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Scott H, Muench A, Appleton S, Reynolds AC, Loffler KA, Bickley K, Haycock J, Lovato N, Micic G, Lack L, Sweetman A. Sex differences in response to cognitive behavioural therapy for insomnia: A chart review of 455 patients with chronic insomnia. Sleep Med 2024; 116:123-128. [PMID: 38460417 DOI: 10.1016/j.sleep.2024.02.034] [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: 12/17/2023] [Revised: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Insomnia is more prevalent in females, however studies examining sex differences in response to insomnia treatment are scarce. This study assessed sex-specific differences in cognitive behavioural therapy for insomnia (CBT-I)-related changes in insomnia symptoms in a large clinical cohort. METHODS A chart review was conducted of a clinical cohort (females n = 305, males n = 150) referred to a sleep clinic. Participants had a registered psychologist confirm diagnosis of chronic insomnia according to DSM-IV/V criteria and a Level 1 or 2 sleep study. Daily sleep diaries and questionnaires including the Insomnia Severity Index (ISI), Flinders Fatigue Scale (FFS), the Daytime Feelings and Functioning Scale (DFFS), and the Depression, Anxiety and Stress Scale-21 items (DASS), were administered at baseline, post-treatment, and three-month follow-up. Linear mixed models determined interactions between sex and timepoint on symptoms. RESULTS Mean (SD) age was 51.7 yrs (15.7, range = 18-90 yrs), and mean BMI was 26.3 kg/m2 (4.9), neither of which differed by sex. At pre-treatment, females demonstrated higher objective total sleep time (min) [343.5 (97.6) vs 323.8 min (92.1), p = 0.044], ISI [19.7 (4.2) vs 18.6 (4.4), p = 0.033], and FFS scores [19.2 (6.0) vs 16.9 (7.2), p = 0.003]. Compared to males, females experienced a greater reduction in FFS and DFFS scores and DASS depressive symptoms (p for interaction: 0.017, 0.043, 0.016 respectively) from baseline to follow-up. The greater reduction in depressive symptoms did not persist after controlling for age, BMI, and sleep apnea severity. Subjective total sleep time similarly increased across treatment for both males [baseline: 335.7 (15.1), post: 357.9 (15.5)] and females [baseline: 318.3 (10.4), post: 354.4 (10.7)], p for interaction: 0.22. CONCLUSION Females and males experience similar, substantial benefits from CBT-I after accounting for comorbidities, suggesting the same treatment can resolve insomnia in both sexes.
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Affiliation(s)
- Hannah Scott
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia.
| | - Alexandria Muench
- Department of Psychiatry, University of Pennsylvania, Philadelphia, USA
| | - Sarah Appleton
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia
| | - Kelly A Loffler
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia
| | - Kelsey Bickley
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia
| | - Jenny Haycock
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia; National Centre for Sleep Health Services Research, Flinders University, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia; National Centre for Sleep Health Services Research, Flinders University, Australia
| | - Gorica Micic
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia
| | - Leon Lack
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia; National Centre for Sleep Health Services Research, Flinders University, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Australia; National Centre for Sleep Health Services Research, Flinders University, Australia
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Manners J, Appleton SL, Reynolds AC, Melaku YA, Gill TK, Lovato N, Sweetman A, Bickley K, Adams R, Lack L, Scott H. The Good Sleeper Scale-15 items: a questionnaire for the standardised assessment of good sleepers. J Sleep Res 2023; 32:e13717. [PMID: 36065002 DOI: 10.1111/jsr.13717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/13/2022] [Accepted: 08/07/2022] [Indexed: 12/01/2022]
Abstract
Research with 'good sleepers' is ubiquitous, yet there are no standardised criteria to identify a 'good sleeper'. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale-15 items (GSS-15). Data were derived from a population-based survey of Australian adults (n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset (n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data (n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut-off scores and test associations with sleep, daytime functioning, health, and quality-of-life. The EFA identified six factors: 'Sleep Difficulties', 'Timing', 'Duration', 'Regularity', 'Adequacy', and 'Perceived Sleep Problem'. The CFA showed that model fit was high and comparable to other sleep instruments, χ2 (63) = 378.22, p < 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency (α = 0.76). Strong correlations were consistently found between GSS-15 global scores and outcomes, including 'a good night's sleep' (r = 0.7), 'feeling un-refreshed' (r = -0.59), and 'experienced sleepiness' (r = -0.51), p < 0.001. Cut-off scores were derived to categorise individuals likely to be a good sleeper (GSS-15 score ≥40) and those very likely to be a good sleeper (GSS-15 score ≥45). The GSS-15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical samples.
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Affiliation(s)
- Jack Manners
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Sarah L Appleton
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kelsey Bickley
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Leon Lack
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Hannah Scott
- Flinders Health and Medical Research Institute: Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Stevens DJ, Appleton S, Bickley K, Holtzhausen L, Adams R. Electroencephalographic Changes in Sleep During Acute and Subacute Phases After Sports-Related Concussion. Nat Sci Sleep 2023; 15:267-273. [PMID: 37155471 PMCID: PMC10122858 DOI: 10.2147/nss.s397900] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/15/2023] [Indexed: 05/10/2023] Open
Abstract
Purpose Little is known about sleep after a concussion, a form of mild traumatic brain injury. Given the importance of sleep for both maintaining brain health and recovery from injury, we sought to examine sleep acutely and subacutely after concussion. Methods Athletes who experienced a sports-related concussion were invited to participate. Participants underwent overnight sleep studies within 7 days of the concussion (acute phase), and again eight-weeks after the concussion (subacute phase). Changes in sleep from both the acute and subacute phases were compared to population normative values. Additionally, changes in sleep from acute to subacute phase were analysed. Results When compared to normative data, the acute and subacute phases of concussion showed longer total sleep time (p < 0.005) and fewer arousals (p < 0.005). The acute phase showed longer rapid eye movement sleep latency (p = 0.014). The subacute phase showed greater total sleep spent in Stage N3% (p = 0.046), increased sleep efficiency (p < 0.001), shorter sleep onset latency (p = 0.013), and reduced wake after sleep onset (p = 0.013). Compared to the acute phase, the subacute phase experienced improved sleep efficiency (p = 0.003), reduced wake after sleep onset (p = 0.02), and reduced latencies for both stage N3 sleep (p = 0.014) and rapid eye movement sleep (p = 0.006). Conclusion This study indicated sleep during both the acute and subacute phases of SRC was characterised by longer and less disrupted sleep, along with improvements in sleep from the acute to subacute phases of SRC.
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Affiliation(s)
- David J Stevens
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
- Correspondence: David J Stevens, Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Level 2a, 5 Laffer Dve, Bedford Park, South Australia, 5041, Australia, Tel +61 7306 1816, Email
| | - Sarah Appleton
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Kelsey Bickley
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Louis Holtzhausen
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Section Sports Medicine, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
- Department of Exercise and Sport Science, University of the Free State, Bloemfontein, South Africa
| | - Robert Adams
- Sleep Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
- Respiratory and Sleep Services, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
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Stevens D, Barr C, Bassett K, Oh A, Lord SR, Crotty M, Bickley K, Mukherjee S, Vakulin A. Reduction in fall risk markers following CPAP treatment of obstructive sleep apnoea in people over 65 years. Sleep Med 2022; 100:448-453. [PMID: 36252413 DOI: 10.1016/j.sleep.2022.09.019] [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: 04/05/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Falls in older people can lead to serious injury and significant societal health and financial burden. Obstructive sleep apnoea (OSA) is associated with impaired gait/balance and may increase fall risk, yet few studies examined whether treating OSA reduces fall risk. This study examined the effect of continuous positive airway pressure (CPAP) on fall risk markers in people over 65yrs diagnosed with OSA. DESIGN Single arm intervention study. SETTING University and tertiary care CPAP clinic. PARTICIPANTS Individuals over 65 years diagnosed with OSA and recommended CPAP. INTERVENTION 3-6 months CPAP therapy. MEASUREMENTS 28 participants had a physiological profile assessment (PPA) at baseline and following 3-6 months of CPAP. The PPA examines visual contrast sensitivity, lower limb proprioception, knee extension strength, reaction time and postural sway to generate a fall risk score (FRS). t-tests were used to determine difference between pre- and post-treatment FRS. Regression was used to examine the associations between CPAP use and daytime sleepiness with FRS. RESULTS CPAP significantly reduced the FRS ([Mean ± SD] 0.59 ± 1.0 vs 0.04 ± 1.1, p = 0.016), contrast sensitivity and lower limb proprioception (P < 0.05). Increased CPAP use was associated with improvement in FRS in unadjusted analysis (β = -0.213, 95%CI -0.371 to -0.056, p = 0.01). Reduction in Epworth sleepiness score was associated with a reduction in FRS in unadjusted (p = 0.023) and adjusted analysis (adjusted for AHI p = 0.027 or O2Nadir p = 0.015). CONCLUSIONS CPAP may reduce fall risk in people over 65yrs, possibly related to better CPAP adherence and reduced daytime sleepiness. Future controlled trials and mechanistic studies are needed to elucidate how CPAP may reduce fall risk.
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Affiliation(s)
- David Stevens
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia; Centre for Nutritional and Gastrointestinal Diseases, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Chris Barr
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Katherine Bassett
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Aaron Oh
- Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, and Faculty of Medicine, University of New South Wales, Sydney, N.S.W, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia; Rehabilitation Unit, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Kelsey Bickley
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sutapa Mukherjee
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia; Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
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Sweetman A, Lovato N, Micic G, Scott H, Bickley K, Haycock J, Harris J, Gradisar M, Lack L. Do symptoms of depression, anxiety or stress impair the effectiveness of cognitive behavioural therapy for insomnia? A chart-review of 455 patients with chronic insomnia. Sleep Med 2020; 75:401-410. [DOI: 10.1016/j.sleep.2020.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
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Bickley K, Lack L, Lovato N. Evaluation of a novel task participation diary as a metric for daytime functioning in the insomnia population. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bickley K, Lack L, Lovato N. Daily task performance in insomnia disorder: the negative affect of sleep and inclusion of effort as a compensatory mechanism. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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