior, Orange, CA USA
| | - Amy Wade
- Inland Empire Health Plan, Rancho Cucamonga, CA USA
| | - Ariel B. Neikrug
- University of California Irvine School of Medicine, Irvine, CA USA
| | - Jane P. Gagliardi
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC USA
| | - Robert McCarron
- University of California Irvine School of Medicine, Irvine, CA USA
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Chappel-Farley MG, Adams JN, Betzel RF, Janecek JC, Sattari NS, Berisha DE, Meza NJ, Niknazar H, Kim S, Dave A, Chen IY, Lui KK, Neikrug AB, Benca RM, Yassa MA, Mander BA. Medial temporal lobe functional network architecture supports sleep-related emotional memory processing in older adults. bioRxiv 2023:2023.10.27.564260. [PMID: 37961192 PMCID: PMC10634911 DOI: 10.1101/2023.10.27.564260] [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] [Indexed: 11/15/2023]
Abstract
Memory consolidation occurs via reactivation of a hippocampal index during non-rapid eye movement slow-wave sleep (NREM SWS) which binds attributes of an experience existing within cortical modules. For memories containing emotional content, hippocampal-amygdala dynamics facilitate consolidation over a sleep bout. This study tested if modularity and centrality-graph theoretical measures that index the level of segregation/integration in a system and the relative import of its nodes-map onto central tenets of memory consolidation theory and sleep-related processing. Findings indicate that greater network integration is tied to overnight emotional memory retention via NREM SWS expression. Greater hippocampal and amygdala influence over network organization supports emotional memory retention, and hippocampal or amygdala control over information flow are differentially associated with distinct stages of memory processing. These centrality measures are also tied to the local expression and coupling of key sleep oscillations tied to sleep-dependent memory consolidation. These findings suggest that measures of intrinsic network connectivity may predict the capacity of brain functional networks to acquire, consolidate, and retrieve emotional memories.
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Affiliation(s)
- Miranda G. Chappel-Farley
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Jenna N. Adams
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Richard F. Betzel
- Department of Psychological and Brain Sciences, University of Indiana Bloomington, Bloomington IN, 47405
| | - John C. Janecek
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Negin S. Sattari
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Destiny E. Berisha
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Novelle J. Meza
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Hamid Niknazar
- Department of Cognitive Sciences, University of California Irvine, Irvine CA, 92697, USA
| | - Soyun Kim
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
| | - Abhishek Dave
- Department of Cognitive Sciences, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ivy Y. Chen
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Kitty K. Lui
- San Diego State University/University of California San Diego, Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92093, USA
| | - Ariel B. Neikrug
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
| | - Ruth M. Benca
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, 53706, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, 53706, WI, USA
- Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, NC, 27109, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
| | - Michael A. Yassa
- Department of Neurobiology and Behavior, University of California Irvine, Irvine CA, 92697, USA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
- Department of Neurology, University of California Irvine, Irvine CA, 92697, USA
| | - Bryce A. Mander
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine CA, 92697, USA
- Department of Cognitive Sciences, University of California Irvine, Irvine CA, 92697, USA
- Department of Psychiatry and Human Behavior, University of California Irvine, Irvine CA, 92697, USA
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine CA, 92697, USA
- Department of Pathology and Laboratory Medicine, University of California Irvine, Irvine CA, 92697, USA
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Neikrug AB. Actigraphy in clinical sleep medicine. Sleep Med Rev 2023; 68:101767. [PMID: 36893499 DOI: 10.1016/j.smrv.2023.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
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Neikrug AB, Stehli A, Xiong GL, Suo S, Le-Bucklin KV, Cant W, McCarron RM. Train New Trainers Primary Care Psychiatry Fellowship-Optimizing Delivery of Behavioral Health Care Through Training for Primary Care Providers. J Contin Educ Health Prof 2022; 42:105-114. [PMID: 35439771 DOI: 10.1097/ceh.0000000000000432] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To expand and optimize the behavioral health workforce, it is necessary to improve primary care providers' (PCPs) overall knowledge and clinical skills in primary care-based psychiatry. Studies on the effects of postgraduate psychiatric education programs for PCPs on psychiatric knowledge are limited. METHODS A total of 251 PCPs completed a 1-year fellowship. Data from program development and evaluation were analyzed for 4 fellowship years (2016-2019). Fellows were surveyed at baseline, midpoint, and postfellowship about mental health stigma, perceived competency, attitudes about psychiatry, satisfaction with current psychiatric knowledge, confidence and comfort to treat psychiatric illnesses, and program satisfaction. Psychiatric knowledge was evaluated at baseline, midpoint, and postfellowship. RESULTS Large effects were noted on perceived competency/self-efficacy and confidence in the treatment of common psychiatric disorders encountered in primary care settings. Positive effects were observed on attitudes of mental health stigma, and even more robust effects were found with improvement in psychiatry clinical knowledge. Knowledge improved by 12% at postfellowship (P < .0001). Correlations of the degree of change in attitude with improved psychiatric literacy demonstrated significant relationships with reduction of stigma total score (r = -0.2133, P = .0043), increased willingness (r = 0.1941, P = .0096), and increased positive attitudes (r = 0.1894, P = .0111). CONCLUSION Innovative initiatives to improve and expand psychiatric knowledge and clinical skills among those who provide the most behavioral health care (PCPs) can have marked impacts on attitudes toward mental health care delivery, stigma, and competency/self-efficacy. Future studies are necessary to consider the impact of this program on clinical practice pattern outcomes on a larger scale.
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Affiliation(s)
- Ariel B Neikrug
- Neikrug: Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA. Stehli: Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA. Xiong: Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA. Suo: Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA. Le-Bucklin: Susan and Henry Samueli College of Health Sciences, University of California Irvine, Irvine, CA. Cant: Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA. McCarron: Department of Psychiatry and Human Behavior, University of California Irvine, Irvine, CA
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Chappel-Farley MG, Mander BA, Neikrug AB, Stehli A, Nan B, Grill JD, Yassa MA, Benca RM. Symptoms of obstructive sleep apnea are associated with less frequent exercise and worse subjective cognitive function across adulthood. Sleep 2022; 45:zsab240. [PMID: 34604910 PMCID: PMC8919199 DOI: 10.1093/sleep/zsab240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 04/23/2021] [Revised: 08/15/2021] [Indexed: 02/07/2023] Open
Abstract
STUDY OBJECTIVES To determine whether subjective measures of exercise and sleep are associated with cognitive complaints and whether exercise effects are mediated by sleep. METHODS This study analyzed questionnaire data from adults (18-89) enrolled in a recruitment registry. The Cognitive Function Instrument (CFI) assessed cognitive complaints. Medical Outcomes Study Sleep Scale (MOS-SS) subscales and factor scores assessed sleep quality, daytime sleepiness, nighttime disturbance, and insomnia and obstructive sleep apnea (OSA)-like symptoms. Exercise frequency was defined as the weekly number of exercise sessions. Exercise frequency, MOS-SS subscales, and factor scores were examined as predictors of CFI score, adjusting for age, body mass index, education, sex, cancer diagnosis, antidepressant usage, psychiatric conditions, and medical comorbidities. Analyses of covariance examined the relationship between sleep duration groups (short, mid-range, and long) and CFI score, adjusting for covariates. Mediation by sleep in the exercise-CFI score relationship was tested. RESULTS Data from 2106 adults were analyzed. Exercise and MOS-SS subscales and factor scores were associated with CFI score. Higher Sleep Adequacy scores were associated with fewer cognitive complaints, whereas higher Sleep Somnolence, Sleep Disturbance, Sleep Problems Index I, Sleep Problems Index II, and factor scores were associated with more cognitive complaints. MOS-SS subscales and factor scores, except Sleep Disturbance and the insomnia factor score, mediated the association between exercise and cognitive complaints. CONCLUSIONS The relationship between exercise frequency and subjective cognitive performance is mediated by sleep. In particular, the mediation effect appears to be driven by symptoms possibly suggestive of OSA which are negatively associated with exercise engagement, sleep quality, daytime sleepiness, and subjective cognitive performance.
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Affiliation(s)
- Miranda G Chappel-Farley
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, USA
| | - Bryce A Mander
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
- Department of Cognitive Sciences, University of California Irvine, Irvine, CA, USA
| | - Ariel B Neikrug
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
| | - Annamarie Stehli
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
| | - Bin Nan
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
- Department of Statistics, University of California, Irvine, Irvine, CA, USA
| | - Joshua D Grill
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Michael A Yassa
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
| | - Ruth M Benca
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, USA
- Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, NC, USA
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8
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Rissling M, Liu L, Youngstedt SD, Trofimenko V, Natarajan L, Neikrug AB, Jeste N, Parker BA, Ancoli-Israel S. Preventing Sleep Disruption With Bright Light Therapy During Chemotherapy for Breast Cancer: A Phase II Randomized Controlled Trial. Front Neurosci 2022; 16:815872. [PMID: 35356054 PMCID: PMC8959343 DOI: 10.3389/fnins.2022.815872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The goal of this study was to examine whether daily increased morning light exposure would maintain or improve sleep and the circadian pattern of relatively more activity in the day and less during the night in women undergoing chemotherapy for breast cancer. Patients and Methods Participants were 39 women with newly diagnosed breast cancer, randomized to either 30-mins of daily morning bright white light (BWL) or dim red light (DRL). Sleep/wake was measured objectively for 72-h with wrist actigraphy and subjectively with the Pittsburgh Sleep Quality Index (PSQI) prior to and during chemotherapy cycles 1 and 4. The study was registered with the National Institutes of Health ClinicalTrials.gov (Clinical Trials number: NCT00478257). Results Results from actigraphy suggested that compared to the DRL group, women in the BWL group had longer night-time sleep, fewer sleep disturbances during the night, and had fewer and shorter daytime naps at the end of cycle 4 of chemotherapy as well as exhibiting less activity at night and more activity during the day by the end of cycle 4. Results from PSQI indicated that components of sleep quality improved but daytime dysfunction deteriorated during cycle 4 treatment in the BWL group; meanwhile the DRL group used more sleep medications in the treatment weeks which might have led to the improved sleep quality during the recovery weeks of both cycles. Conclusion These results suggest that bright white light therapy administered every morning on awakening may protect women undergoing chemotherapy for breast cancer from nighttime sleep and daytime wake disruption. Randomized clinical trials in larger samples are needed to confirm these findings.
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Affiliation(s)
- Michelle Rissling
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Lianqi Liu
- Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Shawn D Youngstedt
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | | | - Loki Natarajan
- Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States
- Moores Cancer Center, University of California, San Diego, San Diego, CA, United States
| | - Ariel B Neikrug
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, United States
| | | | - Barbara A Parker
- Department of Medicine, University of California, San Diego, San Diego, CA, United States
- Moores Cancer Center, University of California, San Diego, San Diego, CA, United States
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
- Moores Cancer Center, University of California, San Diego, San Diego, CA, United States
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9
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Ancoli-Israel S, Liu L, Natarajan L, Rissling M, Neikrug AB, Youngstedt SD, Mills PJ, Sadler GR, Dimsdale JE, Parker BA, Palmer BW. Reductions in sleep quality and circadian activity rhythmicity predict longitudinal changes in objective and subjective cognitive functioning in women treated for breast cancer. Support Care Cancer 2021; 30:3187-3200. [PMID: 34957532 PMCID: PMC8857013 DOI: 10.1007/s00520-021-06743-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine long-term cognitive effects of chemotherapy and identify predictors among women with breast cancer (WBC). PATIENTS AND METHODS Sixty-nine WBC scheduled to receive chemotherapy, and 64 matched-controls with no cancer, participated. Objective and subjective cognition, total sleep time, nap time, circadian activity rhythms (CAR), sleep quality, fatigue, and depression were measured pre-chemotherapy (Baseline), end of cycle 4 (Cycle-4), and one-year post-chemotherapy (1-Year). RESULTS WBC showed no change in objective cognitive measures from Baseline to Cycle-4 but significantly improved from both time points to 1-Year. Matched-controls showed an increase in test performance at all time points. WBC had significantly higher self-reported cognitive dysfunction at Cycle-4 and 1-Year compared to baseline and compared to matched-controls. Worse neuropsychological functioning was predicted by less robust CARs (i.e., inconsistent 24 h pattern), worse sleep quality, longer naps, and worse cognitive complaints. Worse subjective cognition was predicted by lower sleep quality and higher fatigue and depressed mood. CONCLUSION Objective testing showed increases in performance scores from pre- and post-chemotherapy to one year later in WBC, but matched-controls showed an increase in test performance from baseline to Cycle-4 and from Cycle-4 to 1-Year, likely due to a practice effect. The fact that WBC showed no practice effects may reflect a form of learning deficit. Compared with the matched-controls, WBC reported significant worsened cognitive function. In WBC, worse objective and subjective cognitive functioning were predicted by worse sleep and sleep-related behaviors (naps and CAR). Interventions that target sleep, circadian rhythms, and fatigue may benefit cognitive function in WBC.
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Affiliation(s)
- Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0737, USA. .,University of California, San Diego Moores Cancer Center, San Diego, CA, USA.
| | - Lianqi Liu
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Loki Natarajan
- University of California, San Diego Moores Cancer Center, San Diego, CA, USA.,Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Michelle Rissling
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0737, USA
| | - Ariel B Neikrug
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA, USA
| | - Shawn D Youngstedt
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Paul J Mills
- Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Georgia R Sadler
- University of California, San Diego Moores Cancer Center, San Diego, CA, USA.,Department of Surgery, University of California, San Diego, San Diego, CA, USA
| | - Joel E Dimsdale
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0737, USA.,University of California, San Diego Moores Cancer Center, San Diego, CA, USA
| | - Barbara A Parker
- University of California, San Diego Moores Cancer Center, San Diego, CA, USA.,Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0737, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
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10
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Neikrug AB, Mander BA, Radom-Aizik S, Chen IY, Stehli A, Lui KK, Chappel-Farley MG, Dave A, Benca RM. Aerobic fitness and the sleeping brain of adolescents-a pilot study. Sleep Adv 2021; 2:zpab005. [PMID: 33981996 PMCID: PMC8101484 DOI: 10.1093/sleepadvances/zpab005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/17/2021] [Indexed: 11/14/2022]
Abstract
STUDY OBJECTIVES Aerobic fitness (AF) and sleep are major determinants of health in adolescents and impact neurocognitive and psychological development. However, little is known about the interactions between AF and sleep during the developmental transition experienced across adolescence. This study aimed to consider the relationships between AF and habitual sleep patterns and sleep neurophysiology in healthy adolescents. METHODS Subjects (mean age = 14.6 ± 2.3 years old, range 11-17, 11 females) were evaluated for AF (peak VO2 assessed by ramp-type progressive cycle ergometry in the laboratory), habitual sleep duration and efficiency (7-14 days actigraphy), and topographic patterns of spectral power in slow wave, theta, and sleep spindle frequencies in non-rapid eye movement (NREM) sleep using overnight polysomnography (PSG) with high-density electroencephalography (hdEEG, 128 channels). RESULTS Significant relationships were observed between peak VO2 and habitual bedtime (r = -0.650, p = .009) and wake-up time (r = -0.603, p = .017), with greater fitness associated with going to bed and waking up earlier. Peak VO2 significantly predicted slow oscillations (0.5-1 Hz, p = .018) and theta activity (4.5-7.5 Hz, p = .002) over anterior frontal and central derivations (p < .001 and p = .001, respectively) after adjusting for sex and pubertal development stage. Similar associations were detected for fast sleep spindle activity (13-16 Hz, p = .006), which was greater over temporo-parietal derivations. CONCLUSIONS Greater AF was associated with a more mature pattern of topographically-specific features of sleep EEG known to support neuroplasticity and cognitive processes and which are dependent on prefrontal cortex and hippocampal function in adolescents and adults. AF was also correlated with a smaller behavioral sleep phase delay commonly seen during adolescence.
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Affiliation(s)
- Ariel B Neikrug
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine, Irvine, CA
| | - Bryce A Mander
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine, Irvine, CA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, CA
| | - Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center, School of Medicine, University of California Irvine, Irvine, CA
| | - Ivy Y Chen
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine, Irvine, CA
| | - Annamarie Stehli
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine, Irvine, CA
- Pediatric Exercise and Genomics Research Center, School of Medicine, University of California Irvine, Irvine, CA
| | - Kitty K Lui
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine, Irvine, CA
| | - Miranda G Chappel-Farley
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, CA
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA
| | - Abhishek Dave
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine, Irvine, CA
| | - Ruth M Benca
- Department of Psychiatry and Human Behavior, School of Medicine, University of California Irvine, Irvine, CA
- Center for the Neurobiology of Learning and Memory, University of California Irvine, Irvine, CA
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA
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11
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Chen IY, Neikrug AB, Adams J, McMillan L, Yassa MA, Benca RM. 1098 Altered Actigraphic Behavioral Activity Rhythm In Depression. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Disturbances in sleep and behavioral activity rhythms (BAR) are frequently observed in individuals with depression. However, it remains unclear how activity variability across the 24-hour period is specifically associated with this disorder. The present study aimed to examine actigraphy-measured sleep and BAR in depression.
Methods
As part of a larger study, fourteen patients with DSM-5 major depressive episode (27.8±7.7 years, 69.2% female) and 13 healthy controls (21.8±1.2 years, 76.5% female) were evaluated with 7-14 days of wrist-actigraphy. Actigraphy-derived sleep parameters included total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE). Minute-by-minute activity counts were aggregated into hour-by-hour bins; hourly mean activity levels were then generated to depict 24-hour activity patterns (i.e., BAR). Factorial (GroupxTime) mixed models were conducted to examine whether BAR differed between patients with MDD and controls. Generalized Additive Models (GAM), by fitting smoothed nonlinear curves to log-transformed aggregated activity, were performed as exploratory analyses to characterize onset (UP slope) and offset (DOWN slope) of BAR.
Results
Compared to healthy controls, patients with MDD exhibited greater actigraphic TST (p=.026); no other between-group differences were detected for the remaining sleep parameters. Significant between-group differences were observed for mean activity during wakefulness (p<.001). Mixed models assessing hour-by-hour daily activity revealed a significant GroupxTime interaction (p=.001) with significant main effects of group (p=.017) and time (p<.001); patients with MDD had lower activity from 6 to 9 pm (ps<.005). Exploratory GAMs results showed an attenuated DOWN slope in patients with MDD (p=.014), indicating a slower decrease in activity during the evening.
Conclusion
Altered BAR, characterized by an overall dampened activity pattern that was most prominent during the evening, was associated with depression. Furthermore, patients with MDD took longer to wind down in the evening. Future studies are needed to explore the potential benefits of adjunctive interventions addressing both BAR along with sleep in mitigating symptoms of depression.
Support
Research supported by National Institutes of Health R01 MH102392.
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Affiliation(s)
- I Y Chen
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA
| | - A B Neikrug
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA
| | - J Adams
- Department of Neurobiology and Behavior, Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA
| | - L McMillan
- Department of Neurobiology and Behavior, Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA
| | - M A Yassa
- Department of Neurobiology and Behavior, Center for the Neurobiology of Learning and Memory, University of California, Irvine, Irvine, CA
| | - R M Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA
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12
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Lui KK, Mander BA, Radom-Aizik S, Chappel-Farley MG, Dave A, Chen IY, Benca RM, Neikrug AB. 0335 Frontal Expression of NREM Sleep Oscillations are Associated with Executive Function in Children and Adolescents. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The prefrontal cortex, an area known for executive functioning (including inhibition and self-monitoring) develops during childhood and adolescents, with a pattern of posterior to anterior brain development. Slow-wave activity (SWA) in NREM sleep, tracks brain development with high SWA power migrating from occipital to frontal region as brain maturation occurs. This pilot study aimed to examine whether slow wave topography is correlated with executive function in youth.
Methods
Seventeen healthy children and adolescents (ages 11-17; 10 females) underwent overnight polysomnography (PSG) with high-density electroencephalography (hdEEG). Behavior Rating Inventory of Executive Function (BRIEF) was administered to assess executive function. SWA (SWA1: 0.5-1 Hz; SWA2: 1-4.5 Hz) and spindle (slow sigma: 11-13 Hz; fast sigma: 13-16 Hz) activity was analyzed with spectral analysis using Welch’s method. BRIEF subscales of inhibition and monitor were correlated with SWA and sigma power across all derivations, with Holm-Bonferroni correction (126 channels). Significant derivations were then controlled for sex and self-reported Tanner stage using multiple regression
Results
BRIEF-Inhibition scale (i.e., ability to repress impulsivity) and SWA1 in anterior frontal derivations were negatively correlated (R2=0.58, p=0.047 corrected). BRIEF-Monitor scale (i.e., self-perception of one’s own behavior and interpersonal awareness) was negatively correlated with fast sigma in anterior frontal derivations (R2=0.65, p=0.013 corrected). These associations were significant after controlling for sex and Tanner stage.
Conclusion
These results support the hypothesis that NREM sleep oscillations are associated with executive function and reflect changes in neuroplasticity related to “back-to-front” brain maturation. Future longitudinal studies should combine multi-modal neuroimaging of brain structure and local sleep with comprehensive assessments of executive function to evaluate the possible link between local sleep and development of higher-order cognition in frontal brain regions in youth.
Support
NCATS grant #UL1TR001414 & PERC Systems Biology Fund
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Affiliation(s)
- K K Lui
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA
| | - B A Mander
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA
| | - S Radom-Aizik
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, University of California, Irvine, Irvine, CA
| | - M G Chappel-Farley
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA
| | - A Dave
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA
| | - I Y Chen
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA
| | - R M Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA
| | - A B Neikrug
- Department of Psychiatry and Human Behavior, University of California, Irvine, Irvine, CA
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13
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Neikrug AB, Radom-Aizik S, Chen IY, Stehli A, Lui KK, Chappel-Farley MG, Lim AN, Mander BA, Benca RM. 0325 Better Aerobic Fitness is Associated with Distinct Sleep Characteristics in Children and Adolescents - A Pilot Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Aerobic fitness facilitates brain synaptic plasticity, which influences global and local sleep expression. While it is known that sleep patterns/behavior and non-rapid eye movement (NREM) sleep slow wave activity (SWA) tracks brain maturation, little is known about how aerobic fitness and sleep interact during growth and development in children and adolescents. The aim of this pilot study was to characterize relationships among aerobic fitness, measures of global/local sleep expression, and habitual sleep patterns in children and adolescents. We hypothesized that greater aerobic fitness would be associated with better sleep quality, indicated by increased SWA.
Methods
Twenty healthy youth (11-17 years-old, 11 female) were evaluated during summer vacation (no school schedule constraints). Aerobic fitness (VO2peak) was measured using ramp-type progressive cycle ergometry, habitual sleep (i.e., sleep-time consistency and circadian activity patterns) was assessed with 7-day actigraphy, and ad lib sleep was evaluated during overnight polysomnography (PSG) with high-density electroencephalography (hdEEG; 128 channels). Spectral analysis was implemented to quantify SWA (0.5-4.5Hz). Data were analyzed using linear regression analyses and exploratory independent samples t-tests.
Results
Negative correlations were observed between VO2peak and sleep measures including sleep-time consistency (partial r=-0.53, p=0.045) and timing/acrophase of the circadian activity rhythm (partial r=-0.64, p=0.01) while controlling for sex and age. Additionally, after accounting for Tanner stage and sex, data demonstrated significant effects in SWA at frontal derivations (p=0.024) between low and high fitness levels at topographically specific and meaningful EEG derivations, e.g. over frontal cortex.
Conclusion
These results suggest that children and adolescents with greater fitness have less variability in sleep-times (improved sleep consistency), tend to have a more advanced circadian activity phase (i.e., go to sleep earlier), and express greater frontal SWA, supporting the hypothesis that fitness is associated with improved local and global sleep quality. Future research with larger samples is necessary to further evaluate these relationships, and to determine if interventions that improve fitness also improve sleep and related brain plasticity.
Support
NCATS grant #UL1TR001414 & PERC Systems Biology Fund
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Affiliation(s)
| | | | - I Y Chen
- University of California Irvine, Irvine, CA
| | - A Stehli
- University of California Irvine, Irvine, CA
| | - K K Lui
- University of California Irvine, Irvine, CA
| | | | - A N Lim
- University of California Irvine, Irvine, CA
| | - B A Mander
- University of California Irvine, Irvine, CA
| | - R M Benca
- University of California Irvine, Irvine, CA
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14
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Neikrug AB, Chen IY, Palmer JR, McCurry SM, Von Korff M, Perlis M, Vitiello MV. Characterizing Behavioral Activity Rhythms in Older Adults Using Actigraphy. Sensors (Basel) 2020; 20:E549. [PMID: 31963889 PMCID: PMC7014517 DOI: 10.3390/s20020549] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 12/23/2022]
Abstract
Wrist actigraphy has been used to assess sleep in older adult populations for nearly half a century. Over the years, the continuous raw activity data derived from actigraphy has been used for the characterization of factors beyond sleep/wake such as physical activity patterns and circadian rhythms. Behavioral activity rhythms (BAR) are useful to describe individual daily behavioral patterns beyond sleep and wake, which represent important and meaningful clinical outcomes. This paper reviews common rhythmometric approaches and summarizes the available data from the use of these different approaches in older adult populations. We further consider a new approach developed in our laboratory designed to provide graphical characterization of BAR for the observed behavioral phenomenon of activity patterns across time. We illustrate the application of this new approach using actigraphy data collected from a well-characterized sample of older adults (age 60+) with osteoarthritis (OA) pain and insomnia. Generalized additive models (GAM) were implemented to fit smoothed nonlinear curves to log-transformed aggregated actigraphy-derived activity measurements. This approach demonstrated an overall strong model fit (R2 = 0.82, SD = 0.09) and was able to provide meaningful outcome measures allowing for graphical and parameterized characterization of the observed activity patterns within this sample.
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Affiliation(s)
- Ariel B. Neikrug
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697, USA;
| | - Ivy Y. Chen
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA 92697, USA;
| | - Jake R. Palmer
- Department of Psychology, Macquarie University, Sydney, NSW 2113, Australia;
- Healthy Brain Ageing Program, Brain and Mind Centre, University of Sydney, Sydney, NSW 2006, Australia
| | - Susan M. McCurry
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA 98195, USA;
| | - Michael Von Korff
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA; (M.V.K.); (M.V.V.)
| | - Michael Perlis
- Penn Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Michael V. Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA; (M.V.K.); (M.V.V.)
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15
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Affiliation(s)
- I Y Chen
- Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA
- École de psychologie, Université Laval, Québec, QC, CANADA
| | - A B Neikrug
- Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA
| | - B A Mander
- Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA
| | - M Lamy
- École de psychologie, Université Laval, Québec, QC, CANADA
- Centre d’étude des troubles du sommeil, Institut universitaire en santé mentale de Québec, Québec, QC, CANADA
| | - R Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA
| | - C M Morin
- École de psychologie, Université Laval, Québec, QC, CANADA
- Centre d’étude des troubles du sommeil, Institut universitaire en santé mentale de Québec, Québec, QC, CANADA
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16
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Neikrug AB, Okifuji A, Hamilton C, Liao S, Donaldson G. 0911 Behavioral and Activity Rhythms in Patients with Chronic Pain vs. Controls - A Computational Approach for Behavioral Data. Sleep 2018. [DOI: 10.1093/sleep/zsy061.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A B Neikrug
- University of California, Irvine, Irvine, CA
| | - A Okifuji
- University of Utah, Salt Lake City, UT
| | | | - S Liao
- University of Utah, Salt Lake City, UT
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17
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Neikrug AB. Obstructive Sleep Apnea in Parkinson’s Disease—a Mini-Review. Curr Sleep Medicine Rep 2018. [DOI: 10.1007/s40675-018-0111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Neikrug AB, Jungquist C, Donaldson G, Okifuji A, Perlis M. 0390 MEASURING ACTIVITY BY ACTIGRAPHY - ARE WE USING THE RIGHT METHODS? Sleep 2017. [DOI: 10.1093/sleepj/zsx050.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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19
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Neikrug AB, Jungquist C, Donaldson G, Okifuji A, Perlis M. 0377 ACTIVITY MEASURES POST CBT-I FOR CHRONIC PAIN. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Patients with hypersomnia disorders (HD) suffer from debilitating symptoms that result in reduced functioning, depression, anxiety, and overall worse quality of life. Little is known about the need and desire of this population to utilize behavioral sleep medicine (BSM) interventions that focus on psychosocial functioning and quality of life, and there have been limited attempts to develop such interventions. The purpose of this survey study was to gather patient-centered data on engagement in pharmacological and nonpharmacological interventions, the psychosocial impact of HD symptoms on quality of life and mental health, and potential interest in BSM services, such as cognitive behavioral therapy, mindfulness or yoga, and support groups. We obtained responses from 371 individuals with HD (65.2% narcolepsy and 34.8% idiopathic hypersomnia) to an Internet-based survey. Overall, HD patients reported engagement in pharmacological and nonpharmacological interventions, with narcolepsy patients reporting more perceived effectiveness than those with idiopathic hypersomnia. In addition, HD patients reported a strong negative impact on psychosocial functioning, with elevations in depression and anxiety symptoms along with significant impact on functioning and quality of life. The majority (71.7-85.5%) voiced at least some interest in BSM services. These data suggest that there is substantial interest and need for BSM services that focus on assessment and treatment of psychosocial functioning related to HD.
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Affiliation(s)
- Ariel B Neikrug
- a Primary Care Behavioral Health Service , Veteran Administration Healthcare System , Salt Lake City , Utah
| | - Megan R Crawford
- b Department of Behavioral Sciences , Rush University Medical Center , Chicago , Illinois
| | - Jason C Ong
- b Department of Behavioral Sciences , Rush University Medical Center , Chicago , Illinois
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21
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Harmell AL, Neikrug AB, Palmer BW, Avanzino JA, Liu L, Maglione JE, Natarajan L, Corey-Bloom J, Loredo JS, Ancoli-Israel S. Obstructive Sleep Apnea and Cognition in Parkinson's disease. Sleep Med 2016; 21:28-34. [PMID: 27448468 DOI: 10.1016/j.sleep.2016.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 10/27/2015] [Revised: 12/30/2015] [Accepted: 01/07/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is very common in Parkinson's disease (PD). OSA is known to affect patients' cognition. The present study assessed whether PD patients with OSA (PD + OSA) score lower on cognitive measures than those without OSA (PD - OSA). In addition, this study evaluated whether treating the OSA with continuous positive airway pressure (CPAP) in PD + OSA patients results in an improved cognitive functioning. METHODS Eighty-six patients with PD underwent an overnight polysomnography screen for OSA and were administered the Mini-Mental Status Exam (MMSE) and the Montreal Cognitive Assessment (MoCA). This resulted in 38 patients with PD + OSA who were randomly assigned to receive either therapeutic CPAP for 6 weeks (n = 19) or placebo CPAP for three weeks followed by therapeutic CPAP for three weeks (n = 19). Intervention participants completed a neurocognitive battery at baseline and 3- and 6-week time-points. RESULTS Patients with PD + OSA scored significantly lower than PD - OSA on the MMSE and MoCA after controlling for age, education, and PD severity. OSA was a significant predictor of cognition (MMSE p <0.01; MoCA p = 0.028).There were no significant changes between groups in cognition when comparing three weeks of therapeutic CPAP with 3 weeks of placebo CPAP. Comparisons between pre-treatment and 3-week post-therapeutic CPAP for the entire sample also revealed no significant changes on overall neuropsychological (NP) scores. CONCLUSIONS Findings suggest that PD patients with OSA show worse cognitive functioning on cognitive screening measures than those without OSA. However, OSA treatment after three or six weeks of CPAP may not result in overall cognitive improvement in patients with PD.
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Affiliation(s)
- Alexandrea L Harmell
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA
| | - Ariel B Neikrug
- Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Barton W Palmer
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Veterans Administration Healthcare System, San Diego, CA, USA
| | - Julie A Avanzino
- Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA
| | - Lianqi Liu
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Jeanne E Maglione
- Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Veterans Administration Healthcare System, San Diego, CA, USA
| | - Loki Natarajan
- Department of Family and Preventative Medicine, University of California, San Diego, CA, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Jose S Loredo
- Veterans Administration Healthcare System, San Diego, CA, USA; Department of Medicine, University of California, San Diego, CA, USA
| | - Sonia Ancoli-Israel
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Stein Institute for Research on Aging, CA, USA; Department of Medicine, University of California, San Diego, CA, USA.
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Neikrug AB, Avanzino JA, Liu L, Maglione JE, Natarajan L, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Parkinson's disease and REM sleep behavior disorder result in increased non-motor symptoms. Sleep Med 2014; 15:959-66. [PMID: 24938585 DOI: 10.1016/j.sleep.2014.04.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 08/13/2013] [Revised: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Rapid eye movement (REM)-sleep behavior disorder (RBD) is often comorbid with Parkinson's disease (PD). The current study aimed to provide a detailed understanding of the impact of having RBD on multiple non-motor symptoms (NMS) in patients with PD. METHODS A total of 86 participants were evaluated for RBD and assessed for multiple NMS of PD. Principal component analysis was utilized to model multiple measures of NMS in PD, and a multivariate analysis of variance was used to assess the relationship between RBD and the multiple NMS measures. Seven NMS measures were assessed: cognition, quality of life, fatigue, sleepiness, overall sleep, mood, and overall NMS of PD. RESULTS Among the PD patients, 36 were classified as having RBD (objective polysomnography and subjective findings), 26 as not having RBD (neither objective nor subjective findings), and 24 as probably having RBD (either subjective or objective findings). RBD was a significant predictor of increased NMS in PD while controlling for dopaminergic therapy and age (p=0.01). The RBD group reported more NMS of depression (p=0.012), fatigue (p=0.036), overall sleep (p=0.018), and overall NMS (p=0.002). CONCLUSION In PD, RBD is associated with more NMS, particularly increased depressive symptoms, sleep disturbances, and fatigue. More research is needed to assess whether PD patients with RBD represent a subtype of PD with different disease progression and phenomenological presentation.
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Affiliation(s)
- Ariel B Neikrug
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Julie A Avanzino
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Lianqi Liu
- Department of Psychiatry, University of California, San Diego, CA, USA; Department of Veterans Affairs, San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA
| | - Jeanne E Maglione
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Loki Natarajan
- Department of Family and Preventative Medicine, University of California, San Diego, CA, USA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Barton W Palmer
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Veterans Medical Research Foundation, San Diego, CA, USA
| | - Jose S Loredo
- Department of Medicine, University of California, San Diego, CA, USA
| | - Sonia Ancoli-Israel
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Department of Veterans Affairs, San Diego Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, USA; Veterans Medical Research Foundation, San Diego, CA, USA; Department of Medicine, University of California, San Diego, CA, USA.
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23
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Neikrug AB, Liu L, Avanzino JA, Maglione JE, Natarajan L, Bradley L, Maugeri A, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Continuous positive airway pressure improves sleep and daytime sleepiness in patients with Parkinson disease and sleep apnea. Sleep 2014; 37:177-85. [PMID: 24470706 DOI: 10.5665/sleep.3332] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA), common in Parkinson disease (PD), contributes to sleep disturbances and daytime sleepiness. We assessed the effect of continuous positive airway pressure (CPAP) on OSA, sleep, and daytime sleepiness in patients with PD. DESIGN This was a randomized placebo-controlled, crossover design. Patients with PD and OSA were randomized into 6 w of therapeutic treatment or 3 w of placebo followed by 3 w of therapeutic treatment. Patients were evaluated by polysomnography (PSG) and multiple sleep latency test (MSLT) pretreatment (baseline), after 3 w, and after 6 w of CPAP treatment. Analyses included mixed models, paired analysis, and within-group analyses comparing 3 w to 6 w of treatment. SETTING Sleep laboratory. PARTICIPANTS Thirty-eight patients with PD (mean age = 67.2 ± 9.2 y; 12 females). INTERVENTION Continuous positive airway pressure. MEASUREMENTS PSG OUTCOME MEASURES: sleep efficiency, %sleep stages (N1, N2, N3, R), arousal index, apnea-hypopnea index (AHI), and % time oxygen saturation < 90% (%time SaO2 < 90%). MSLT outcome measures: mean sleep-onset latency (MSL). RESULTS There were significant group-by-time interactions for AHI (P < 0.001), % time SaO2 < 90% (P = 0.02), %N2 (P = 0.015) and %N3 (P = 0.014). Subjects receiving therapeutic CPAP showed significant decrease in AHI, %time SaO2 < 90%, %N2, and significant increase in %N3 indicating effectiveness of CPAP in the treatment of OSA, improvement in nighttime oxygenation, and in deepening sleep. The paired sample analyses revealed that 3 w of therapeutic treatment resulted in significant decreases in arousal index (t = 3.4, P = 0.002). All improvements after 3 w were maintained at 6 w. Finally, 3 w of therapeutic CPAP also resulted in overall decreases in daytime sleepiness (P = 0.011). CONCLUSIONS Therapeutic continuous positive airway pressure versus placebo was effective in reducing apnea events, improving oxygen saturation, and deepening sleep in patients with Parkinson disease and obstructive sleep apnea. Additionally, arousal index was reduced and effects were maintained at 6 weeks. Finally, 3 weeks of continuous positive airway pressure treatment resulted in reduced daytime sleepiness measured by multiple sleep latency test. These results emphasize the importance of identifying and treating obstructive sleep apnea in patients with Parkinson disease.
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Affiliation(s)
- Ariel B Neikrug
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Lianqi Liu
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Julie A Avanzino
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Jeanne E Maglione
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Loki Natarajan
- Department of Family and Preventive Medicine, University of California San Diego, San Diego, CA
| | - Lenette Bradley
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Alex Maugeri
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Jody Corey-Bloom
- Department of Neurosciences, University of California San Diego, San Diego, CA
| | - Barton W Palmer
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Veterans Medical Research Foundation, San Diego, CA
| | - Jose S Loredo
- Department of Medicine, University of California San Diego, San Diego, CA
| | - Sonia Ancoli-Israel
- San Diego State University and University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Department of Psychiatry, University of California San Diego, San Diego, CA ; Department of Medicine, University of California San Diego, San Diego, CA ; Veterans Affairs Center of Excellence for Stress and Mental Health, San Diego, CA
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24
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Neikrug AB, Maglione JE, Liu L, Natarajan L, Avanzino JA, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Effects of sleep disorders on the non-motor symptoms of Parkinson disease. J Clin Sleep Med 2013; 9:1119-29. [PMID: 24235892 DOI: 10.5664/jcsm.3148] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate the impact of sleep disorders on non-motor symptoms in patients with Parkinson disease (PD). DESIGN This was a cross-sectional study. Patients with PD were evaluated for obstructive sleep apnea (OSA), restless legs syndrome (RLS), periodic limb movement syndrome (PLMS), and REM sleep behavior disorder (RBD). Cognition was assessed with the Montreal Cognitive Assessment and patients completed self-reported questionnaires assessing non-motor symptoms including depressive symptoms, fatigue, sleep complaints, daytime sleepiness, and quality of life. SETTING Sleep laboratory. PARTICIPANTS 86 patients with PD (mean age = 67.4 ± 8.8 years; range: 47-89; 29 women). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Having sleep disorders was a predictor of overall non-motor symptoms in PD (R(2) = 0.33, p < 0.001) while controlling for age, PD severity, and dopaminergic therapy. These analyses revealed that RBD (p = 0.006) and RLS (p = 0.014) were significant predictors of increased non-motor symptoms, but OSA was not. More specifically, having a sleep disorder significantly predicted sleep complaints (ΔR(2) = 0.13, p = 0.006), depressive symptoms (ΔR(2) = 0.01, p = 0.03), fatigue (ΔR(2) = 0.12, p = 0.007), poor quality of life (ΔR(2) = 0.13, p = 0.002), and cognitive decline (ΔR(2) = 0.09, p = 0.036). Additionally, increasing number of sleep disorders (0, 1, or ≥ 2 sleep disorders) was a significant contributor to non-motor symptom impairment (R(2) = 0.28, p < 0.001). CONCLUSION In this study of PD patients, presence of comorbid sleep disorders predicted more non-motor symptoms including increased sleep complaints, more depressive symptoms, lower quality of life, poorer cognition, and more fatigue. RBD and RLS were factors of overall increased non-motor symptoms, but OSA was not.
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Affiliation(s)
- Ariel B Neikrug
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA ; Veterans Medical Research Foundation, San Diego, CA
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Maglione JE, Liu L, Neikrug AB, Poon T, Natarajan L, Calderon J, Avanzino JA, Corey-Bloom J, Palmer BW, Loredo JS, Ancoli-Israel S. Actigraphy for the assessment of sleep measures in Parkinson's disease. Sleep 2013; 36:1209-17. [PMID: 23904681 DOI: 10.5665/sleep.2888] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the usefulness of actigraphy for assessment of nighttime sleep measures in patients with Parkinson's disease (PD). DESIGN Participants underwent overnight sleep assessment simultaneously by polysomnography (PSG) and actigraphy. SETTING Overnight sleep study in academic sleep research laboratory. PARTICIPANTS Sixty-one patients (mean age 67.74 ± 8.88 y) with mild to moderate PD. MEASUREMENTS Sleep measures including total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep onset latency (SOL) were calculated independently from data derived from PSG and from actigraphy. Different actigraphy scoring settings were compared. RESULTS No single tested actigraphy scoring setting was optimal for all sleep measures. A customized setting of an activity threshold of 10, with five consecutive immobile minutes for sleep onset, yielded the combination of mean TST, SE, and WASO values that best approximated mean values determined by PSG with differences of 6.05 ± 85.67 min for TST, 1.1 ± 0.641% for SE, and 4.35 ± 59.56 min for WASO. There were significant but moderate correlations between actigraphy and PSG measurements (rs = 0.496, P < 0.001 for TST, rs = 0.384, P = 0.002 for SE, and rs = 0.400, P = 0.001 for WASO) using these settings. Greater disease stage was associated with greater differences between TST (R(2) = 0.099, beta = 0.315, P = 0.018), SE (R(2) = 0.107, beta = 0.327, P = 0.014), and WASO (R(2) = 0.094, beta = 0.307, P = 0.021) values derived by actigraphy and PSG explaining some of the variability. Using a setting of 10 immobile min for sleep onset yielded a mean SOL that was within 1 min of that estimated by PSG. However SOL values determined by actigraphy and PSG were not significantly correlated at any tested setting. CONCLUSIONS Our results suggest that actigraphy may be useful for measurement of mean TST, SE, and WASO values in groups of patients with mild to moderate Parkinson's disease. However, there is a significant degree of variability in accuracy among individual patients. The importance of determining optimal scoring parameters for each population studied is underscored.
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Affiliation(s)
- Jeanne E Maglione
- Department of Psychiatry, University of California San Diego, San Diego, CA 92093-0733, USA.
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26
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Covassin N, Neikrug AB, Liu L, Maglione J, Natarajan L, Corey-Bloom J, Loredo JS, Palmer BW, Redwine LS, Ancoli-Israel S. Relationships between clinical characteristics and nocturnal cardiac autonomic activity in Parkinson's disease. Auton Neurosci 2012; 171:85-8. [PMID: 23141523 DOI: 10.1016/j.autneu.2012.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 10/11/2012] [Accepted: 10/14/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The aim of the present study was to explore the association between Parkinson's disease (PD) clinical characteristics and cardiac autonomic control across sleep stages. METHODS Frequency-domain heart rate variability (HRV) measures were estimated in 18 PD patients undergoing a night of polysomnography. RESULTS Significant relationships were found between PD severity and nocturnal HRV indices. The associations were restricted to rapid eye movement (R) sleep. CONCLUSIONS The progressive nocturnal cardiac autonomic impairment occurring with more severe PD can be subclinical emerging only during conditions requiring active modulation of physiological functions such as R-sleep.
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Affiliation(s)
- Naima Covassin
- Department of General Psychology, University of Padova, Italy
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27
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Neikrug AB, Rissling M, Trofimenko V, Liu L, Natarajan L, Lawton S, Parker BA, Ancoli-Israel S. Bright light therapy protects women from circadian rhythm desynchronization during chemotherapy for breast cancer. Behav Sleep Med 2012; 10:202-16. [PMID: 22742438 DOI: 10.1080/15402002.2011.634940] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Circadian rhythms (CRs) are commonly disrupted in women undergoing chemotherapy for breast cancer (BC). Bright light improves and strengthens CRs in other populations. This randomized controlled study examined the effect of morning administration of bright light therapy on CRs in women undergoing chemotherapy for BC. It was hypothesized that women receiving bright light therapy would exhibit more robust rhythms than women exposed to dim light. Thirty-nine women newly diagnosed with BC and scheduled for chemotherapy were randomized into 2 groups: bright white light (BWL) or dim red light (DRL). Women were instructed to use the light box every morning for 30 min during their first 4 cycles of chemotherapy. Wrist actigraphy was recorded at 5 time points: prior to chemotherapy (baseline), Cycle-1 treatment week (C1TW), Cycle-1 recovery week (C1RW), Cycle-4 treatment week (C4TW), and Cycle-4 recovery week (C4RW). There was a Group × Time interaction at C4TW compared to baseline such that the DRL group showed significant deterioration in the mean of the activity rhythm (mesor) and amplitude, whereas the BWL group exhibited a significant increase in both mesor and amplitude. The DRL group also exhibited significant deterioration in overall rhythm robustness at C1TW, C4TW, and C4RW. Women in the BWL group also showed significant decreases in overall rhythm robustness at C1TW and C4TW, but returned to baseline levels at both recovery weeks. The results suggest that morning administration of bright light may protect women from experiencing CR deterioration during chemotherapy.
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Affiliation(s)
- Ariel B Neikrug
- Department of Psychiatry University of California San Diego, La Jolla, CA 92093-0733, USA
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28
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Covassin N, Neikrug AB, Liu L, Corey-Bloom J, Loredo JS, Palmer BW, Maglione J, Ancoli-Israel S. Clinical correlates of periodic limb movements in sleep in Parkinson's disease. J Neurol Sci 2012; 316:131-6. [PMID: 22277375 PMCID: PMC3321115 DOI: 10.1016/j.jns.2012.01.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [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: 09/27/2011] [Revised: 11/21/2011] [Accepted: 01/04/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of the current study was to investigate the frequency of periodic limb movements in sleep (PLMS) in Parkinson's disease (PD) and their impact on nocturnal sleep and daytime functioning. METHODS Forty-five PD patients (mean age 68.5 ± 8.7 years; 32 males) underwent one night of polysomnography (PSG). Clinical assessment and questionnaires evaluating sleep disturbance and quality of life (QoL) were completed. Patients were divided into two groups based on their PLMS index (PLMSI): PLMSI ≥ 15 (PLMS+) and PLMSI <15 (PLMS-). RESULTS There were 26 (57.8%) PD patients in the PLMS+group and 19 (42.2%) patients in the PLMS-group. Subjective assessment revealed an association between PLMS+status and greater PD symptom severity, more subjective sleep disturbance, and decreased QoL. All patients showed poor sleep, and no significant group differences were detected on PSG measures. CONCLUSION We observed that PLMS occurred frequently in PD and increased with more severe PD. Although PLMS did not affect objective sleep, it was associated with increased sleep complaints and reduced QoL. Overall, our findings support the association between PLMS and PD as well as the clinical relevance of sleep disturbances in PD.
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Affiliation(s)
| | | | - Lianqi Liu
- Department of Psychiatry, University of California San Diego
| | | | - Jose S. Loredo
- Department of Medicine, University of California San Diego
| | | | - Jeanne Maglione
- Department of Psychiatry, University of California San Diego
| | - Sonia Ancoli-Israel
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology
- Department of Psychiatry, University of California San Diego
- Department of Medicine, University of California San Diego
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Abstract
OBJECTIVES To review the literature on sleep disturbances in nursing home settings. Although 50% of older adults complain of sleep difficulties, increased reports of sleep disturbances are generally associated with poor health. After controlling for comorbidities that often contribute to poor sleep, studies have shown that primary sleep disturbances in healthy older adults are, in fact, rare. Although common in older adults, sleep complaints are even more prevalent in elders living in nursing homes and the sleep disturbances experienced by institutionalized older adults are more severe. Factors contributing to sleep impairment in nursing home residents include age-related changes in sleep architecture and circadian rhythms, sleep disorders, dementia, depression, other medical illness, polypharmacy, and institutional and environmental factors. It is important that nursing home residents suffering from sleep problems be evaluated and treated. CONCLUSION Implementing some environmental and culture changes could result in significant improvement in the sleep of nursing home residents.
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Affiliation(s)
- A B Neikrug
- Department of Psychiatry, University of California, San Diego, SDSU/UCSD Joint Doctoral Program in Clinical Psychology, La Jolla, CA 92093-0733, USA
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Savard J, Liu L, Natarajan L, Rissling MB, Neikrug AB, He F, Dimsdale JE, Mills PJ, Parker BA, Sadler GR, Ancoli-Israel S. Breast cancer patients have progressively impaired sleep-wake activity rhythms during chemotherapy. Sleep 2009; 32:1155-60. [PMID: 19750920 DOI: 10.1093/sleep/32.9.1155] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Prior cross-sectional studies have shown that cancer patients have sleep-wake activity cycles that show little distinction between daytime and nighttime, a pattern indicative of circadian disruption. This pattern is seen both before and during cancer treatment. Long-term data are needed, however, to assess to what extent circadian rhythm impairments evolve over the course of chemotherapy. The goal of this study was to assess the longitudinal course of sleep-wake activity rhythms before and during chemotherapy for breast cancer. PATIENTS AND METHODS Ninety-five women scheduled to receive neoadjuvant or adjuvant anthracycline based chemotherapy for a stage I-III breast cancer participated. The participants wore a wrist actigraph for 72 consecutive hours at baseline (pre-chemotherapy), as well as during the weeks 1, 2 and 3 (W1, W2, W3) of cycle 1 and cycle 4 of chemotherapy. Sleep-wake circadian activity variables were computed based on actigraphic data. RESULTS Compared to baseline, with the exception of acrophase, all circadian rhythm variables examined, including amplitude, mesor, up-mesor, down-mesor, and rhythmicity were significantly impaired during the first week of both chemotherapy cycles. Although the circadian variables approached baseline values during W2 and W3 of cycle 1, most remained significantly more impaired during W2 and W3 of cycle 4. CONCLUSION These data suggest that the first administration of chemotherapy is associated with transient disruption of sleep-wake rhythm, while repeated administration of chemotherapy results in progressively worse and more enduring impairments in sleep-wake activity rhythms.
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Affiliation(s)
- Josée Savard
- School of Psychology, Université Laval, Québec, Canada
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31
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Neikrug AB, Ancoli-Israel S. Sleep disorders in the older adult - a mini-review. Gerontology 2009; 56:181-9. [PMID: 19738366 DOI: 10.1159/000236900] [Citation(s) in RCA: 249] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Accepted: 07/23/2009] [Indexed: 11/19/2022] Open
Abstract
Approximately 50% of older adults complain of difficulty sleeping. Poor sleep results in increased risk of significant morbidity and mortality. The decrements seen in the sleep of the older adult are often due to a decrease in the ability to get needed sleep. However, the decreased ability is less a function of age and more a function of other factors that accompany aging, such as medical and psychiatric illness, increased medication use, advances in the endogenous circadian clock and a higher prevalence of specific sleep disorders. Given the large number of older adults with sleep complaints and sleep disorders, there is a need for health care professionals to have an increased awareness of these sleep disturbances to better enable them to assess and treat these patients. A thorough sleep history (preferably in the presence of their bed partner) is required for a proper diagnosis, and when appropriate, an overnight sleep recording should be done. Treatment of primary sleep problems can improve the quality of life and daytime functioning of older adults. This paper reviews the diagnoses and characteristics of sleep disorders generally found in the older adult. While aimed at the practicing geriatrician, this paper is also of importance for any gerontologist interested in sleep.
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Affiliation(s)
- Ariel B Neikrug
- Department of Psychiatry, University of California, San Diego, 92093-0733, USA
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