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Musich M, Beversdorf DQ, McCrae CS, Curtis AF. Subjective-Objective Sleep Discrepancy in a Predominately White and Educated Older Adult Population: Examining the Associations with Cognition and Insomnia. J Gerontol B Psychol Sci Soc Sci 2024:gbae074. [PMID: 38679960 DOI: 10.1093/geronb/gbae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVES This study examined associations between various cognitive domains and sleep discrepancy (self-reported versus objectively measured sleep), and evaluated interactive associations with insomnia status (non-insomnia versus insomnia). METHOD Older adults (N=65, Mage=68.72, SD=5.06, 43 insomnia/22 non-insomnia) aged 60+ reported subjective sleep (7-days of sleep diaries), objective sleep assessment (one-night polysomnography, PSG, via Sleep ProfilerTM during the 7-day period), and completed cognitive tasks (NIH Toolbox-Cognition Battery) measuring attention and processing speed, working memory, inhibitory control, cognitive flexibility, and episodic memory. The sleep diary variable corresponding to same one-night of PSG was used to calculate the sleep discrepancy (diary minus PSG parameter) variables for total sleep time, sleep onset latency, wake after sleep onset, and sleep efficiency. Regression analyses determined independent and interactive (with insomnia status) associations between cognition and sleep discrepancy, controlling for age, sex, apnea-hypopnea index, and sleep medication usage. RESULTS Working memory interacted with insomnia status in associations with sleep discrepancy related to total sleep time and sleep efficiency. In those with insomnia, worse working memory was associated with shorter self-reported total sleep time (p=.008) and lower sleep efficiency (p=.04) than PSG measured. DISCUSSION In older adults with insomnia, worse working memory may be a contributing factor to sleep discrepancy. Future investigations of underlying neurophysiological factors and consideration of other objective sleep measures (actigraphy) are warranted. Prospective findings may help determine whether sleep discrepancy is a potential marker of future cognitive decline.
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Affiliation(s)
- Madison Musich
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - David Q Beversdorf
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
- Department of Radiology and Neurology, University of Missouri-Columbia, Columbia, Missouri, USA
| | | | - Ashley F Curtis
- College of Nursing, University of South Florida, Tampa, Florida, USA
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Curtis AF, Musich M, Costa AN, Gonzales J, Gonzales H, Ferguson BJ, Kille B, Thomas AL, Wei X, Liu P, Greenlief CM, Shenker JI, Beversdorf DQ. Feasibility and Preliminary Efficacy of American Elderberry Juice for Improving Cognition and Inflammation in Patients with Mild Cognitive Impairment. Int J Mol Sci 2024; 25:4352. [PMID: 38673938 PMCID: PMC11050618 DOI: 10.3390/ijms25084352] [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: 03/06/2024] [Revised: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Despite data showing that nutritional interventions high in antioxidant/anti-inflammatory properties (anthocyanin-rich foods, such as blueberries/elderberries) may decrease risk of memory loss and cognitive decline, evidence for such effects in mild cognitive impairment (MCI) is limited. This study examined preliminary effects of American elderberry (Sambucus nigra subsp. canadensis) juice on cognition and inflammatory markers in patients with MCI. In a randomized, double-blind, placebo-controlled trial, patients with MCI (n = 24, Mage = 76.33 ± 6.95) received American elderberry (n = 11) or placebo (n = 13) juice (5 mL orally 3 times a day) for 6 months. At baseline, 3 months, and 6 months, patients completed tasks measuring global cognition, verbal memory, language, visuospatial cognitive flexibility/problem solving, and memory. A subsample (n = 12, 7 elderberry/5 placebo) provided blood samples to measure serum inflammatory markers. Multilevel models examined effects of the condition (elderberry/placebo), time (baseline/3 months/6 months), and condition by time interactions on cognition/inflammation outcomes. Attrition rates for elderberry (18%) and placebo (15%) conditions were fairly low. The dosage compliance (elderberry-97%; placebo-97%) and completion of cognitive (elderberry-88%; placebo-87%) and blood-based (elderberry-100%; placebo-100%) assessments was high. Elderberry (not placebo) trended (p = 0.09) towards faster visuospatial problem solving performance from baseline to 6 months. For the elderberry condition, there were significant or significantly trending decreases over time across several markers of low-grade peripheral inflammation, including vasorin, prenylcysteine oxidase 1, and complement Factor D. Only one inflammatory marker showed an increase over time (alpha-2-macroglobin). In contrast, for the placebo, several inflammatory marker levels increased across time (L-lactate dehydrogenase B chain, complement Factor D), with one showing deceased levels over time (L-lactate dehydrogenase A chain). Daily elderberry juice consumption in patients with MCI is feasible and well tolerated and may provide some benefit to visuospatial cognitive flexibility. Preliminary findings suggest elderberry juice may reduce low-grade inflammation compared to a placebo-control. These promising findings support the need for larger, more definitive prospective studies with longer follow-ups to better understand mechanisms of action and the clinical utility of elderberries for potentially mitigating cognitive decline.
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Affiliation(s)
- Ashley F. Curtis
- College of Nursing, University of South Florida, Tampa, FL 33620, USA; (A.F.C.); (A.N.C.)
| | - Madison Musich
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65201, USA; (M.M.); (B.K.)
| | - Amy N. Costa
- College of Nursing, University of South Florida, Tampa, FL 33620, USA; (A.F.C.); (A.N.C.)
- Department of Psychology, University of South Florida, Tampa, FL 33620, USA
| | - Joshua Gonzales
- School of Osteopathic Medicine, A. T. Still University, Kirksville, MO 63501, USA;
- Department of Internal Medicine, School of Medicine, Indiana University, Indianapolis, IN 46202, USA
| | - Hyeri Gonzales
- School of Medicine, University of Missouri, Columbia, MO 65211, USA;
| | - Bradley J. Ferguson
- Department of Neurology, University of Missouri, Columbia, MO 65211, USA; (B.J.F.); (J.I.S.)
| | - Briana Kille
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65201, USA; (M.M.); (B.K.)
- Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Andrew L. Thomas
- Division of Plant Science and Technology, University of Missouri, Southwest Research Extension and Education Center, Mt. Vernon, MO 65201, USA;
| | - Xing Wei
- Charles W. Gehrke Proteomics Center, Department of Chemistry, University of Missouri, Columbia, MO 65201, USA; (X.W.); (P.L.); (C.M.G.)
| | - Pei Liu
- Charles W. Gehrke Proteomics Center, Department of Chemistry, University of Missouri, Columbia, MO 65201, USA; (X.W.); (P.L.); (C.M.G.)
| | - C. Michael Greenlief
- Charles W. Gehrke Proteomics Center, Department of Chemistry, University of Missouri, Columbia, MO 65201, USA; (X.W.); (P.L.); (C.M.G.)
| | - Joel I. Shenker
- Department of Neurology, University of Missouri, Columbia, MO 65211, USA; (B.J.F.); (J.I.S.)
| | - David Q. Beversdorf
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65201, USA; (M.M.); (B.K.)
- Department of Neurology, University of Missouri, Columbia, MO 65211, USA; (B.J.F.); (J.I.S.)
- Department of Radiology, University of Missouri, Columbia, MO 65211, USA
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Curtis AF, Jagannathan S, Musich M, Miller MB, McCrae CS. Mid-to-Late-Life Anxiety and Sleep during Initial Phase of COVID-19: Age- and Sex-Specific Insights to Inform Future Pandemic Healthcare. Brain Sci 2024; 14:346. [PMID: 38671998 PMCID: PMC11047835 DOI: 10.3390/brainsci14040346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
This study examined associations between COVID-19-related anxiety and sleep in middle-aged and older adults and tested whether these varied by age or sex. In June/July 2020, middle-aged/older adults aged 50+ (n = 277, 45% women, Mage = 64.68 ± 7.83) in the United States completed measures of sleep and COVID-19-related anxiety. Multiple regressions examined whether anxiety was independently associated with or interacted with age or sex in its associations with sleep health, controlling for age, education, medical conditions, sleep/pain medication use, and COVID-19 status. Greater COVID-19 anxiety was associated with worse sleep quality and daytime dysfunction. COVID-19-related anxiety interacted with age (not sex) in associations with total sleep time and sleep efficiency. Greater anxiety was associated with shorter total sleep time and lower sleep efficiency in oldest-older adults (~73 years old) and youngest-older adults (~65 years old) but not middle-aged adults (~57 years old). In mid to late life, older adults may be most vulnerable to the impact of COVID-19-related anxiety on sleep health. Social and behavioral (e.g., knowledge on age-related vulnerability to COVID-19 risk/morbidity/mortality, uncertainty, and changes to daily routines) and physiological factors (sleep disruption and age-related autonomic dysfunction) may underlie these associations. Interventions that mitigate negative pandemic-related psychological and sleep outcomes may be particularly relevant for older adults.
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Affiliation(s)
- Ashley F. Curtis
- College of Nursing, University of South Florida, Tampa, FL 33612, USA
| | - Sadhika Jagannathan
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV 26506, USA;
| | - Madison Musich
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO 65211, USA;
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri-Columbia, Columbia, MO 65212, USA;
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Curtis AF, Nair N, Hayse B, McGovney K, Mikula C, Halder P, Craggs JG, Kiselica A, McCrae CS. Preliminary investigation of the interactive role of physiological arousal and insomnia complaints in gray matter volume alterations in chronic widespread pain. J Clin Sleep Med 2024; 20:293-302. [PMID: 37823586 PMCID: PMC10835766 DOI: 10.5664/jcsm.10860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
STUDY OBJECTIVES Brain regions involved in insomnia and chronic pain are overlapping and diffuse. The interactive role of physiological arousal in associations between insomnia symptoms and neural regions is unknown. This preliminary study examined whether arousal interacted with sleep in associations with gray matter volume of frontal (dorsolateral prefrontal cortex, anterior cingulate cortex) and temporal (right/left hippocampus) regions in adults with chronic widespread pain and insomnia complaints. METHODS Forty-seven adults with chronic widespread pain and insomnia (mean age = 46.00, standard deviation = 13.88, 89% women) completed 14 daily diaries measuring sleep onset latency (SOL), wake time after sleep onset, and total sleep time (TST), as well as Holter monitor assessments of heart rate variability (measuring physiological arousal), and magnetic resonance imaging. Multiple regressions examined whether average SOL, wake time after sleep onset, or TST were independently or interactively (with arousal/heart rate variability) associated with dorsolateral prefrontal cortex, anterior cingulate cortex, and left/right hippocampus gray matter volumes. RESULTS Shorter TST was associated with lower right hippocampus volume. TST also interacted with arousal in its association with right hippocampal volume, Specifically, shorter TST was associated with lower volume at highest and average arousal levels. SOL interacted with arousal in its association with anterior cingulate cortex volume, such that, among individuals with lowest arousal, longer SOL was associated with lower volume. CONCLUSIONS Preliminary findings highlight the interactive roles of physiological arousal and insomnia symptoms in associations with neural structure in chronic widespread pain and insomnia. Individuals with the highest physiological arousal may be particularly vulnerable to the impact of shorter TST on hippocampal volume loss. Reducing SOL may only impact anterior cingulate cortex volume in those with lower physiological arousal. CITATION Curtis AF, Nair N, Hayse B, et al. Preliminary investigation of the interactive role of physiological arousal and insomnia complaints in gray matter volume alterations in chronic widespread pain. J Clin Sleep Med. 2024;20(2):293-302.
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Affiliation(s)
- Ashley F. Curtis
- College of Nursing, University of South Florida, Tampa, Florida
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Neetu Nair
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
| | - Braden Hayse
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
| | - Kevin McGovney
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
| | - Cynthia Mikula
- Department of Health Psychology, University of Missouri-Columbia, Columbia, Missouri
| | - Puja Halder
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
| | - Jason G. Craggs
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
- Department of Physical Therapy, University of Missouri-Columbia, Columbia, Missouri
- Department of Psychiatry & Behavioral Neurosciences, University of South Florida, Tampa, FL
| | - Andrew Kiselica
- Department of Health Psychology, University of Missouri-Columbia, Columbia, Missouri
| | - Christina S. McCrae
- College of Nursing, University of South Florida, Tampa, Florida
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
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Stearns MA, McCrae CS, Curtis AF, Nair N, Hayse B, Nadorff DK, Wilkerson A. Adolescent sleep mediates maternal depressive problems and parenting behaviors: daughter and son differences in a majority Black and Hispanic sample. J Clin Sleep Med 2024. [PMID: 38189515 DOI: 10.5664/jcsm.10996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
STUDY OBJECTIVES Parents who experience depressive symptoms are less likely to use positive parenting behaviors, in part because of sad affect and inconsistency, which can lead to disengaged parenting. Their children also are more likely to get too little sleep, get too much sleep, or have trouble sleeping, leading to increased child irritability and defiance, which may make it more difficult for a parent to use clear rules and result in more harsh parenting behaviors. The current study examined whether adolescent sleep (too little, too much, trouble sleeping) mediated the relation between maternal depression and parenting behaviors (harsh parenting, positive parenting, clear rules). Further, child gender was examined as a moderator (i.e., moderated mediation). METHODS The sample (N=318) consisted of mothers reporting on adolescents aged 16-18 (M=16.89, SD=.429; 53.4% female) from the 10th wave of the Schools and Families Educating Children Study (SAFE). Measures included the Child Behavior Checklist (CBCL), Center for Epidemiologic Studies Depression Scale (CESD), and the Parenting Practices Questionnaire (PPQ). RESULTS Too little sleep mediated the relation between maternal depressive problems and clear rules in the overall sample (β = .05), and between maternal depressive problems and positive parenting (β = .11), clear rules (β = .13), and harsh parenting (β = .14) for only sons. Too much sleep mediated the relation between maternal depressive problems and harsh parenting in the overall sample (β = .03), but no mediation occurred for sons and daughters separately. Trouble sleeping did not serve as a mediator in the overall sample but mediated the relation between maternal depressive problems and clear rules for daughters (β = .03) and between maternal depressive problems and harsh parenting for sons (β = .09). CONCLUSIONS These results suggest that adolescent sleep difficulties may be one contributing factor to why mothers who are dealing with depressive symptoms have difficulty using clear rules/positive parenting and use more harsh parenting behaviors. In addition, several of these mediations differed for sons and daughters, indicating important gender differences which may help to better inform and design intervention programs for mothers experiencing depression.
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Affiliation(s)
| | | | | | - Neetu Nair
- Department of Psychiatry, University of Missouri, Columbia, MO
| | - Braden Hayse
- Department of Psychological Sciences, University of Missouri, Columbia, MO
| | | | - Allison Wilkerson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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Curtis AF, Costa AN, Musich M, Schmiedeler A, Jagannathan S, Connell M, Atkinson A, Miller MB, McCrae CS. Sex as a moderator of the sleep and cognition relationship in middle-aged and older adults: A preliminary investigation. Behav Sleep Med 2024; 22:14-27. [PMID: 36809223 DOI: 10.1080/15402002.2023.2177293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Despite known sex differences in the prevalence of sleep disturbance and cognitive impairment, research investigating sex differences in sleep/cognition associations is limited. We examined sex as a moderator of associations between self-reported sleep and objective cognition in middle-aged/older adults. METHODS Adults aged 50+ (32 men/31 women, Mage = 63.6 ± 7.7) completed the Pittsburgh Sleep Quality Index (PSQI) and cognitive tasks: Stroop (processing speed, inhibition), Posner (spatial attentional orienting) and Sternberg (working memory). Multiple regressions examined whether PSQI metrics (global score, sleep quality ratings, sleep duration, sleep efficiency) were independently or interactively (with sex) associated with cognition, controlling for age and education. RESULTS Sex interacted with sleep quality ratings in its association with endogenous spatial attentional orienting (∆R2 = .10, p = .01). Worse ratings of sleep quality were associated with worse orienting in women (B = 22.73, SE = 9.53, p = .02), not men (p = .24). Sex interacted with sleep efficiency in its associations with processing speed (∆R2 = .06, p = .04). Lower sleep efficiency was associated with slower Stroop control trial performance in women (B = -15.91, SE = 7.57, p = .04), not men (p = .48). CONCLUSIONS Preliminary findings suggest middle-aged/older women are more vulnerable to associations between poor sleep quality and low sleep efficiency on spatial attentional orienting and processing speed, respectively. Future studies in larger samples investigating sex-specific prospective sleep and cognition associations are warranted.
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Affiliation(s)
- Ashley F Curtis
- College of Nursing, University of South Florida, Tampa, Florida, USA
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Amy N Costa
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Madison Musich
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Anthony Schmiedeler
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
- Department of Educational, School, and Counseling Psychology, University of Missouri-Columbia, Columbia, Missouri, USA
| | | | - Maggie Connell
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Angela Atkinson
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
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Costa AN, Coman A, Musich M, Park J, Beversdorf DQ, McCrae CS, Curtis AF. Sleep characteristics and pain in middle-aged and older adults: Sex-specific impact of physical and sitting activity. Sleep Med 2023; 111:180-190. [PMID: 37788556 DOI: 10.1016/j.sleep.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/30/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES The relationship between poor sleep health and worse pain is established. Physical activity has been successful in reducing chronic pain and improving sleep in aging adults. Despite known sex differences (more women than men experiencing chronic pain and insomnia), sex-specific patterns of interactive associations between physical activity, sleep, and pain remain unexplored. This study tested whether physical and sitting activity moderated associations between sleep characteristics and pain intensity, and whether sex further moderated these relationships. METHODS Participants aged 50+ (N = 170, Mage = 64.34, 72 women) completed an online survey measuring pre-sleep arousal (Pre-sleep Arousal Scale), sleep (Pittsburgh Sleep Quality Index), past month average pain intensity, and physical activity (International Physical Activity Questionnaire). Multiple regressions evaluated whether minutes of physical activity (total, vigorous, moderate, walking) or sitting activity, pre-sleep arousal, sleep, sex, or their interaction was associated with pain. Analyses controlled for education, difficulty walking, body mass index, total medical conditions, pain medication, and depressive/anxiety symptoms. RESULTS In women, vigorous activity interacted with total pre-sleep arousal and somatic pre-sleep arousal in its association with pain. Higher total arousal and somatic arousal were associated with worse pain intensity only for women who reported highest levels of vigorous activity. No such associations were observed for men or for other physical or sitting activity levels. CONCLUSIONS Vigorous physical activity may exacerbate the association between more pre-sleep arousal and worse pain in middle-aged and older women. Research should explore potential sex-specific mechanisms (e.g., inflammatory cytokines, arousal neural networks) underlying these results.
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Affiliation(s)
- Amy N Costa
- Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - Adriana Coman
- Department of Biological Chemistry, Grinnell College, Grinnell, IA, USA
| | - Madison Musich
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - Jeeeun Park
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA; Department of Biological Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - David Q Beversdorf
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA; Department of Neurology, University of Missouri-Columbia, Columbia, MO, USA; Department of Radiology, University of Missouri-Columbia, Columbia, MO, USA
| | | | - Ashley F Curtis
- College of Nursing, University of South Florida, Tampa, FL, USA.
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Musich M, Costa AN, Salathe V, Miller MB, Curtis AF. Sex-Specific Contributions of Alcohol and Hypertension on Everyday Cognition in Middle-Aged and Older Adults. J Womens Health (Larchmt) 2023; 32:1086-1095. [PMID: 37023399 DOI: 10.1089/jwh.2022.0462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Background: Separate lines of research have linked hypertension and alcohol use disorder to cognition among adults. Despite known sex differences in both of these conditions, studies examining associations on cognition are limited. We aimed to determine whether hypertension impacts the relationship between alcohol use and everyday subjective cognition and whether sex moderates this relationship in middle-aged and older adults. Materials and Methods: Participants (N = 275) 50+ years of age, who reported drinking, completed surveys measuring alcohol use (Alcohol Use Disorder Identification Test consumption items), self-reported history of hypertension, and everyday subjective cognition (Cognitive Failures Questionnaire [CFQ]). Regression was used to test a moderated moderation model examining independent and interactive roles of alcohol use, hypertension, and sex on cognition (CFQ scores: total, memory, distractibility, blunders, and names). Analyses controlled for age, years of education, race, body mass index, smoking status, depressive symptoms, global subjective sleep quality, number of prescription medication used, and number of comorbid medical conditions. Results: Sex moderated the interactive associations of hypertension and alcohol use frequency on CFQ-distractibility. Specifically, in women with hypertension, more alcohol use was associated with greater CFQ-distractibility (B = 0.96, SE = 0.34, p = 0.005). Discussion: Sex moderates the interactive association of hypertension and alcohol use on some aspects of subjective cognition in mid-to-late life. In women with hypertension, alcohol use may exacerbate problems with attentional control. Further exploration of sex- and or gender-specific mechanisms underlying these is warranted.
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Affiliation(s)
- Madison Musich
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Amy N Costa
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Victoria Salathe
- Department of Biological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Ashley F Curtis
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
- College of Nursing, University of South Florida, Tampa, Florida, USA
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McCrae CS, Curtis AF, Stearns MA, Nair N, Golzy M, Shenker JI, Beversdorf DQ, Cottle A, Rowe MA. Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia in Rural Family Caregivers of People With Dementia (NiteCAPP): Mixed Methods Study. JMIR Aging 2023; 6:e45859. [PMID: 37616032 PMCID: PMC10485710 DOI: 10.2196/45859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/12/2023] [Accepted: 07/04/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Informal caregivers of people with dementia frequently experience chronic insomnia, contributing to stress and poor health outcomes. Rural caregivers are particularly vulnerable but have limited access to cognitive behavioral therapy for insomnia (CBT-I), a recommended frontline treatment for chronic insomnia. Web-based delivery promises to improve insomnia, particularly for rural caregivers who have limited access to traditional in-person treatments. Our team translated an efficacious 4-session standard CBT-I content protocol into digital format to create NiteCAPP. OBJECTIVE This study aimed to (1) adapt NiteCAPP for dementia caregivers to create NiteCAPP CARES, a tailored digital format with standard CBT-I content plus caregiver-focused modifications; (2) conduct usability testing and evaluate acceptability of NiteCAPP CARES' content and features; and (3) pilot-test the adapted intervention to evaluate feasibility and preliminary effects on sleep and related health outcomes. METHODS We followed Medical Research Council recommendations for evaluating complex medical interventions to explore user needs and adapt and validate content using a stepwise approach: (1) a rural dementia caregiver (n=5) and primary care provider (n=5) advisory panel gave feedback that was used to adapt NiteCAPP; (2) caregiver (n=5) and primary care provider (n=7) focus groups reviewed the newly adapted NiteCAPP CARES and provided feedback that guided further adaptations; and (3) NiteCAPP CARES was pilot-tested in caregivers (n=5) for feasibility and to establish preliminary effects. Self-report usability measures were collected following intervention. Before and after treatment, 14 daily electronic sleep diaries and questionnaires were collected to evaluate arousal, health, mood, burden, subjective cognition, and interpersonal processes. RESULTS The stepped approach provided user and expert feedback on satisfaction, usefulness, and content, resulting in a new digital CBT-I tailored for rural dementia caregivers: NiteCAPP CARES. The advisory panel recommended streamlining content, eliminating jargon, and including caregiver-focused content. Focus groups gave NiteCAPP CARES high usefulness ratings (mean score 4.4, SD 0.79, scored from 1=least to 5=most favorable; score range 4.2-4.8). Multiple features were evaluated positively, including the intervention's comprehensive and engaging information, caregiver focus, good layout, easy-to-access intervention material, and easy-to-understand sleep graphs. Suggestions for improvement included the provision of day and night viewing options, collapsible text, font size options, tabbed access to videos, and a glossary of terms. Pilot-test users rated usefulness (mean score 4.3, SD 0.83; range 4.1-4.5) and satisfaction (mean score 8.4, SD 1.41, scored from 1=least to 10=most satisfied; range 7.4-9.0) highly. Preliminary effects on caregiver sleep, arousal, health, mood, burden, cognition, and interpersonal processes (all P<.05) were promising. CONCLUSIONS Adaptations made to standard digital CBT-I created a feasible, tailored digital intervention for rural dementia caregivers. Important next steps include further examination of feasibility and efficacy in a randomized controlled trial with an active control condition, a multisite effectiveness trial, and eventual broad dissemination. TRIAL REGISTRATION ClinicalTrials.gov NCT04632628; https://clinicaltrials.gov/ct2/show/NCT04632628.
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Affiliation(s)
- Christina S McCrae
- Department of Psychiatry, University of Missouri, Columbia, MO, United States
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - Ashley F Curtis
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - Melanie A Stearns
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - Neetu Nair
- Department of Psychiatry, University of Missouri, Columbia, MO, United States
| | - Mojgan Golzy
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, United States
| | - Joel I Shenker
- Department of Neurology, University of Missouri, Columbia, MO, United States
| | - David Q Beversdorf
- Department of Neurology, University of Missouri, Columbia, MO, United States
- Departments of Radiology, University of Missouri, Columbia, MO, United States
- Department of Psychological Sciences, University of Missouri, Columbia, MO, United States
- The Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, United States
| | | | - Meredeth A Rowe
- College of Nursing, University of South Florida, Tampa, FL, United States
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10
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Costa AN, Curtis AF, Musich M, Guandique AA, McCrae CS. Self-reported cognition in older adults with insomnia: Associations with sleep and domain specific cognition. J Sleep Res 2023; 32:e13751. [PMID: 36217906 DOI: 10.1111/jsr.13751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/01/2022] [Accepted: 09/21/2022] [Indexed: 02/03/2023]
Abstract
Poor subjective evaluation of cognition and sleep are associated with cognitive decline in older adults. Relationships among self-reported cognition, sleep, and cognitive domains remain unclear. We evaluated the interactive associations of objective cognition and subjective sleep with self-reported cognition in older adults with insomnia. Fifty-one older adults (Mage = 69.19, SD = 7.95) with insomnia completed 14 days of self-reported cognition ratings (0-very poor, 100-very good), sleep (total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency), and daily cognitive tasks: Letter series (reasoning), word list delayed recall (verbal memory), Symbol Digit Modalities Test (SDMT) (attention/processing speed), and number copy (processing speed). Multiple regressions for each cognitive task determined whether average objective cognition or sleep were independently/interactively associated with average self-reported cognition, controlling for age, education, and depression. The interaction between SDMT performance and TST was associated with self-reported cognition. Specifically, the relationship between scores and self-reported cognition was congruent in those with the shortest TST. Similarly, the interactions between SDMT and WASO, as well as sleep efficiency, were associated with self-reported. Specifically, the relationship between scores and self-reported cognition was congruent in those with longest and average WASO, as well as shortest and average sleep efficiency. The findings suggest, in an older adult population with insomnia, a congruent association exists between attention/processing speed and self-reported cognition in those with worse subjective sleep (shorter TST, longer WASO, and lower SE). Insomnia symptoms should be taken into consideration when examining the relationship between objective cognition and self-reported cognition.
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Affiliation(s)
- Amy N Costa
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Ashley F Curtis
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA.,Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Madison Musich
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Alan A Guandique
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
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11
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Costa AN, Nowakowski LM, McCrae CS, Cowan N, Curtis AF. Discrepancies in Objective and Subjective Cognition in Middle-Aged and Older Adults: Does Personality Matter? Gerontol Geriatr Med 2023; 9:23337214221146663. [PMID: 36644685 PMCID: PMC9837265 DOI: 10.1177/23337214221146663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 01/13/2023] Open
Abstract
Associations between subjective cognition and current objective functioning are inconclusive. Given known associations between personality and cognition, this study tested whether personality moderates associations between subjective memory and objective cognition in middle-aged and older adults. Participants (N = 62, M age = 63.8, SD = 7.7, 33 men) completed assessments of personality (Big Five Inventory-10), subjective memory (Cognitive Failures Questionnaire [CFQ-memory]), and objective cognition (processing speed, attention, inhibition [Stroop], working memory [Sternberg], set-shifting [Wisconsin Card Sorting Task]). Multiple regressions and simple slopes analyses examined whether personality moderates associations between subjective memory and objective cognition, controlling for age, number of medical conditions, and household income. Extraversion moderated associations between processing speed and CFQ-memory. Agreeableness moderated associations between set-shifting and CFQ-memory. Among individuals with higher extraversion and lower agreeableness, objectively worse cognition was associated with the fewest memory complaints. Findings suggest personality may impact the discrepancies between subjective memory and objective cognition in mid-to-late life.
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Affiliation(s)
| | | | | | | | - Ashley F. Curtis
- University of Missouri, Columbia, USA,University of South Florida, Tampa, USA,Ashley F. Curtis, College of Nursing, University of South Florida, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA.
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12
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Freeman LK, Miller MB, Simenson A, Sparrow E, Costa AN, Musich M, McCrae CS, Curtis AF. Sex differences in associations between alcohol use and sleep in mid-to-late life. Sleep Med 2022; 100:298-303. [PMID: 36152525 DOI: 10.1016/j.sleep.2022.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/05/2022] [Revised: 08/18/2022] [Accepted: 08/24/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To examine associations between alcohol use and sleep in middled-aged/older adults and to test sex as a moderator of this relationship. METHODS Participants were 183 adults (46% female) ages 50 and above who consumed alcohol in the past year. Linear regressions tested sex as a moderator of associations between alcohol use and sleep parameters. Alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT). Overall sleep health and sleep quality were assessed using the Pittsburgh Sleep Quality Index (PSQI), and pre-sleep arousal was assessed using the Pre-Sleep Arousal Scale. RESULTS Overall, 11% of participants screened positive for hazardous drinking (AUDIT scores of 7+/8+ for women/men), and 59% reported poor overall sleep health (scores >5 on the PSQI). Alcohol use was not associated with overall sleep health (B = -0.25, p = .08) or pre-sleep arousal (B = 0.15, p = .64). However, contrary to hypotheses, more hazardous drinking was associated with better subjective sleep quality, only among women (B = -0.08, p = .009). Alcohol use was not associated with sleep quality among men (B = 0.01, p = .58). Associations remained significant when controlling for age, symptoms of anxiety and depression, body mass index, use of sleep medication, number of medical conditions, and chronic pain. CONCLUSIONS Among middle-aged and older adults, alcohol use is more strongly associated with sleep patterns among women than men, when assessed concurrently (i.e., at the same time point). Findings support the need for further consideration of sex differences in associations between alcohol use and sleep.
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Affiliation(s)
- Lindsey K Freeman
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO, 65211, USA
| | - Mary Beth Miller
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO, 65211, USA; Department of Psychiatry, University of Missouri, 1 Hospital Dr, Columbia, MO, 65212, USA
| | - Angelynn Simenson
- Department of Psychiatry, University of Missouri, 1 Hospital Dr, Columbia, MO, 65212, USA
| | - Emilie Sparrow
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO, 65211, USA
| | - Amy N Costa
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO, 65211, USA
| | - Madison Musich
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO, 65211, USA
| | - Christina S McCrae
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO, 65211, USA; Department of Psychiatry, University of Missouri, 1 Hospital Dr, Columbia, MO, 65212, USA
| | - Ashley F Curtis
- Department of Psychological Sciences, University of Missouri, 210 McAlester Hall, Columbia, MO, 65211, USA; Department of Psychiatry, University of Missouri, 1 Hospital Dr, Columbia, MO, 65212, USA.
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13
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McGovney KD, Curtis AF, McCrae CS. Actigraphic Physical Activity, Pain Intensity, and Polysomnographic Sleep in Fibromyalgia. Behav Sleep Med 2022:1-14. [PMID: 35856908 DOI: 10.1080/15402002.2022.2102009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Fibromyalgia involves chronic pain and disrupted physical activity and sleep. Research examining the relationship between pre-bedtime physical activity, pain, and objective sleep is limited. This study examined whether objectively measured physical activity levels (via actigraphy), pain intensity, or their interaction are associated with polysomnographic sleep outcomes. METHODS Adults with fibromyalgia and insomnia complaints (n = 134, mean age = 52 yrs, SD = 12 yrs, 94% female) completed 14 days of biaxial, wrist worn actigraphy, pain ratings, and a single night of polysomnography (PSG). Average activity for intervals 9:00-12:00, 12:00-15:00, 15:00-18:00, 18:00-21:00 was computed. Multiple regressions examined whether average activity, average evening pain, or their interaction were associated with PSG outcomes: sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency, %stage1, %stage2, %stage3, and %rapid eye movement. Analyses controlled for age, body mass index, average bedtime, time in bed, and sleep/pain medication use. RESULTS Greater morning actigraphic physical activity from 9:00 to 12:00 was independently associated with greater %stage 1 sleep (B = 0.01, SE = 0.00, p < .01). Greater afternoon activity from 12:00 to 15:00 independently predicted a higher WASO (p < .001). Associations between afternoon physical activity from 12:00 to 15:00 and greater %stage 1 (p < .001) were significant for at higher (~71/100), average (~52/100), but not lowest (~32/100) pain. CONCLUSION Greater morning and afternoon activity is associated with greater PSG sleep fragmentation and greater %stage 1 sleep in individuals with fibromyalgia and insomnia complaints, and the relationship between higher physical activity and greater %stage 1 is stronger for individuals with higher pain. Further studies examining causal pathways between physical activity, activity pacing, and sleep are warranted in fibromyalgia.
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Affiliation(s)
- Kevin D McGovney
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Ashley F Curtis
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA.,Department of Psychiatry, University of Missouri, Columbia, Missouri, USA
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri, Columbia, Missouri, USA
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14
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McCrae CS, Curtis AF, Cottle A, Beversdorf DB, Shenker J, Mooney BP, Popescu M, Rantz M, Groer M, Stein P, Golzy M, Stearns MA, Simenson A, Nair N, Rowe MA. Impact of Web-Based Cognitive Behavioral Therapy for Insomnia on Stress, Health, Mood, Cognitive, Inflammatory, and Neurodegenerative Outcomes in Rural Dementia Caregivers: Protocol for the NiteCAPP CARES and NiteCAPP SHARES Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e37874. [PMID: 35700020 PMCID: PMC9240954 DOI: 10.2196/37874] [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] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Chronic insomnia affects up to 63% of family dementia caregivers. Research suggests that chronic insomnia prompts changes in central stress processing that have downstream negative effects on health and mood, as well as on cognitive, inflammatory, and neurodegenerative functioning. We hypothesize that cognitive behavioral therapy for insomnia (CBT-I) will reverse those downstream effects by improving insomnia and restoring healthy central stress processing. Rural caregivers are particularly vulnerable, but they have limited access to CBT-I; therefore, we developed an accessible digital version using community input (NiteCAPP CARES). OBJECTIVE This trial will evaluate the acceptability, feasibility, and short-term and long-term effects of NiteCAPP CARES on the sleep and stress mechanisms underlying poor caregiver health and functioning. METHODS Dyads (n=100) consisting of caregivers with chronic insomnia and their coresiding persons with dementia will be recruited from Columbia and surrounding areas in Missouri, United States. Participant dyads will be randomized to 4 weeks (plus 4 bimonthly booster sessions) of NiteCAPP CARES or a web-based sleep hygiene control (NiteCAPP SHARES). Participants will be assessed at baseline, after treatment, and 6- and 12-month follow-ups. The following assessments will be completed by caregivers: 1 week of actigraphy and daily diaries measuring sleep, Insomnia Severity Index, arousal (heart rate variability), inflammation (blood-derived biomarkers: interleukin-6 and C-reactive protein), neurodegeneration (blood-derived biomarkers: plasma amyloid beta [Aβ40 and Aβ42], total tau, and phosphorylated tau [p-tau181 and p-tau217]), cognition (Joggle battery, NIH Toolbox for Assessment of Neurological and Behavioral Function, and Cognitive Failures Questionnaire), stress and burden, health, and mood (depression and anxiety). Persons with dementia will complete 1 week of actigraphy at each time point. RESULTS Recruitment procedures started in February 2022. All data are expected to be collected by 2026. Full trial results are planned to be published by 2027. Secondary analyses of baseline data will be subsequently published. CONCLUSIONS This randomized controlled trial tests NiteCAPP CARES, a web-based CBT-I for rural caregivers. The knowledge obtained will address not only what outcomes improve but also how and why they improve and for how long, which will help us to modify NiteCAPP CARES to optimize treatment potency and support future pragmatic testing and dissemination. TRIAL REGISTRATION ClinicalTrials.gov NCT04896775; https://clinicaltrials.gov/ct2/show/NCT04896775. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37874.
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Affiliation(s)
| | | | | | | | - Joel Shenker
- University of Missouri, Columbia, MO, United States
| | | | | | | | - Maureen Groer
- University of South Florida, Tampa, FL, United States
| | | | - Mojgan Golzy
- University of Missouri, Columbia, MO, United States
| | | | | | - Neetu Nair
- University of Missouri, Columbia, MO, United States
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15
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Abstract
STUDY OBJECTIVES Subjective memory complaints and objective cognitive dysfunction are common in aging populations, however research investigating the associations between them is inconclusive. Given the high prevalence of sleep complaints in middle-aged/older adults, this research tested whether objective cognition interacted with sleep parameters in its associations with subjective cognition. METHODS Cognitively healthy adults aged 50+ completed the Pittsburgh Sleep Quality Index, Cognitive Failures Questionnaire (CFQ) and cognitive tasks: Stroop, Sternberg, and Posner cueing. Multiple regression and simple slope analyses examined whether objective cognition interacted with sleep parameters in its associations with subjective memory. RESULTS Stroop performance and sleep (efficiency and disturbances) had interactive associations with CFQ-memory. Specifically, better Stroop performance (faster reaction time, RT-control trials) was associated with more memory complaints at worst and average, but not best sleep efficiency. Additionally, faster RT was associated with more memory complaints only for worst sleep disturbance. Similarly, Sternberg performance and sleep (efficiency and disturbances) had interactive associations with CFQ-memory. Specifically, higher proportion correct was associated with more memory complaints only at worst sleep efficiency and sleep disturbance. Finally, Posner performance and sleep disturbance had an interactive association with CFQ-memory. Faster exogenous orienting was associated with more memory complaints only for worst sleep disturbance. CONCLUSIONS Objective cognition interacts with sleep efficiency and sleep disturbances in its associations with subjective memory in mid-to-late life. Findings suggest sleep fragmentation plays a role in the discrepant relationship between objective and subjective cognition. Future studies should investigate this relationship in aging populations with sleep disorders and/or cognitive impairments.
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Affiliation(s)
- Amy N Costa
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO
| | | | - Nelson Cowan
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO
| | - Ashley F Curtis
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO.,Department of Psychiatry, University of Missouri-Columbia, Columbia, MO
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16
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Miller MB, Curtis AF, Hall NA, Freeman LK, Everson AT, Martinez LD, Park CJ, McCrae CS. Daily associations between modifiable sleep behaviors and nighttime sleep among young adult drinkers with insomnia. J Clin Sleep Med 2022; 18:703-712. [PMID: 34605392 PMCID: PMC8883105 DOI: 10.5664/jcsm.9706] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Empirical evidence linking individual sleep hygiene practices to subsequent sleep parameters is limited, particularly at the daily level. This study compared the strength of daily, within-person associations between these modifiable sleep behaviors and nighttime sleep in young adult drinkers with insomnia. METHODS Young adults (ages 18-30 years; n = 56) who met diagnostic criteria for insomnia and reported past-month binge drinking wore wrist actigraphy and completed online sleep diaries for 8.5 days (standard deviation = 2.3; 477 reports). Diaries assessed engagement in 11 sleep hygiene recommendations. Multilevel models tested daily associations between sleep behaviors and 3 outcomes: sleep quality, self-reported sleep efficiency, and actigraphy-measured sleep efficiency. RESULTS Participants self-reported better sleep quality/efficiency on days that they slept in a comfortable environment, limited naps to 30 minutes, and maintained a consistent wake time. They self-reported worse sleep quality and efficiency on nights that they avoided alcohol use before bedtime. No sleep behaviors were significantly associated with actigraphy-measured sleep efficiency after correcting for inflation in type I error. CONCLUSIONS The sleep hygiene recommendations most strongly associated with sleep at the daily level were consistent with stimulus control. Creating a comfortable sleep environment also emerged as an important correlate of daily sleep. Heavy drinkers with insomnia may perceive better sleep if they drink before bedtime; however, this finding may be unique to this population. CITATION Miller MB, Curtis AF, Hall NA, et al. Daily associations between modifiable sleep behaviors and nighttime sleep among young adult drinkers with insomnia. J Clin Sleep Med. 2022;18(3):703-712.
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Affiliation(s)
- Mary Beth Miller
- Address correspondence to: Mary Beth Miller, PhD, One Hospital Drive DC067.00, Columbia, MO 65212; Tel: (573) 882-1813; Fax: (573) 884-1070;
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17
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Roth AJ, Curtis AF, Rowe MA, McCrae CS. Using Telehealth to Deliver Cognitive Behavioral Treatment of Insomnia to a Caregiver of a Person With Alzheimer's Disease. J Cogn Psychother 2022; 36:3-23. [PMID: 35121676 DOI: 10.1891/jcpsy-d-20-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive behavioral therapy for Insomnia (CBT-I) is the gold standard treatment for insomnia. There is limited access to qualified providers to deliver CBT-I; moreover, there are patient populations who struggle with access to insomnia care due to limited time and resources. This includes caregivers for persons with Alzheimer's disease, for whom sleep disturbance is a common concern. Utilizing telehealth to deliver CBT-I may be particularly important for vulnerable populations such as caregivers of persons with dementia, as it can offer an accessible, safe, and cost-effective treatment option that can be tailored to meet the needs of a specific population. This case study illustrates the successful implementation of a four-session CBT-I protocol through telehealth with a caregiver of a person with Alzheimer's disease. Given the success of this case and the conditions for psychological care the recent pandemic has created, continued research into the efficacy of sleep-related interventions through telehealth is warranted.
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Affiliation(s)
- Alicia J Roth
- Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri, Columbia, Missouri.,Department of Psychological Sciences, University of Missouri, Columbia, Missouri
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18
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Curtis AF, Schmiedeler A, Musich M, Connell M, Miller MB, McCrae CS. COVID-19-Related Anxiety and Cognition in Middle-Aged and Older Adults: Examining Sex as a Moderator. Psychol Rep 2022; 126:1260-1283. [PMID: 35099322 PMCID: PMC8810388 DOI: 10.1177/00332941211064820] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aging populations experience disproportionate risk for cognitive decline, which may be exacerbated by coronavirus (COVID-19) illness, particularly among women. This study tested sex as a moderator of associations between COVID-19 state anxiety and cognition in middle-aged/older adults. Adults aged 50+ (N = 275; 151 men/124 women) completed the Coronavirus Anxiety Scale and Cognitive Failures Questionnaire online from remote locations in July/August 2020. A subset of participants (n = 62) completed an objective cognitive task (Stroop). Multiple regressions determined whether sex moderated associations between COVID-19 anxiety and cognitive outcomes. Sex was a significant moderator, such that for women (not men), greater COVID-19 anxiety was associated with more memory failures and blunders (subjective measures) and worse processing speed (objective measure). COVID-19 state anxiety is linked to everyday cognition and processing speed in women, but not men. Consistency across subjective and objective measures promotes the need for sex-specific understanding of the pandemic’s behavioral and cognitive effects in mid-to-late life.
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Affiliation(s)
- Ashley F. Curtis
- Department of Psychiatry, University of Missouri, Columbia, MO, USA; Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Anthony Schmiedeler
- Department of Psychiatry, University of Missouri, Columbia, MO, USA; Department of Educational, School, and Counseling Psychology, University of Missouri, Columbia, MO, USA
| | - Madison Musich
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Maggie Connell
- Department of Psychiatry, University of Missouri, Columbia, MO, USA
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, MO, USA
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McCrae CS, Craggs JG, Curtis AF, Nair N, Kay D, Staud R, Berry RB, Robinson ME. Neural activation changes in response to pain following cognitive behavioral therapy for patients with comorbid fibromyalgia and insomnia: a pilot study. J Clin Sleep Med 2022; 18:203-215. [PMID: 34310276 PMCID: PMC8807905 DOI: 10.5664/jcsm.9540] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To examine whether cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) lead to neural activation changes in response to pain in fibromyalgia. METHODS Thirty-two patients with fibromyalgia (mean age = 55.9, standard deviation = 12.2) underwent an experimental pain protocol during functional magnetic resonance imaging and completed 14-day diaries assessing total wake time, total sleep time, and pain intensity before and after CBT-I, CBT-P, or waitlist control. Random effects analysis of covariance identified regions with significant group (CBT-I, CBT-P, waitlist control) by time (baseline, post-treatment) interactions in blood oxygen level-dependent response to pain. Linear regressions using residualized change scores examined how changes in total wake time, total sleep time, and pain intensity were related to activation (blood oxygen level-dependent) changes. RESULTS Twelve regions exhibited small to moderate effects with significant interactions Ps < .00; right hemisphere: inferior frontal, middle occipital, and superior temporal gyri, insula, lentiform nucleus; left hemisphere: angular, superior temporal, midfrontal, inferior occipital, midtemporal, and inferior frontal gyri. Blood oxygen level-dependent response to pain decreased in 8 regions following CBT-I, and in 3 regions following CBT-P (CBT-I effects > CBT-P). Blood oxygen level-dependent response also increased in 3 regions following CBT-P and in 6 regions following waitlist control. Improved total wake time and/or total sleep time, not pain intensity, predicted decreased blood oxygen level-dependence in 7 regions (Ps < .05), accounting for 18%-47% of the variance. CONCLUSIONS CBT-I prompted greater decreases in neural activation in response to pain across more regions associated with pain and sleep processing than CBT-P. Reported sleep improvements may underlie those decreases. Future research examining the longer-term impact of CBT-I and improved sleep on central pain and sleep mechanisms is warranted. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Sleep and Pain Interventions in Fibromyalgia (SPIN); Identifier: NCT02001077; URL: https://clinicaltrials.gov/ct2/show/NCT02001077. CITATION McCrae CS, Craggs JG, Curtis AF, et al. Neural activation changes in response to pain following cognitive behavioral therapy for patients with comorbid fibromyalgia and insomnia: a pilot study. J Clin Sleep Med. 2022;18(1):203-215.
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Affiliation(s)
- Christina S. McCrae
- Department of Psychiatry, University of Missouri, Columbia, Missouri,Address correspondence to: Christina S. McCrae, PhD, Department of Psychiatry, 1 Hospital Drive, Columbia, MO 65212; Tel: (573) 882-0982; Fax: (573) 884-1070;
| | - Jason G. Craggs
- Physical Therapy, University of Missouri, Columbia, Missouri,Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Ashley F. Curtis
- Department of Psychiatry, University of Missouri, Columbia, Missouri,Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Neetu Nair
- Department of Psychiatry, University of Missouri, Columbia, Missouri
| | - Daniel Kay
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Roland Staud
- Rheumatology and Clinical Immunology, University of Florida, Gainesville, Florida
| | - Richard B. Berry
- Division of Pulmonary, Critical Care, and Sleep Medicine, Gainesville, Florida
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20
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Miller MB, Carpenter RW, Freeman LK, Curtis AF, Yurasek AM, McCrae CS. Cannabis use as a moderator of cognitive behavioral therapy for insomnia. J Clin Sleep Med 2021; 18:1047-1054. [PMID: 34870584 DOI: 10.5664/jcsm.9796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/13/2022]
Abstract
STUDY OBJECTIVES Cannabis use is common among young adults and has been proposed as a potential treatment for insomnia. However, controlled studies examining the impact of cannabis use on insomnia symptoms are rare. This secondary analysis of published trial data tested cannabis use during cognitive behavioral treatment for insomnia (CBT-I) as a moderator of treatment efficacy. METHODS Young adults (ages 18-30 years) who reported past-month binge drinking (4/5+ drinks for women/men) and met DSM-5 and research diagnostic criteria for Insomnia Disorder were randomized to CBT-I (n=28) or sleep hygiene (SH; n=28). Interaction effects were tested using multilevel models. Outcomes included insomnia severity, actigraphy-assessed sleep efficiency, diary-assessed sleep quality, drinking quantity, and alcohol-related consequences. RESULTS Twenty-six participants (46%; 12 SH and 14 CBT-I) reported using cannabis during the treatment phase of the study, on an average of 23% of treatment days (range=3-100%). Relative to those who did not use cannabis, participants who used cannabis during treatment reported heavier drinking and more frequent cigarette use. Approximately 1 in 4 cannabis users (27%) reported using cannabis to help with sleep; however, cannabis and non-cannabis users did not differ in use of alcohol as a sleep aid. Controlling for sex, race, drinking quantity, cigarette use, symptoms of depression, and symptoms of anxiety, use of cannabis during treatment did not moderate CBT-I effects on insomnia severity (b= -.002, p=.99) or other outcomes (all p >.20). CONCLUSIONS CBT-I is effective in reducing insomnia symptoms among young adult drinkers with insomnia, regardless of cannabis use. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Identifier: NCT03627832.
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO
| | - Ryan W Carpenter
- Department of Psychological Sciences, University of Missouri-St. Louis, St. Louis, MO
| | - Lindsey K Freeman
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO.,Department of Psychological Sciences, University of Missouri, Columbia, MO
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO.,Department of Psychological Sciences, University of Missouri, Columbia, MO
| | - Ali M Yurasek
- Health Education and Behavior Department, College of Health and Human Performance, University of Florida, Gainesville, FL
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO
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McCrae CS, Mazurek MO, Curtis AF, Beversdorf DQ, Deroche CB, Golzy M, Sohl KA, Ner ZH, Davis BE, Stearns MA, Nair N. Protocol for targeting insomnia in school-aged children with autism spectrum disorder without intellectual disability: a randomised control trial. BMJ Open 2021; 11:e045944. [PMID: 34433593 PMCID: PMC8388273 DOI: 10.1136/bmjopen-2020-045944] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 08/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Insomnia affects up to 80% of children with autism spectrum disorder (ASD). Negative consequences of insomnia in ASD include decreased quality of life (QOL), impaired learning and cognition, increased stereotypic and challenging behaviours, and increased parental stress. Cognitive behavioural treatment for childhood insomnia (CBT-CI) is a promising treatment for dealing with insomnia and its negative consequences but has not yet been studied in school-aged children with ASD and comorbid insomnia. Access to healthcare is another challenge for children with ASD, particularly in rural and underserved regions. Previous studies indicate that ASD and insomnia share common arousal-based underpinnings, and we hypothesise that CBT-CI will reduce the hyperarousal associated with insomnia and ASD. This trial will be the first to examine CBT-CI adapted for children with ASD and will provide new information about two different modes of delivery across a variety of primary and secondary child and parent sleep and related outcomes. Knowledge obtained from this trial might allow us to develop new or modify current treatments to better target childhood insomnia and ASD. METHODS AND ANALYSIS Children (N=180) 6-12 years of age with ASD and insomnia will be recruited from an established autism database, a paediatric clinic and community outreach in the Columbia, MO and surrounding areas. Participants will be randomised to CBT-CI adapted for children with ASD (in-person or remote using computers with cameras) or Sleep Hygiene and Related Education. Participants will be assessed at baseline, post-treatment, 6-month and 12-month follow-ups. The following assessments will be completed regarding the children: objective and subjective sleep, daytime functioning (adaptive functioning, attention, challenging behaviours, anxiety), QOL and physiological arousal (heart rate variability) and parents: objective and subjective sleep, daytime functioning (anxiety, depression, fatigue), QOL, physiological arousal and parental burden/stress. ETHICS AND DISSEMINATION Ethics approval was obtained in January 2020 from the University of Missouri. Ethics approval was obtained in July 2020 from the US Army Medical Research and Development Command, Office of Research Protections and Human Research Protection Office. All data are expected to be collected by 2024. Full trial results are planned to be published by 2025. Secondary analyses of baseline data will be subsequently published. TRIAL REGISTRATION NUMBER NCT04545606; Pre-results.
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Affiliation(s)
| | - Micah O Mazurek
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - Ashley F Curtis
- Psychiatry, University of Missouri, Columbia, MO, USA
- Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - David Q Beversdorf
- Departments of Radiology, Neurology, Psychological Sciences, and the Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA
| | - Chelsea B Deroche
- Department of Health Management & Informatics, University of Missouri, Columbia, MO, USA
| | - Mojgan Golzy
- Department of Health Management & Informatics, University of Missouri, Columbia, MO, USA
| | - Kristin A Sohl
- Department of Child Health, University of Missouri, Columbia, MO, USA
| | - Zarah H Ner
- Department of Child Health, University of Missouri, Columbia, MO, USA
| | - Beth Ellen Davis
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | | | - Neetu Nair
- Psychiatry, University of Missouri, Columbia, MO, USA
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22
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Curtis AF, Rodgers M, Miller MB, McCrae CS. Impact of Sex on COVID-19 Media Exposure, Anxiety, Perceived Risk, and Severity in Middle-Aged and Older Adults. J Aging Health 2021; 34:51-59. [PMID: 34114480 DOI: 10.1177/08982643211025383] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To examine associations between COVID-19 media exposure and anxiety/perceived risk/severity and investigate their dependency on sex in middle-aged/older adults. METHODS Adults aged 50+ years completed online surveys: Coronavirus Anxiety Scale, COVID-19 media exposure, COVID-19 media dependency for health information, and COVID-19 perceived risk and severity. Multiple regressions examined independent and interactive (with sex) associations between COVID-19 media exposure/dependency and COVID-19 anxiety/perceived risk and severity. Analyses controlled for age, education, race, total medical conditions, and COVID-19 status. RESULTS Higher COVID-19 media exposure was associated with higher COVID-19 anxiety among men (not women) and higher perceived risk/severity in both sexes. Higher COVID-19 media dependency was associated with higher COVID-19 anxiety and perceived risk/severity in both sexes. CONCLUSION In middle-aged/older adults, the use/dependency of media for COVID-19 information may be linked to negative psychological health and increased COVID-19 perceived risk and severity. Men may be at increased risk of anxiety related to media exposure.
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Affiliation(s)
- Ashley F Curtis
- Department of Psychiatry, 14716University of Missouri, Columbia, MO, USA.,Department of Psychological Sciences, 14716University of Missouri, Columbia, MO, USA
| | - Mikayla Rodgers
- Department of Psychiatry, 14716University of Missouri, Columbia, MO, USA
| | - Mary Beth Miller
- Department of Psychiatry, 14716University of Missouri, Columbia, MO, USA
| | - Christina S McCrae
- Department of Psychiatry, 14716University of Missouri, Columbia, MO, USA
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Miller MB, Curtis AF, Chan WS, Deroche CB, McCrae CS. Daily associations between sleep and opioid use among adults with comorbid symptoms of insomnia and fibromyalgia. J Clin Sleep Med 2021; 17:729-737. [PMID: 33226334 DOI: 10.5664/jcsm.9002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Disturbed sleep and use of opioid pain medication are common among individuals with chronic pain. Anecdotally, opioids are thought to promote sleep by relieving pain. This study aimed to determine whether opioid use is associated with daily sleep parameters (and vice versa) in adults with comorbid symptoms of insomnia and fibromyalgia. METHODS Individuals reporting symptoms of insomnia and opioid use for fibromyalgia (n = 65, 93% women, 79% White) wore wrist actigraphy and completed daily diaries for 14 days (910 observations). Analyses examined daily associations between opioid dose (measured in lowest recommended dosage units) and three sleep parameters (actigraphy/self-reported total wake time and self-reported sleep quality). Multilevel models were used to account for the clustering of daily sleep and opioid assessments (level 1) within individuals (level 2). RESULTS Opioid use did not have a significant daily effect on total wake time or sleep quality, and sleep parameters did not significantly impact opioid use the next day; however, participants reported worse sleep quality and greater doses of opioids on evenings that they experienced greater pain. CONCLUSIONS Among adults reporting symptoms of insomnia and opioid use for fibromyalgia pain, opioid use is not reliably associated with wake time or sleep quality that night, and these sleep parameters are not significantly associated with opioid use the next day; however, evening pain has an adverse daily impact on both sleep quality and opioid use. Studies identifying strategies to prevent and manage fibromyalgia pain are needed, especially for individuals reporting comorbid insomnia and opioid use.
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri.,Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Wai Sze Chan
- Department of Psychology, The University of Hong Kong, Hong Kong
| | - Chelsea B Deroche
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, Missouri
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24
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McCrae CS, Curtis AF, Nair N, Berry J, Davenport M, McGovney K, Berry RB, McCoy K, Marsiske M. Impact of a brief behavioral treatment for insomnia (BBTi) on metacognition in older adults. Sleep Med 2021; 80:286-293. [PMID: 33610076 DOI: 10.1016/j.sleep.2021.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/28/2020] [Revised: 12/11/2020] [Accepted: 01/26/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Brief (≤4 sessions) behavioral treatment for insomnia (BBTi) improves insomnia symptoms in older adults. Findings for BBTi-related improvements in objective cognition are mixed, with our recent trial reporting no effects. Metacognition (appraisal of one's own performance) has not been examined. This study examined the effects of BBTi on metacognition in older adults with insomnia. METHODS Older adults with insomnia [N = 62, Mage = 69.45 (SD = 7.71)] were randomized to 4-weeks of BBTi (n = 32; psychoeducation, sleep hygiene, stimulus control, sleep restriction, relaxation, review/maintenance) or self-monitoring control (SMC; n = 30; social conversations). Throughout the study (2 week baseline, 4 week treatment, 2 week post-treament, 2 week 3-month followup), participants completed daily paper/pencil cognitive tasks (measuring verbal memory, attention, processing speed and reasoning) and provided daily metacognition ratings of their performance in four areas: quality, satisfaction, compared to same age peers, compared to own ability. Two-week averages of metacognitive ratings were calculated for baseline, treatment-first half, treatment-second half, post-treatment, and 3-month follow-up. Multilevel Modeling examined treatment effects (BBTi/SMC) over time on metacognition, controlling for age and sex. RESULTS A significant group by time interaction (p = 0.05) revealed consistent improvements over time in better metacognitive ratings relative to same age peers for BBTi. Specifically, baseline ratings [mean (M) = 51.21, standard error (SE) = 3.15] improved at first half of treatment (M = 56.65, SE = 3.15, p < 0.001), maintained improvement at second-half of treatment (p = 0.18), showed additional improvement at post-treatment (M = 60.79, SE = 3.15, p = 0.02), and maintained improvement at follow-up (M = 62.30, SE = 3.15; p = 0.02). SMC prompted inconsistent and smaller improvements between baseline (M = 53.24, SE = 3.29) and first-half of treatment (M = 56.62, SE = 3.28; p = 0.004), with additional improvement at second-half of treatment (M = 59.39, SE = 3.28; p = 0.02) that was maintained at post-treatment (p = 0.73) and returned to levels observed at first-half of treatment (M = 57.78, SE = 3.21; p = 0.55). Significant main effects of time (all ps < 0.001) for other metacognition variables (Quality, Satisfaction, Compared to own ability) indicated general improvements over time for both groups. DISCUSSION Metacognition generally improved over time regardless of treatment. BBTi selectively improved ratings of performance relative to same age peers. Repeated objective testing alone may improve metacognition in older adults with insomnia. Better understanding of metacognition and how to improve it has important implications for older adults as metacognitive complaints have been associated with mild cognitive impairment.
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Affiliation(s)
- Christina S McCrae
- Department of Psychiatry, University of Missouri-Columbia, Columbia, MO, USA.
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri-Columbia, Columbia, MO, USA; Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - Neetu Nair
- Department of Psychiatry, University of Missouri-Columbia, Columbia, MO, USA
| | - Jasmine Berry
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - Mattina Davenport
- Department of Psychiatry, University of Missouri-Columbia, Columbia, MO, USA
| | - Kevin McGovney
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO, USA
| | - Richard B Berry
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Karin McCoy
- Neuropsychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Curtis AF, Dzierzewski JM, Buman MP, Giacobbi PR, Roberts BL, Aiken-Morgan AT, Marsiske M, McCrae CS. Preliminary investigation of interactive associations of sleep and pain with cognition in sedentary middle-aged and older adults. J Clin Sleep Med 2021; 17:233-242. [PMID: 33006311 PMCID: PMC7853205 DOI: 10.5664/jcsm.8856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/05/2019] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The objective of this study was to examine independent and interactive associations between self-reported sleep (sleep efficiency and total sleep time [TST]) and pain with cognition in sedentary middle-aged and older adults. METHODS Seventy-five sedentary adults at least 50 years of age (Mage = 63.24, standard deviation = 8.87) completed 14 daily diaries measuring sleep and pain. Weekly average sleep efficiency, TST, and pain were computed. Participants also completed computerized cognitive tasks: Letter Series (reasoning), N-back (working memory), Symbol Digit Modalities Test (processing speed, attention), and Number Copy (processing speed). Multiple regression analyses were conducted to determine independent and interactive (with pain) associations of sleep efficiency and TST with cognition, controlling for age, education, and sex. RESULTS Sleep efficiency and pain interacted in their associations with Letter Series performance and N-back difference scores (2-back minus 1-back). Specifically, higher sleep efficiency was associated with better reasoning and working memory in those with highest pain but not average or lowest pain. TST and pain also interacted in their associations with Letter Series performance. Specifically, longer TST associated with worse reasoning in those with lowest (not average or highest) pain. CONCLUSIONS Preliminary results show that in sedentary middle-aged and older adults, pain and sleep interact in their associations with executive function tasks. Higher sleep efficiency may be associated with better reasoning and working memory in those with highest pain. Lower TST may be associated with better reasoning in those with lowest pain. Studies evaluating temporal associations between sleep, pain, and cognition are needed.
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Affiliation(s)
- Ashley F. Curtis
- Department of Psychiatry, University of Missouri, Columbia, Missouri
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | | | - Matthew P. Buman
- College of Health Solutions, Arizona State University, Tempe, Arizona
| | - Peter R. Giacobbi
- College of Physical Activity and Sport Sciences, West Virginia University, Morgantown, West Virginia
| | | | - Adrienne T. Aiken-Morgan
- Department of Psychology, North Carolina A&T State University, Greensboro, North Carolina
- Center on Health and Society, Social Science Research Institute, Duke University, Durham, North Carolina
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
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McCrae CS, Curtis AF. From bit player to key mechanism: the role of sleep in exercise. J Clin Sleep Med 2020; 16:19-20. [DOI: 10.5664/jcsm.8886] [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: 11/13/2022]
Affiliation(s)
- Christina S. McCrae
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
| | - Ashley F. Curtis
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
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McGovney KD, Curtis AF, McCrae CS. Associations between objective afternoon and evening physical activity and objective sleep in patients with fibromyalgia and insomnia. J Sleep Res 2020; 30:e13220. [PMID: 33124122 DOI: 10.1111/jsr.13220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 11/28/2022]
Abstract
Patients with fibromyalgia (FM) suffer from chronic pain, which limits physical activity and is associated with disturbed sleep. However, the relationship between physical activity, pain and sleep is unclear in these patients. This study examined whether actigraphic (Actiwatch-2, Philips Respironics) afternoon and evening activity and pain are associated with actigraphic sleep. Adults with FM and insomnia complaints (n = 160, mean age [Mage ] = 52, SD = 12, 94% female) completed 14 days of actigraphy. Activity levels (i.e., activity counts per minute) were recorded, and average afternoon/evening activity for intervals 12:00-3:00 PM, 3:00-6:00 PM and 6:00-9:00 PM was computed. Multiple linear regressions examined whether afternoon/evening activity, pain (daily evening diaries from 0 [no pain sensation] to 100 [most intense pain imaginable]), or their interaction, predicted sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE). Greater afternoon activity was independently associated with lower SE (B = -0.08, p < .001), lower TST (β = -0.36, standard error [SE] = 0.06, p < .001) and longer WASO (B = 0.34, p < .001). Greater early evening activity was independently associated with lower SE (B = -0.06, p < .001), lower TST (β = -0.26, SE = 0.06, p < .001) and longer WASO (B = 0.23, p < .001). Self-reported pain intensity interacted with afternoon and early evening physical activity, such that associations between higher activity and lower SE were stronger for individuals reporting higher pain. Late evening activity was not associated with sleep outcomes. Results suggest that in FM, increased afternoon and early evening physical activity is associated with sleep disturbance, and this relationship is stronger in individuals with higher pain.
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Affiliation(s)
- Kevin D McGovney
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Ashley F Curtis
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA.,Department of Psychiatry, University of Missouri, Columbia, MO, USA
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McCrae CS, Curtis AF, Craggs J, Deroche C, Sahota P, Siva C, Staud R, Robinson M. Protocol for the impact of CBT for insomnia on pain symptoms and central sensitisation in fibromyalgia: a randomised controlled trial. BMJ Open 2020; 10:e033760. [PMID: 32933953 PMCID: PMC7493102 DOI: 10.1136/bmjopen-2019-033760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/24/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Approximately 50% of individuals with fibromyalgia (a chronic widespread pain condition) have comorbid insomnia. Treatment for these comorbid cases typically target pain, but growing research supports direct interventions for insomnia (eg, cognitive behavioural treatment for insomnia (CBT-I)) in these patients. Previous research suggests sustained hyperarousal mediated by a neural central sensitisation mechanism may underlie insomnia and chronic pain symptoms in fibromyalgia. We hypothesise CBT-I will improve insomnia symptoms, improve clinical pain and reduce central sensitisation. The trial will be the first to evaluate the short-term and long-term neural mechanisms underlying insomnia and pain improvements in fibromyalgia. Knowledge obtained from this trial might allow us to develop new or modify current treatments to better target pain mechanisms, perhaps reversing chronic pain or preventing it. METHODS AND ANALYSIS Female participants (n=130) 18 years of age and older with comorbid fibromyalgia (with pain severity of at least 50/100) and insomnia will be recruited from the University of Missouri in Columbia, Missouri, and surrounding areas. Participants will be randomised to 8 weeks (plus 4 bimonthly booster sessions) of CBT-I or a sleep hygiene control group (SH). Participants will be assessed at baseline, post-treatment, 6 and 12 months follow-ups. The following assessments will be completed: 2 weeks of daily diaries measuring sleep and pain, daily actigraphy, insomnia severity index, pain-related disability, single night of polysomnography recording, arousal (heart rate variability, cognitive affective arousal), structural and functional MRI to examine pain-related neural activity and plasticity and mood (depression, anxiety). ETHICS AND DISSEMINATION Ethics approval was obtained in July 2018 from the University of Missouri. All data are expected to be collected by 2022. Full trial results are planned to be published by 2024. Secondary analyses of baseline data will be subsequently published. TRIAL REGISTRATION NUMBER NCT03744156.
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Affiliation(s)
- Christina S McCrae
- Department of Psychiatry, University of Missouri System, Columbia, Missouri, USA
| | - Ashley F Curtis
- Departments of Psychiatry and Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Jason Craggs
- Departments of Physical Therapy and Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Chelsea Deroche
- Department of Health Management and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Pradeep Sahota
- Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Chokkalingam Siva
- Division of Immunology and Rheumatology, University of Missouri, Columbia, Missouri, USA
| | - Roland Staud
- Department of Rheumatology, University of Florida, Gainesville, Florida, USA
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
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Yurasek AM, Miller MB, Pritschmann R, Curtis AF, McCrae C. Negative mood as a mediator of the association between insomnia severity and marijuana problems in college students. J Sleep Res 2020; 29:e12985. [PMID: 31997499 PMCID: PMC7387201 DOI: 10.1111/jsr.12985] [Citation(s) in RCA: 2] [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: 09/05/2019] [Revised: 12/01/2019] [Accepted: 12/23/2019] [Indexed: 11/27/2022]
Abstract
Insomnia symptoms have been linked to problematic marijuana use among young adults, but the mechanism underlying this association and whether sex differences exist, remains unclear. Using cross-sectional data, this study examined negative mood as a mediator of the association between insomnia and marijuana problems among male and female college students. Undergraduate students (n = 267; 61% female) reporting marijuana use in the past month completed an online survey assessing insomnia symptoms, negative mood and marijuana problems. Controlling for relevant covariates, negative mood was examined as a mediator of the association between insomnia and marijuana problems using bootstrapped significance tests for indirect effects (n-boot = 1,000). Results indicated that higher levels of insomnia were associated with greater levels of negative mood (regardless of sex), which in turn were associated with greater marijuana-related problems. In conclusion, insomnia symptoms are associated with more negative mood among college students who use marijuana, and this effect on negative mood accounts for a large part of the association of insomnia symptoms with marijuana-related problems. Research is needed to determine if these associations are maintained prospectively.
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Affiliation(s)
- Ali M. Yurasek
- College of Health and Human Performance, Health Education and Behavior Department, University of Florida, Gainesville, FL 32611
| | - Mary Beth Miller
- Department of Psychiatry, 1 Hospital Drive DC067.00, University of Missouri, Columbia, MO 65212
| | - Ricarda Pritschmann
- College of Health and Human Performance, Health Education and Behavior Department, University of Florida, Gainesville, FL 32611
| | - Ashley F. Curtis
- Department of Psychiatry, 1 Hospital Drive DC067.00, University of Missouri, Columbia, MO 65212
| | - Christina McCrae
- Department of Psychiatry, 1 Hospital Drive DC067.00, University of Missouri, Columbia, MO 65212
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Curtis AF, Roth AJ, Sears SF, Conti JB, Berry RB, Dzierzewski JM, McCrae CS. Associations between pain, objective sleep efficiency and cognition in patients with implantable cardioverter defibrillators. Sleep Med 2020; 72:122-125. [PMID: 32615460 DOI: 10.1016/j.sleep.2020.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/10/2019] [Revised: 01/02/2020] [Accepted: 03/28/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Patients with implantable cardioverter defibrillators (ICDs) frequently experience sleep disruption. Prior work shows associations between objective (actigraphic) sleep and cognition in these patients, but whether pain affects associations between measures of sleep fragmentation (eg, sleep efficiency, SE) and cognition is unknown. The present study examined independent and interactive associations between objective SE and pain on cognitive performance in patients with ICDs. METHODS A total of 37 patients with ICDs (Mage = 60.0, SD = 12.4) and self-reported sleep disturbance completed 14 days of actigraphy. Average SE was computed [(average total sleep time/average time in bed) × 100%]. Patients completed the Short Form 36 Health Survey pain section, and computerized tasks measuring executive functioning (letter series, N-Back task), sustained attention/processing speed (symbol digit modalities test, SDMT), and simple reaction time. Multiple linear regressions examined whether SE independently predicted or interacted with pain ratings to predict cognitive performance. RESULTS SE interacted with pain to predict SDMT performance, accounting for 12% unique variance. In patients reporting worse pain, higher SE was associated with better SDMT performance. Similar patterns of association on SDMT were not observed in patients with average or low pain. SE and pain ratings did not independently predict SDMT performance. Performance on other cognitive tasks was not associated with any predictors. CONCLUSION Better sleep efficiency may play an important role in improving sustained attention/processing speed in patients with ICDs and perceived severe pain. Future research should examine whether interventions aimed at improving sleep fragmentation provide benefit to lower order cognition, particularly in patients with worse pain.
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Affiliation(s)
- Ashley F Curtis
- Department of Psychiatry, University of Missouri, Columbia, MO, USA; Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Alicia J Roth
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, OH, USA
| | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, NC, USA; Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Jamie B Conti
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Richard B Berry
- College of Medicine, University of Florida, Gainesville, FL, USA
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Curtis AF, McGovney K, McCrae CS. 1026 Associations Between Physiological Arousal and Executive Function in Adults With Chronic Widespread Pain and Insomnia Complaints. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1022] [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
Individuals with chronic widespread pain (CWP) commonly experience increased physiological arousal, insomnia symptoms, and cognitive disturbance. Higher arousal (as measured by heart rate variability, HRV) is associated with worse executive function in healthy adults, suggesting that hyperarousal selectively disrupts prefrontal cortical activity. However, the HRV/cognition relationship in CWP, the moderating impact of insomnia severity, as well as the components of executive function affected, are unclear. The present study assessed independent associations between HRV and components of executive functioning in patients with CWP and insomnia complaints, and evaluated whether these associations depend on insomnia severity.
Methods
Forty-two adults (Mage=46.2, SD=13.7) with comorbid CWP and insomnia complaints (difficulty falling/staying asleep plus daytime dysfunction) underwent 5-minutes of Holter monitoring to assess resting HRV. The root mean standard deviation of successive normal to normal heartbeats (RMSDNN) was computed as the HRV index. Participants completed the Insomnia Severity Index (ISI). Participants also completed three computerized tasks measuring executive function: Stroop task (inhibition), Sternberg task (working memory), and the Balloon Analogue Risk Task (risk taking behavior). Multiple regressions examined whether RMSDNN independently predicted or interacted with ISI to predict cognition, controlling for age.
Results
RMSDNN independently predicted Stroop performance, with higher RMSDNN (lower arousal) associated with lower interference scores (better inhibitory function), B=-.003, SE=.001, p=.029, Full Model R2=.31. RMSDNN and ISI did not independently predict or interact to predict Sternberg/BART performance.
Conclusion
In patients with CWP and insomnia symptoms, reduced physiological arousal was associated with better inhibition, and this did not depend on insomnia severity. Findings highlight the potential underlying role of hyperarousal in a specific component of executive disruption in CWP. Results suggest that treatments aimed at reducing physiological arousal in comorbid CWP and insomnia (e.g., relaxation, HRV biofeedback) may selectively improve inhibitory function. Findings warrant further consideration in larger samples and prospective analyses.
Support
Research was supported by the National Institute of Nursing Research (NR017168; PI: McCrae). Data collected as part of clinical trial NCT02001077 Sleep and Pain Interventions (SPIN2) at the University of Missouri (PI: McCrae).
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McCrae C, Curtis AF, Nair N, Deroche CB, Shenker J, Rowe M. 0501 Development and Initial Evaluation of Web-Based Cognitive Behavioral Therapy for Insomnia “Nitecapp” in Rural Dementia Caregivers: A Mixed-Methods Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.498] [Citation(s) in RCA: 2] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Informal caregivers (CGs) of persons with dementia frequently experience insomnia. The time consuming and unpredictable schedule of CGs, and associated emotional/physical exhaustion emphasize the need for brief, easily accessible interventions to treat insomnia. Internet-based behavioral insomnia interventions hold promise, particularly for rural CGs who have limited access to traditional in-person treatments. This study aimed to 1) translate an efficacious 4 session cognitive behavioral therapy for insomnia (CBT-I) to web-based “NiteCAPP” for dementia caregivers, and 2) conduct NiteCAPP usability testing/evaluate acceptability of content and features.
Methods
NiteCAPP is an online CBT-I that incorporates guided delivery through weekly therapist moderator feedback. A stepwise approach was implemented in order to explore user needs and validate NiteCAPP content in a focus group of rural dementia caregivers (n=5) and primary care providers (PCPs; n=5). Participants conducted usability testing and provided ratings of program content (1-least favorable to 5-most favorable) regarding ease of use, amount of information, website maintaining interest, adequate font size, videos maintaining interest/easy to understand/helpful. Participants also indicated whether they had at home internet access, method of internet access, and provided open ended feedback on NiteCAPP. Feedback transcripts were compiled and analyzed independently (C.S.M., A.F.C.) through deductive content analysis. Topics mentioned frequently were categorized and merged into common themes during consensus meeting, and NiteCAPP was subsequently adapted.
Results
Average ratings for NiteCAPP features were high, ranging from 4.1/5 to 4.7/5 across all items. All participants had access to internet through both phone and computer. No barriers to use identified. Feedback themes were largely positive (e.g., comprehensive written material, promotes independence, excellent visual tools for therapy moderator feedback, good pacing, use of visual contrast). Negative themes for improvement/adaptation included adding font size options, a light/dark mode, tab with all videos, reducing amount of scrolling, adding a glossary of terms.
Conclusion
Rural dementia CGs and PCPs evaluated NiteCAPP as easy to use with acceptable features and program content and no barriers to access. Improvement themes were used to adapt NiteCAPP. Next steps are to evaluate feasibility and preliminary efficacy of NiteCAPP in rural dementia CGs with insomnia.
Support
none
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Affiliation(s)
- C McCrae
- University of Missouri, Columbia, MO
| | | | - N Nair
- University of Missouri, Columbia, MO
| | | | - J Shenker
- University of Missouri, Columbia, MO
| | - M Rowe
- University of South Florida, Tampa, FL
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McGovney KD, Curtis AF, Mazurek M, Chan WS, Deroche CB, Munoz M, Davenport M, Takamatsu S, Takahashi N, Muckerman J, McCann D, Sahota P, Mills B, McCrae CS. 0922 Nightly Associations Between Pre-Bedtime Activity, Actigraphic Light, and Sleep in Children With ASD and Insomnia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.918] [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
Approximately two thirds of children with Autism Spectrum Disorder (ASD) suffer from chronic insomnia. Current behavioral interventions for insomnia in children with ASD use sleep hygiene guidelines to educate parents and their children regarding sleep promoting habits. However, the relationship between pre-bedtime physical activity/light and sleep is understudied in ASD. The current study examined daily associations between pre-bedtime actigraphically assessed activity/light levels and objective/subjective sleep outcomes in children with ASD and insomnia.
Methods
Thirty children (Mage=8.5 yrs, SD=1.78 yrs) with comorbid ASD and insomnia completed 14 days of actigraphy measuring ambient white light intensity and activity levels every 30 seconds. Validated sleep scoring algorithms (in Actiware V. 6.0.9) estimated objective sleep onset latency (SOL), total sleep time (TST), wake time after sleep onset (WASO), and average activity/light levels 30, 60, and 120 mins prior to bedtime. Additionally, average activity/light levels 120-240, and 240-360 mins prior to bedtime were computed. Children also completed 14 daily sleep diaries (with parental assistance) measuring subjective reports of the same sleep parameters. Associations between daily estimations of pre-bedtime activity levels, light, and nighttime objective and subjective sleep were examined through multilevel modelling. Bonferroni corrections were performed to account for multiple comparisons.
Results
After Bonferroni corrections (p<.025 significance level), greater activity within 30 minutes (B=0.0465, p=.0093) and 60 minutes (B=0.0681, p=.0005) of bedtime were associated with longer subjective SOL. Pre-bedtime light exposure was not a significant predictor of sleep outcomes.
Conclusion
Results suggest that in general, variations in daily pre-bedtime activity, but not light, are associated with worse nightly subjective SOL in children with ASD and insomnia. Findings support that sleep hygiene recommendations in children with ASD include avoidance of higher levels of pre-sleep physical activity. Prospective studies examining temporal causal relationships between pre-bedtime activity and sleep in ASD are warranted.
Support
Research was supported by a University of Missouri Research Board award (McCrae, PI; Mazurek, Co-PI). Data collected as part of clinical trial NCT02755051 Targeting Sleep in Kids with Autism Spectrum Disorder at the University of Missouri (PI: McCrae).
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Affiliation(s)
- K D McGovney
- Department of Psychiatry, University of Missouri, Columbia, MO
| | - A F Curtis
- Department of Psychiatry, University of Missouri, Columbia, MO
| | - M Mazurek
- Curry School of Education and Human Development, University of Virginia, Charlottesville, VA
| | - W S Chan
- Department of Psychology, The University of Hong Kong, Hong Kong, HONG KONG
| | - C B Deroche
- Biostatistics and Medicine Research Design Unit, School of Medicine, University of Missouri, Columbia, MO
| | - M Munoz
- Department of Educational, School, and Counseling Psychology, University of Missouri, Columbia, MO
| | - M Davenport
- Department of Educational, School, and Counseling Psychology, University of Missouri, Columbia, MO
| | | | - N Takahashi
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO
| | - J Muckerman
- Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO
| | - D McCann
- Department of Psychiatry, University of Missouri, Columbia, MO
| | - P Sahota
- Department of Neurology, University of Missouri, Columbia, MO
| | - B Mills
- Department of Psychiatry, University of Missouri, Columbia, MO
| | - C S McCrae
- Department of Psychiatry, University of Missouri, Columbia, MO
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McCrae CS, Curtis AF, Miller MB, Nair N, Rathinakumar H, Davenport M, Berry JR, McGovney K, Staud R, Berry R, Robinson M. Effect of cognitive behavioural therapy on sleep and opioid medication use in adults with fibromyalgia and insomnia. J Sleep Res 2020; 29:e13020. [PMID: 32126156 DOI: 10.1111/jsr.13020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 01/24/2023]
Abstract
Sleep and opioid medications used to treat insomnia and chronic pain are associated with adverse side effects (falls and cognitive disturbance). Although behavioural treatments such as cognitive behavioral therapy for insomnia (CBT-I) and pain (CBT-P) improve sleep and clinical pain, their effects on sleep and opioid medication use are unclear. In this secondary analysis of published trial data, we investigated whether CBT-I and CBT-P reduced reliance on sleep/opioid medication in patients with fibromyalgia and insomnia (FMI). Patients with FMI (n = 113, Mage = 53.0, SD = 10.9) completed 8 weeks of CBT-I (n = 39), CBT-P (n = 37) or waitlist control (WLC; n = 37). Participants completed 14 daily diaries at baseline, post-treatment and 6-month follow-up, assessing sleep and opioid medication usage. Multilevel modelling examined group by time effects on days of medication use. A significant interaction revealed CBT-P reduced the number of days of sleep medication use at post-treatment, but usage returned to baseline levels at follow-up. There were no other significant within- or between-group effects. CBT-P led to immediate reductions in sleep medication usage, despite lack of explicit content regarding sleep medication. CBT-I and CBT-P may be ineffective as stand-alone treatments for altering opioid use in FMI. Future work should explore CBT as an adjunct to other behavioural techniques for opioid reduction.
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Affiliation(s)
- Christina S McCrae
- Department of Psychiatry, University of Missouri, Columbia, Missouri, United States
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri, Columbia, Missouri, United States.,Department of Psychological Sciences, University of Missouri, Columbia, Missouri, United States
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, Missouri, United States
| | - Neetu Nair
- Department of Psychiatry, University of Missouri, Columbia, Missouri, United States
| | | | - Mattina Davenport
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, United States
| | - Jasmine R Berry
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, United States
| | - Kevin McGovney
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, United States
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Richard Berry
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Michael Robinson
- Department of Clinical Health Psychology, University of Florida, Gainesville, Florida, United States
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McCrae CS, Curtis AF, Williams JM, Dautovich ND, McNamara JPH, Stripling A, Dzierzewski JM, Berry RB, McCoy KM, Marsiske M. Effects of Brief Behavioral Treatment for Insomnia on Daily Associations between Self-Reported Sleep and Objective Cognitive Performance in Older Adults. Behav Sleep Med 2020; 18:577-588. [PMID: 31203649 PMCID: PMC7981847 DOI: 10.1080/15402002.2019.1632201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Behavioral treatments for insomnia improve sleep in older adults, but research documenting their effects on cognitive performance is mixed. We explored whether a brief behavioral treatment for insomnia (BBTi) impacts daily associations between sleep parameters and next day cognition. METHODS Sixty-two older adults (Mage = 69.45 years, SD = 7.71) with insomnia completed either 4 weeks of BBTi or self-monitoring control (SMC). At baseline, post-treatment, and 3 month follow-up, participants completed 14 days of diaries measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE), as well as daily cognitive tests measuring processing speed (i.e., symbol digit modalities test, SDMT), and reasoning (i.e., letter series). At each time period, associations between sleep parameters and daily cognition, controlling for age, education, insomnia duration, use of sleep medications, and depression (i.e., Beck Depression Inventory-2nd Edition scores), were examined through multilevel modeling. RESULTS At post-treatment, we observed an interactive fixed effect of treatment condition (i.e., BBTi/SMC) and TST on daily SDMT and letter series performance. For BBTi, longer TST was associated with better letter series performance, and did not predict SDMT performance. For SMC, longer TST was associated with worse SDMT, and was not associated with letter series performance. Greater WASO (regardless of group) was associated with better SDMT performance at post-treatment. Associations were not maintained at follow-up. CONCLUSIONS Sleep duration may play an important role in BBTi-related improvements in daily higher order cognition. Maintenance of these associations may be facilitated by booster sessions following post-treatment. CLINICAL TRIAL IDENTIFIER NCT02967185.
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Affiliation(s)
| | - Ashley F. Curtis
- Department of Psychiatry, University of Missouri-Columbia,
Columbia, MO
| | | | | | | | - Ashley Stripling
- College of Psychology, Nova Southeastern University, Fort
Lauderdale, Florida,Department of Psychiatry, Geisel School of Medicine,
Dartmouth College, Hanover, NH
| | | | | | - Karin M. McCoy
- Neuropsychology Service, South Texas Veterans Health Care
System, San Antonio, TX
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL
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McCrae CS, Chan WS, Curtis AF, Deroche CB, Munoz M, Takamatsu S, Muckerman JE, Takahashi N, McCann D, McGovney K, Sahota P, Mazurek MO. Cognitive behavioral treatment of insomnia in school‐aged children with autism spectrum disorder: A pilot feasibility study. Autism Res 2019; 13:167-176. [DOI: 10.1002/aur.2204] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 08/22/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Christina S. McCrae
- Department of PsychiatryUniversity of Missouri Columbia Missouri
- Thompson Center for Autism and Neurodevelopmental DisordersUniversity of Missouri Columbia Missouri
| | - Wai Sze Chan
- Department of PsychologyThe University of Hong Kong Pok Fu Lam Hong Kong
| | - Ashley F. Curtis
- Department of PsychiatryUniversity of Missouri Columbia Missouri
| | - Chelsea B. Deroche
- Biostatistics and Research Design Unit, School of MedicineUniversity of Missouri Columbia Missouri
| | - Melissa Munoz
- Department of Educational, School, and Counseling PsychologyUniversity of Missouri Columbia Missouri
| | | | - Julie E. Muckerman
- Thompson Center for Autism and Neurodevelopmental DisordersUniversity of Missouri Columbia Missouri
| | - Nicole Takahashi
- Thompson Center for Autism and Neurodevelopmental DisordersUniversity of Missouri Columbia Missouri
| | - Dillon McCann
- Department of Health SciencesUniversity of Missouri Columbia Missouri
| | - Kevin McGovney
- Department of Chemistry and Biological SciencesUniversity of Missouri Columbia Missouri
| | - Pradeep Sahota
- Department of NeurologyUniversity of Missouri Columbia Missouri
| | - Micah O. Mazurek
- Curry School of Education and Human DevelopmentUniversity of Virginia Charlottesville Virginia
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Miller MB, Yurasek AM, Pritshmann R, Curtis AF, McCrae CS. 0332 Negative Mood as a Mediator of the Association between Insomnia Symptoms and Marijuana Problems in Young Adults. Sleep 2019. [DOI: 10.1093/sleep/zsz067.331] [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: 11/13/2022] Open
Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, USA
| | - Ali M Yurasek
- Department of Health Education and Behavior, University of Florida College of Health & Human Performance, Gainesville, FL, USA
| | - Ricarda Pritshmann
- Department of Health Education and Behavior, University of Florida College of Health & Human Performance, Gainesville, FL, USA
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, USA
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, USA
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Curtis AF, Roth AJ, Conti JB, Sears SF, Dzierzewski JM, Berry RB, McCrae CS. 0856 Higher Sleep Efficiency Improves Attention and Processing Speed in Patients with Severe Pain and Implantable Cardioverter Defibrillators. Sleep 2019. [DOI: 10.1093/sleep/zsz067.854] [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: 11/12/2022] Open
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Curtis AF, Miller MB, Rathinakumar H, Robinson M, Staud R, Berry RB, McCrae CS. 0846 Opioid Use and Sleep Architecture in Fibromyalgia. Sleep 2019. [DOI: 10.1093/sleep/zsz067.844] [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: 11/14/2022] Open
Affiliation(s)
| | - Mary B Miller
- Psychiatry, University of Missouri, Columbia, MO, USA
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McGovney KD, Curtis AF, McCann D, McCrae CS. 0847 Associations between Objective Afternoon and Evening Physical Activity and Objective Sleep in Fibromyalgia. Sleep 2019. [DOI: 10.1093/sleep/zsz067.845] [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: 11/13/2022] Open
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McGovney KD, Curtis AF, McCann D, McCrae CS. 0425 Actigraphy Assessment in Fibromyalgia: A Standardized Protocol to Reduce Discrepancies between Subjective and Objective Sleep. Sleep 2019. [DOI: 10.1093/sleep/zsz067.424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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McCrae CS, Williams J, Roditi D, Anderson R, Mundt JM, Miller MB, Curtis AF, Waxenberg LB, Staud R, Berry RB, Robinson ME. Cognitive behavioral treatments for insomnia and pain in adults with comorbid chronic insomnia and fibromyalgia: clinical outcomes from the SPIN randomized controlled trial. Sleep 2019; 42:zsy234. [PMID: 30496533 PMCID: PMC6424087 DOI: 10.1093/sleep/zsy234] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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: 03/15/2018] [Revised: 10/25/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To examine the effects of cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in patients with comorbid fibromyalgia and insomnia. METHODS One hundred thirteen patients (Mage = 53, SD = 10.9) were randomized to eight sessions of CBT-I (n = 39), CBT-P (n = 37), or a waitlist control (WLC, n = 37). Primary (self-reported sleep onset latency [SOL], wake after sleep onset [WASO], sleep efficiency [SE], sleep quality [SQ], and pain ratings) and secondary outcomes (dysfunctional beliefs and attitudes about sleep [DBAS]; actigraphy and polysomnography SOL, WASO, and SE; McGill Pain Questionnaire; Pain Disability Index; depression; and anxiety) were examined at posttreatment and 6 months. RESULTS Mixed effects analyses revealed that both treatments improved self-reported WASO, SE, and SQ relative to control at posttreatment and follow-up, with generally larger effect sizes for CBT-I. DBAS improved in CBT-I only. Pain and mood improvements did not differ by group. Clinical significance analyses revealed the proportion of participants no longer reporting difficulties initiating and maintaining sleep was higher for CBT-I posttreatment and for both treatments at 6 months relative to control. Few participants achieved >50% pain reductions. Proportion achieving pain reductions of >30% (~1/3) was higher for both treatments posttreatment and for CBT-I at 6 months relative to control. CONCLUSIONS CBT-I and CBT-P improved self-reported insomnia symptoms. CBT-I prompted improvements of larger magnitude that were maintained. Neither treatment improved pain or mood. However, both prompted clinically meaningful, immediate pain reductions in one third of patients. Improvements persisted for CBT-I, suggesting that CBT-I may provide better long-term pain reduction than CBT-P. Research identifying which patients benefit and mechanisms driving intervention effects is needed. CLINICAL TRIAL Sleep and Pain Interventions in Fibromyalgia (SPIN), clinicaltrials.gov, NCT02001077.
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Affiliation(s)
- Christina S McCrae
- Department of Psychiatry, University of Missouri – Columbia, Columbia, MO
| | - Jacob Williams
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Daniela Roditi
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Ryan Anderson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Jennifer M Mundt
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri – Columbia, Columbia, MO
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri – Columbia, Columbia, MO
| | - Lori B Waxenberg
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Roland Staud
- Department of Rheumatology and Clinical Immunology, University of Florida, Gainesville, FL
| | - Richard B Berry
- Division of Pulmonary, Critical Care and Sleep Medicine, Gainesville, FL
| | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
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Curtis AF, Roth AJ, Sears SF, Conti JB, Berry RB, Dzierzewski JM, Rathinakumar H, McCrae CS. Cognitive performance in patients with implantable cardioverter defibrillators: Associations with objective sleep duration, age and anxiety. J Sleep Res 2018; 28:e12810. [PMID: 30549143 DOI: 10.1111/jsr.12810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/31/2022]
Abstract
Sleep disturbance and anxiety are highly prevalent in patients with implantable cardiac defibrillators (ICDs). There is limited research, however, on the associations between cognitive performance and sleep parameters, age and anxiety. Forty-one patients with ICDs and self-reported sleep disturbance completed 14 days of actigraphy (Mage = 60.3, SD = 12.3) measuring total sleep time (TST), and a computerized cognitive test battery measuring processing speed and attention (i.e. simple reaction time and symbol digit modality task [SDMT]) and executive function (i.e. flanker task, letter series task and N-back task). Multiple regressions determined whether independent effects of TST, age and anxiety, as well as interactive effects of TST and age, predicted cognitive performance. TST predicted performance on two tasks of executive function (i.e. letter series and N-back task), as well as an attentional vigilance and processing speed task (i.e. SDMT), and this did not depend on patient age. On letter series, N-back and SDMT, longer TST predicted better performance. Increasing age was a predictor of worse performance on SDMT and flanker tasks. No other predictors were associated with task performance. Results show that sleep duration, not anxiety, may be an important predictor of higher-order cognitive functioning and lower-order tasks measuring processing speed and attention in ICD patients, with longer sleep duration showing greater benefit for performance.
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Affiliation(s)
- Ashley F Curtis
- Department of Psychiatry, University of Missouri, Columbia, Missouri
| | - Alicia J Roth
- Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio
| | - Samuel F Sears
- Departments of Psychology and Cardiovascular Sciences, East Carolina University, Greenville, North Carolina
| | - Jamie B Conti
- Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Richard B Berry
- College of Medicine, University of Florida, Gainesville, Florida
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Miller MB, Chan WS, Curtis AF, Boissoneault J, Robinson M, Staud R, Berry RB, McCrae CS. Pain intensity as a moderator of the association between opioid use and insomnia symptoms among adults with chronic pain. Sleep Med 2018; 52:98-102. [PMID: 30296735 PMCID: PMC6246793 DOI: 10.1016/j.sleep.2018.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/02/2018] [Accepted: 08/27/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Research documenting the impact of opioid use on sleep among individuals with chronic pain has been mixed. This study aimed to determine if pain intensity moderates the association between opioid use and insomnia symptoms among adults with comorbid symptoms of insomnia and chronic widespread pain. METHODS Participants (N = 144; 95% female; mean age = 51.6, SD = 11.4) completed assessments of insomnia symptoms, pain and use of sleep/pain medication. Multiple regression was used to determine if pain intensity moderates the association between opioid use (yes/no) sleep onset latency (SOL), wake after sleep onset (WASO), sleep quality, or time in bed. Analyses controlled for gender, symptoms of sleep apnea, symptoms of depression, use of sleep medication (yes/no), and use of non-opioid pain medication (yes/no). RESULTS Stronger pain intensity was associated with longer self-reported WASO and worse sleep quality, independent of opioid use. Conversely, opioid use was associated with longer time in bed, independent of pain intensity. Opioid use and pain intensity interacted in the prediction of SOL, such that opioid use (vs. non-use) was associated with longer SOL in the context of mild but not moderate to severe pain intensity. CONCLUSIONS Opioid use was associated with more difficulty falling asleep among adults with chronic pain; however, this cross-sectional effect was only significant among those reporting lower pain intensity. Authors speculate that this effect is masked among those with severe pain because the pain-related sleep debt they acquire throughout the night then facilitates sleep onset the next day.
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Affiliation(s)
- Mary Beth Miller
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, USA
| | - Wai Sze Chan
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, USA
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Richard B Berry
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO, USA.
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Curtis AF, Williams JM, McCoy KJM, McCrae CS. Chronic Pain, Sleep, and Cognition in Older Adults With Insomnia: A Daily Multilevel Analysis. J Clin Sleep Med 2018; 14:1765-1772. [PMID: 30353817 DOI: 10.5664/jcsm.7392] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/23/2018] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVES The goal of this study was to examine daily associations between sleep and cognition in older adults suffering from insomnia, with or without a history of chronic pain. METHODS Sixty older adults with insomnia and a history of chronic pain (HxCP; n = 33, mean age = 69.5 years, standard deviation = 7.8) or no history of chronic pain (NCP; n = 27, mean age = 69.7 years, standard deviation = 7.9) completed 14 days of diaries and actigraphy, measuring sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), and sleep quality. Participants completed daily cognitive measures of processing speed (ie, symbol digit modalities test, SDMT), reasoning (ie, letter series), and verbal memory (ie, word list delayed recall). For HxCP and NCP, associations between sleep parameters, daily pain, depressive symptoms (ie, Beck Depression Inventory, Second Edition scores), and daily cognition, controlling for age, and global cognition were examined through multilevel modeling. RESULTS For HxCP, greater self-reported WASO was associated with worse next-day SDMT performance, whereas greater actigraphic WASO was associated with better next-day SDMT performance. Greater depression was associated with worse daily letter series performance. Greater self-reported WASO and SE were associated with better next-day delayed recall. For NCP, greater self-reported WASO and depression were associated with better daily SDMT performance, whereas worse daily pain was associated with worse SDMT and delayed recall performance. CONCLUSIONS In older adults with HxCP, improving sleep may benefit lower level cognition, whereas reducing depression may affect higher level cognition. Discrepancies in sleep parameters promote assessment of objective and subjective sleep outcomes when investigating effects of insomnia on cognition. CLINICAL TRIAL REGISTRATION Title: Intraindividual Variability in Sleep and Cognitive Performance in Older Adults (REST), Registry: ClinicalTrials.gov, Identifier: NCT02967185, URL: https://clinicaltrials.gov/ct2/show/NCT02967185.
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Affiliation(s)
- Ashley F Curtis
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
| | | | - Karin J M McCoy
- Neuropsychology Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri
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McCrae CS, Mundt JM, Curtis AF, Craggs JG, O'Shea AM, Staud R, Berry RB, Perlstein WM, Robinson ME. Gray Matter Changes Following Cognitive Behavioral Therapy for Patients With Comorbid Fibromyalgia and Insomnia: A Pilot Study. J Clin Sleep Med 2018; 14:1595-1603. [PMID: 30176973 DOI: 10.5664/jcsm.7344] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/20/2018] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVES Insomnia frequently co-occurs with fibromyalgia, which is associated with gray matter atrophy. We examined the effect of cognitive behavioral therapy for insomnia (CBT-I) and pain (CBT-P) on cortical thickness. METHODS Patients with fibromyalgia and insomnia underwent MRI before and after random assignment to CBT-I (n = 14), CBT-P (n = 16), or waitlist control (WLC; n = 7). RESULTS Repeated-measures analyses of variance revealed significant interactions for two regions (left lateral orbitofrontal cortex, left rostral middle frontal, Ps < .05) and trends for four regions (right medial orbitofrontal cortex, right posterior cingulate, left caudal middle frontal, left transverse temporal; Ps < .10). Cortical thickness increased in all regions for CBT-I and decreased in five regions for CBT-P and WLC. Hierarchical regressions revealed that for the CBT-I group, reductions in wake after sleep onset were associated with an increase in cortical thickness. CONCLUSIONS Our pilot study presents novel evidence suggesting that CBT-I may slow or reverse cortical gray matter atrophy in patients with fibromyalgia and insomnia. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov, Identifier: NCT02001077, Title: Sleep and Pain Interventions in Fibromyalgia (SPIN), URL: https://clinicaltrials.gov/ct2/show/NCT02001077.
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Affiliation(s)
| | | | - Ashley F Curtis
- Department of Psychiatry, University of Missouri, Columbia, Missouri
| | - Jason G Craggs
- Department of Psychiatry, University of Missouri, Columbia, Missouri
| | - Andrew M O'Shea
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Roland Staud
- Department of Rheumatology and Clinical Immunology, University of Florida, Gainesville, Florida
| | - Richard B Berry
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, Florida
| | - William M Perlstein
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Michael E Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
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Curtis AF, Miller MB, Boissoneault J, Robinson M, Staud R, Berry RB, McCrae CS. Discrepancies in sleep diary and actigraphy assessments in adults with fibromyalgia: Associations with opioid dose and age. J Sleep Res 2018; 28:e12746. [PMID: 30062746 DOI: 10.1111/jsr.12746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/06/2018] [Accepted: 07/04/2018] [Indexed: 11/28/2022]
Abstract
Sleep diary and actigraphy assessments of insomnia symptoms in patients with fibromyalgia (FM) are often discrepant. We examined whether opioid dose and age interact in predicting magnitude or direction of discrepancies. Participants (N = 199, M = 51.5 years, SD = 11.7) with FM and insomnia completed 14 days of diaries and actigraphy. Multiple regressions determined whether average opioid dose and its interaction with age predicted magnitude or direction of diary/actigraphy discrepancies in sleep onset latency (SOL), wake after sleep onset (WASO) and sleep efficiency (SE), controlling for sex, use of sleep medication, evening pain and total sleep time. Higher opioid dose predicted greater magnitude of discrepancy in SOL and SE. Opioid dose interacted with age to predict direction but not magnitude of discrepancy in SOL and SE. Specifically, higher opioid use was associated with better subjective (shorter SOL, higher SE) than objective reports of sleep among younger adults, and longer subjective than objectively measured SOL among older adults. Opioid dose did not predict magnitude or direction of WASO discrepancies. In FM, a higher opioid dose increases diary/actigraphy SOL and SE discrepancies, and direction of discrepancies may depend on age. We speculate that increased opioid use combined with age-related factors, such as slow wave sleep disruption, increased awakenings and/or cognitive decline, may impact perceived sleep.
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Affiliation(s)
- Ashley F Curtis
- Department of Psychiatry, University of Missouri, Columbia, Missouri
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, Missouri
| | - Jeff Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Michael Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Richard B Berry
- Department of Medicine, University of Florida, Gainesville, Florida
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McCrae CS, Curtis AF, Williams JM, Dautovich ND, McNamara JPH, Stripling A, Dzierzewski JM, Chan WS, Berry RB, McCoy KJM, Marsiske M. Efficacy of brief behavioral treatment for insomnia in older adults: examination of sleep, mood, and cognitive outcomes. Sleep Med 2018; 51:153-166. [PMID: 30195661 DOI: 10.1016/j.sleep.2018.05.018] [Citation(s) in RCA: 24] [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: 02/08/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of the present study was to examine the effects of a brief behavioral intervention for insomnia (BBTi) on sleep parameters, mood, and cognitive functioning in older adults. METHODS Older adults (aged 65 years or more) underwent four weekly sessions of BBTi or self-monitoring control (SMC). Participants completed 14 days of sleep diaries and actigraphy measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE), and sleep quality ratings at baseline, post-treatment, and three month follow-up. Participants also completed mood scales (Geriatric Depression Scale [GDS]; Beck Depression Inventory-II; and State Trait Anxiety Inventory) and neuropsychological testing (measuring global cognition, language, memory, attention and processing speed, and executive function) at the three timepoints. RESULTS Significant condition (BBTi vs. SMC) x time (baseline vs. post-treatment vs. follow-up) interactions revealed that BBTi improved relative to baseline in sleep diary-reported SOL, WASO, SE, and sleep quality, and these improvements were maintained at follow-up. SMC showed no change in these measures. A main effect of time showed that actigraphy-measured WASO improved from baseline for both BBTi and SMC at post-treatment. A main effect of time revealed that both BBTi and SMC patients endorsed fewer GDS symptoms relative to baseline at post-treatment and follow-up. We observed no change in performance on neuropsychological measures. CONCLUSIONS A four-week BBTi is an efficacious intervention for reducing insomnia symptoms in older adults. BBTi does not selectively improve mood or cognitive functioning. Future work should examine effects of BBTi on physiological measures of sleep architecture and day-to-day cognition. CLINICAL TRIAL IDENTIFER NCT02967185.
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Affiliation(s)
- Christina S McCrae
- Department of Psychiatry, University of Missouri-Columbia, Columbia, MO, USA.
| | - Ashley F Curtis
- Department of Psychiatry, University of Missouri-Columbia, Columbia, MO, USA
| | | | | | | | - Ashley Stripling
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | | | - Wai Sze Chan
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Richard B Berry
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Karin J M McCoy
- Neuropsychology Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Michael Marsiske
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Curtis AF, Miller MB, Boissoneault J, Robinson M, Staud R, Berry RB, McCrae CS. 0912 Sleep Diary vs Actigraphy based Outcomes in Adults with Fibromyalgia: Do Opioid Dose and Age Predict Discrepancies? Sleep 2018. [DOI: 10.1093/sleep/zsy061.911] [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: 11/13/2022] Open
Affiliation(s)
- A F Curtis
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO
| | - M B Miller
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO
| | - J Boissoneault
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - M Robinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - R Staud
- Department of Medicine, University of Florida, Gainesville, FL
| | - R B Berry
- Department of Medicine, University of Florida, Gainesville, FL
| | - C S McCrae
- Department of Psychiatry, University of Missouri School of Medicine, Columbia, MO
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Miller MB, Chan WS, Curtis AF, Boissoneault J, Michael R, Staud R, Berry RB, McCrae CS. 0909 Opioid Use and Sleep among Adults with Chronic Pain: A Daily Process Model. Sleep 2018. [DOI: 10.1093/sleep/zsy061.908] [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: 11/14/2022] Open
Affiliation(s)
| | | | | | | | - R Michael
- University of Florida, Gainesville, FL
| | - R Staud
- University of Florida, Gainesville, FL
| | - R B Berry
- University of Florida, Gainesville, FL
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