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Meaklim H, Le F, Drummond SPA, Bains SK, Varma P, Junge MF, Jackson ML. Insomnia is more likely to persist than remit after a time of stress and uncertainty: a longitudinal cohort study examining trajectories and predictors of insomnia symptoms. Sleep 2024; 47:zsae028. [PMID: 38308584 PMCID: PMC11009016 DOI: 10.1093/sleep/zsae028] [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: 08/28/2023] [Revised: 12/07/2023] [Indexed: 02/05/2024] Open
Abstract
STUDY OBJECTIVES The study aimed to characterize insomnia symptom trajectories over 12 months during a time of stress and uncertainty, the coronavirus disease 2019 (COVID-19) pandemic. It also aimed to investigate sleep and psychological predictors of persistent insomnia symptoms. METHODS This longitudinal cohort study comprised 2069 participants with and without insomnia symptoms during the first year of the pandemic. Participants completed online surveys investigating sleep, insomnia, and mental health at four timepoints over 12 months (April 2020-May 2021). Additional trait-level cognitive/psychological questionnaires were administered at 3 months only. RESULTS Six distinct classes of insomnia symptoms emerged: (1) severe persistent insomnia symptoms (21.65%), (2) moderate persistent insomnia symptoms (32.62%), (3) persistent good sleep (32.82%), (4) severe insomnia symptoms at baseline but remitting over time (2.27%), (5) moderate insomnia symptoms at baseline but remitting over time (7.78%), and (6) good sleep at baseline but deteriorating into insomnia symptoms over time (2.85%). Persistent insomnia trajectories were predicted by high levels of sleep reactivity, sleep effort, pre-sleep cognitive arousal, and depressive symptoms at baseline. A combination of high sleep reactivity and sleep effort reduced the odds of insomnia remitting. Higher sleep reactivity also predicted the deterioration of good sleep into insomnia symptoms over 12 months. Lastly, intolerance of uncertainty emerged as the only trait-level cognitive/psychological predictor of insomnia trajectory classes. CONCLUSIONS Insomnia was more likely to persist than remit over the first year of the COVID-19 pandemic. Addressing sleep reactivity and sleep effort appears critical for reducing insomnia persistence rates after times of stress and uncertainty.
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Affiliation(s)
- Hailey Meaklim
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Flora Le
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Sukhjit K Bains
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Moira F Junge
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Sleep Health Foundation, East Melbourne, VIC, Australia
| | - Melinda L Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Rajaratnam SMW, Czeisler CA. Association of Chronotype and Shiftwork with COVID-19 Infection. J Occup Environ Med 2024:00043764-990000000-00542. [PMID: 38595269 DOI: 10.1097/jom.0000000000003103] [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: 04/11/2024]
Abstract
OBJECTIVE This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work. METHODS Cross-sectional survey of 19,821 U.S. adults. RESULTS COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift/remote work, sleep duration and comorbidities, morning chronotype was associated with a higher (aOR: 1.15, 95% CI 1.10-1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78-0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28-2.74). CONCLUSION Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection.
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Affiliation(s)
| | | | | | | | | | | | | | - Rashon I Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Wiley JF, Rajaratnam SMW, Czeisler CA. Association of Obstructive Sleep Apnea with Post-Acute Sequelae of SARS-CoV-2 Infection. Am J Med 2024:S0002-9343(24)00109-8. [PMID: 38401674 DOI: 10.1016/j.amjmed.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/09/2024] [Accepted: 02/11/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Obstructive sleep apnea is associated with COVID-19 infection. Less clear is whether obstructive sleep apnea is a risk factor for the development of post-acute sequelae of SARS-CoV-2 infection (PASC). STUDY DESIGN Cross-sectional survey of a general population of 24,803 US adults to determine the association of obstructive sleep apnea with PASC. RESULTS COVID-19 infection occurred in 10,324 (41.6%) participants. Prevalence of persistent (>3 months post infection) putative PASC-related physical and mental health symptoms ranged from 6.5% (peripheral edema) to 19.6% (nervous/anxious). In logistic regression models, obstructive sleep apnea was associated with all putative PASC-related symptoms with the highest adjusted odds ratios being fever (2.053) and nervous/anxious (1.939). In 4 logistic regression models of overall PASC derived from elastic net regression, obstructive sleep apnea was associated with PASC (range of adjusted odds ratios: 1.934-2.071); this association was mitigated in those with treated obstructive sleep apnea. In the best fitting overall model requiring ≥3 symptoms, PASC prevalence was 21.9%. CONCLUSION In a general population sample, obstructive sleep apnea is associated with the development of PASC-related symptoms and a global definition of PASC. Treated obstructive sleep apnea mitigates the latter risk. The presence of 3 or more PASC symptoms may be useful in identifying cases and for future research.
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Affiliation(s)
- Stuart F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine.
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine
| | - Mark É Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, Mass; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine
| | - Lauren A Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Melinda L Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon I Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass
| | - Christine F McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Joshua F Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M W Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Mass; Division of Sleep Medicine
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Hoyos CM, Phillips CL, Marshall NS, Yaffe K, Martins R, Lagopoulos J, Jackson ML, Mowszowski L, Grunstein RR, Naismith SL. REducing Sleep Apnoea for the PrEvention of Dementia (REShAPED): Protocol for a multi-site feasibility randomised controlled trial. Contemp Clin Trials 2024; 137:107424. [PMID: 38145713 DOI: 10.1016/j.cct.2023.107424] [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: 08/29/2023] [Revised: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023]
Abstract
There is accumulating evidence that has linked OSA with increased risk of cognitive decline and dementia. Here we present the protocol for an Australian, multi-site randomised controlled, parallel open-label trial which will evaluate the feasibility for a full-scale trial investigating the effects of treating OSA on cognitive decline in older adults at risk of dementia within memory clinic settings. We will randomise 180 older adults to either the treatment intervention group or control group for 2 years. Inclusion criteria include: 50-85 years; mild-severe OSA (defined average ODI ≥ 10 with 3% oxygen desaturation determined by wrist oximetry over two nights); and subjective cognitive complaints or mild cognitive impairment. The treatment intervention arm aims to achieve an optimal treatment response based on reducing hypoxic burden with either CPAP, mandibular advancement splint, positional therapy, or oxygen therapy. Furthermore, participants will receive up to 8 sessions which involve motivational interviewing, collaborative goal setting, and behavioural sleep management. The control arm will not receive OSA treatment as part of this trial, however there will be no OSA treatment restrictions, and any treatment will be documented. Primary outcomes are 1) acceptability based upon willingness of participants to be randomised; 2) alleviating hypoxic burden by reducing OSA severity; 3) tolerability of the trial burden based upon collection of outcomes over the 2-year follow-up. Secondary outcomes include safety and cognitive function. Outcomes will be collected at 0, 6 and 24-months. This feasibility study aims to will provide the basis for a larger longer-term trial of dementia prevention.
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Affiliation(s)
- Camilla M Hoyos
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia.
| | - Craig L Phillips
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia; Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Nathaniel S Marshall
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia
| | - Kristine Yaffe
- UCSF Weill Institute for Neurosciences, San Francisco, CA, USA
| | - Ralph Martins
- Faculty of Medicine and Human Health Sciences, Macquarie University, North Ryde, Sydney, Australia; Centre for Ageing, Cognition and Wellbeing, Macquarie University, North Ryde, Sydney, Australia
| | - Jim Lagopoulos
- Thompson Institute, University of Sunshine Coast, Queensland, Australia
| | - Melinda L Jackson
- Turner Institute of Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Loren Mowszowski
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Camperdown, Sydney, Australia
| | - Ronald R Grunstein
- Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, Macquarie University, Sydney, Australia; CPC-RPA Clinic, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, Australia
| | - Sharon L Naismith
- Healthy Brain Ageing Program, School of Psychology, The University of Sydney, Camperdown, Sydney, Australia; Brain and Mind Centre, The University of Sydney, Camperdown, Sydney, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, Sydney, Australia
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Saravanan K, Downey L, Sawyer A, Jackson ML, Berlowitz DJ, Graco M. Understanding the Relationships Between Sleep Quality and Depression and Anxiety in Neurotrauma: A Scoping Review. J Neurotrauma 2024; 41:13-31. [PMID: 37650845 DOI: 10.1089/neu.2023.0033] [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: 09/01/2023] Open
Abstract
Sleep problems, depression, and anxiety are highly prevalent after a spinal cord injury (SCI) and traumatic brain injury (TBI) and may worsen functional outcomes and quality of life. This scoping review examined the existing literature to understand the relationships between sleep quality, depression, and anxiety in persons with SCI and TBI, and to identify gaps in the literature. A systematic search of seven databases was conducted. The findings of 30 eligible studies reporting associations between sleep quality and depression and/or anxiety after SCI or TBI were synthesized. The included studies were mostly cross-sectional and employed a range of subjective and objective measures of sleep quality. Poor subjective sleep quality and insomnia tended to be significantly associated with increased levels of depression and/or anxiety, but no such associations were reported when sleep quality was measured objectively. Two longitudinal studies observed worsening depressive symptoms over time were related to insomnia and persistent sleep complaints. Two interventional studies found that treating sleep problems improved symptoms of depression and anxiety. The findings of this review suggest that sleep and psychopathology are related in persons with neurotraumatic injuries. This has important therapeutic implications, because individuals may benefit from therapy targeting both sleep and psychological issues. More longitudinal and interventional studies are warranted to further understand the direction and strength of the relationships and how they impact patient outcomes.
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Affiliation(s)
- Krisha Saravanan
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Luke Downey
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Abbey Sawyer
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayon, Victoria, Australia
| | - David J Berlowitz
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
| | - Marnie Graco
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- The University of Melbourne, Parkville, Victoria, Australia
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6
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Wiley JF, Rajaratnam SM, Czeisler CA. Association of Obstructive Sleep Apnea with Post-Acute Sequelae of SARS-CoV-2 infection (PASC). medRxiv 2023:2023.12.30.23300666. [PMID: 38234859 PMCID: PMC10793517 DOI: 10.1101/2023.12.30.23300666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Obstructive sleep apnea (OSA) is associated with COVID-19 infection. Fewer investigations have assessed OSA as a possible risk for the development of Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Research Question In a general population, is OSA associated with increased odds of PASC-related symptoms and with an overall definition of PASC? Study Design Cross-sectional survey of a general population of 24,803 U.S. adults. Results COVID-19 infection occurred in 10,324 (41.6%) participants. Prevalence rates for a wide variety of persistent (> 3 months post infection) putative PASC-related physical and mental health symptoms ranged from 6.5% (peripheral edema) to 19.6% (nervous/anxious). In logistic regression models adjusted for demographic, anthropometric, comorbid medical and socioeconomic factors, OSA was associated with all putative PASC-related symptoms with the highest adjusted odds ratios (aOR) being fever (2.053) and nervous/anxious (1.939) respectively. Elastic net regression identified the 13 of 37 symptoms most strongly associated with COVID-19 infection. Four definitions of PASC were developed using these symptoms either weighted equally or proportionally by their regression coefficients. In all 4 logistic regression models using these definitions, OSA was associated with PASC (range of aORs: 1.934-2.071); this association was mitigated in those with treated OSA. In the best fitting overall model requiring ≥3 symptoms, PASC prevalence was 21.9%. Conclusion In a general population sample, OSA is associated with the development of PASC-related symptoms and a global definition of PASC. A PASC definition requiring the presence of 3 or more symptoms may be useful in identifying cases and for future research.
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Affiliation(s)
- Stuart F. Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Mark É. Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, MA
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Lauren A. Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon I. Lane
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - Christine F. McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Joshua F. Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M.W. Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
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Verma S, Varma P, Brown A, Bei B, Gibson R, Valenta T, Pietsch A, Cavuoto M, Woodward M, McCurry S, Jackson ML. Multi-modal sleep intervention for community-dwelling people living with dementia and primary caregiver dyads with sleep disturbance: protocol of a single-arm feasibility trial. PeerJ 2023; 11:e16543. [PMID: 38107589 PMCID: PMC10725664 DOI: 10.7717/peerj.16543] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
Background Disturbed sleep is common among people living with dementia and their informal caregivers, and is associated with negative health outcomes. Dyadic, multi-modal interventions targeting caregiver and care-recipient sleep have been recommended yet remain limited. This protocol details the development of a single-arm feasibility trial of a multi-modal, therapist-led, six-week intervention targeting sleep disturbance in dyads of people living with dementia and their primary caregiver. Methods We aim to recruit 24 co-residing, community-dwelling dyads of people living with dementia and their primary informal caregiver (n = 48) with sleep concerns (Pittsburgh Sleep Quality Index ≥5 for caregivers, and caregiver-endorsed sleep concerns for the person living with dementia). People who live in residential care settings, are employed in night shift work, or are diagnosed with current, severe mental health conditions or narcolepsy, will be excluded. Participants will wear an actigraph and complete sleep diaries for two weeks prior, and during the last two weeks, of active intervention. The intervention is therapist-led and includes a mix of weekly small group video sessions and personalised, dyadic sessions (up to 90 min each) over six weeks. Sessions are supported by a 37-page workbook offering strategies and spaces for reflections/notes. Primary feasibility outcomes are caregiver: session attendance, attrition, and self-reported project satisfaction. Secondary outcomes include dyadic self-reported and objectively-assessed sleep, depression and anxiety symptoms, quality of life, and social support. Self-report outcomes will be assessed at pre- and post-intervention. Discussion If feasible, this intervention could be tested in a larger randomised controlled trial to investigate its efficacy, and, upon further testing, may potentially represent a non-pharmacological approach to reduce sleep disturbance among people living with dementia and their caregivers. ANZCTR Trial registration ACTRN12622000144718: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382960&showOriginal=true&isReview=true.
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Affiliation(s)
| | | | - Aimee Brown
- Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Centre, Richmond, Victoria, Australia
| | - Bei Bei
- Monash University, Clayton, Victoria, Australia
| | - Rosemary Gibson
- Health and Ageing Research Team, School of Psychology, Massey University, Palmerston North, New Zealand
| | - Tom Valenta
- Independent Researcher, Melbourne, Victoria, Australia
| | - Ann Pietsch
- Independent Researcher, Adelaide, South Australia, Australia
| | | | - Michael Woodward
- Aged and Continuing Care Services, Austin Health, Heidelberg, Victoria, Australia
| | - Susan McCurry
- School of Nursing, University of Washington, Washington, United States of America
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Meaklim H, Rehm IC, Junge MF, Monfries M, Kennedy GA, Bucks RS, Meltzer LJ, Jackson ML. Development of a Novel Behavioral Sleep Medicine Education Workshop Designed to Increase Trainee Psychologists' Knowledge and Skills in Insomnia Management. Behav Sleep Med 2023; 21:787-801. [PMID: 36606306 DOI: 10.1080/15402002.2022.2164766] [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: 01/07/2023]
Abstract
OBJECTIVES Despite the clear influence of poor sleep on mental health, sleep education has been neglected in psychology training programs. Here, we develop a novel behavioral sleep medicine (BSM) education workshop, the Sleep Psychology Workshop, designed for integration within graduate psychology programs. We also examined the potential efficacy and acceptability of the workshop to upskill trainee psychologists in sleep and insomnia management. METHODS The Sleep Psychology Workshop was developed using a modified Delphi Method. Eleven trainee psychologists completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the workshop, delivered as three, two-hour lectures (total of six hours). Sleep knowledge, attitudes, and practice assessments were completed pre-and post-intervention using the GradPsyKAPS Questionnaire. A focus group and 6-month follow-up survey captured feedback and qualitative data. RESULTS Trainees' sleep knowledge quiz scores (% correct) increased from 60% to 79% pre- to post-workshop (p = .002). Trainees' self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep disturbances increased, along with their confidence to manage insomnia (all p < .02). Participant feedback was positive, with 91% of trainees rating the workshop as "excellent" and qualitative data highlighting trainees developing practical skills in BSM. Six months post-intervention, 100% of trainees endorsed routinely asking their clients about sleep, with 82% reporting improvements in their own sleep. CONCLUSIONS The Sleep Psychology Workshop is a potentially effective and acceptable introductory BSM education program for trainee psychologists, ready for integration within the graduate psychology curriculum.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
| | - Imogen C Rehm
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | | | - Melissa Monfries
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Gerard A Kennedy
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Romola S Bucks
- Schools of Psychological Science and Population and Global Health, University of Western Australia, Western Australia, Australia
| | - Lisa J Meltzer
- Department of Pediatrics, National Jewish Health, Denver, USA
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Victoria, Australia
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Pattison E, Tolson J, Barnes M, Saunders WJ, Bartlett D, Downey LA, Jackson ML. Improved depressive symptoms, and emotional regulation and reactivity, in individuals with obstructive sleep apnea after short- and long-term CPAP therapy use. Sleep Med 2023; 111:13-20. [PMID: 37714031 DOI: 10.1016/j.sleep.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/14/2023] [Accepted: 08/27/2023] [Indexed: 09/17/2023]
Abstract
Obstructive Sleep Apnoea (OSA) is associated with high rates of depression; however, if and how treatment of OSA improves depressive symptoms is unclear. To further understand this link we considered the role of emotional regulation - the ability to control and express our emotional responses - thought to be a central component of depression. This study aimed to assess changes in depressive symptoms and emotional responses in individuals with OSA after 4- and 12-months of continuous positive airway pressure (CPAP) treatment. One-hundred and twenty-one OSA participants (50 female, Mage = 51.93; mean AHI = 36.27) were recruited from a tertiary clinical sleep service prior to CPAP initiation, and randomised to either a CPAP group or a 4 month wait-list group. Participants completed the Center for Epidemiological Studies Depression Scale, the Emotional Reactivity Scale and the Difficulties in Emotion Regulation Scale at baseline, and 1-, 2-, and 4-months follow-up. The CPAP group also completed the questionnaires 12-months after CPAP initiation. CPAP use at 1 month and 12 months was 5.1h/night and 4.9h/night, respectively. Significant improvements in depressive symptoms, emotional regulation and reactivity, and subjective sleepiness were observed after 4 months in both groups, however, the within group changes were only significant for those using CPAP. After 12-months of CPAP treatment, these improvements were maintained. There was no association between CPAP treatment adherence and improvements in any outcome. CPAP treatment for 12 months may reduce symptoms of depression and improve emotional regulation in individuals with OSA.
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Affiliation(s)
- Emily Pattison
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia; RMIT University, School of Health and Biomedical Science, Melbourne, Australia
| | - Julie Tolson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia; The University of Melbourne, Melbourne, Australia
| | - William J Saunders
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Delwyn Bartlett
- Woolcock Institute for Medical Research, & the University of Sydney, NSW, Australia
| | - Luke A Downey
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia; Centre for Human Psychopharmacology, Swinburne University, Hawthorn, Melbourne, Australia
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
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Meaklim H, Meltzer LJ, Rehm IC, Junge MF, Monfries M, Kennedy GA, Bucks RS, Graco M, Jackson ML. Disseminating sleep education to graduate psychology programs online: a knowledge translation study to improve the management of insomnia. Sleep 2023; 46:zsad169. [PMID: 37327117 PMCID: PMC10566250 DOI: 10.1093/sleep/zsad169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/14/2023] [Indexed: 06/18/2023] Open
Abstract
STUDY OBJECTIVES Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework. METHODS Using a non-randomized waitlist control design, graduate psychology students attended a validated 6-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months. RESULTS Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students' sleep knowledge and self-efficacy to manage sleep disturbances using cognitive behavioral therapy for insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p < .001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency. CONCLUSIONS Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
| | - Lisa J Meltzer
- National Jewish Health, Denver, CO, USA
- Nyxeos Consulting, Denver, CO, USA
| | - Imogen C Rehm
- College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Moira F Junge
- Sleep Health Foundation, East Melbourne, VIC, Australia
| | - Melissa Monfries
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
| | - Gerard A Kennedy
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC, Australia
| | - Romola S Bucks
- Schools of Psychological Science and Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, VIC, Australia
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11
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Tolson J, Bartlett DJ, Barnes M, Rochford PD, Jordan AS, Jackson ML. A randomized controlled trial of a multi-dimensional intervention to improve CPAP use and self-efficacy. Sleep Med 2023; 109:202-210. [PMID: 37478656 DOI: 10.1016/j.sleep.2023.06.024] [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: 12/06/2022] [Revised: 06/04/2023] [Accepted: 06/25/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES To assess the utility of a tailored intervention program to improve continuous positive airway pressure (CPAP) use and self-efficacy in individuals with obstructive sleep apnea (OSA). METHODS 81 participants (mean age 52.1 ± 11.6 years; 35 females) with OSA were randomized to either a multi-dimensional intervention (PSY CPAP, n = 38) or treatment as usual (TAU CPAP, n = 43). The intervention included a psychoeducation session prior to CPAP initiation, a booster psychoeducation session in the first weeks of commencing CPAP, follow-up phone calls on days 1 and 7, and a review appointment on day 14. CPAP use was compared between the PSY CPAP and TAU CPAP groups at 1 week, 1 month, and 4 months. Self-efficacy scores (risk perception, outcome expectancies, and CPAP self-efficacy) were compared between groups following the initial psychoeducation session and again at 1 month and 4 months. RESULTS CPAP use was higher in the PSY CPAP group compared to the TAU CPAP group for all time points (p = .02). Outcome expectancies improved significantly over time in PSY CPAP participants (p = .007). Change in risk perception was associated with CPAP use at 1 week (p = .02) for PSY CPAP participants. However, risk perception did not mediate the effect between group and CPAP use at 1 week. CONCLUSIONS Interventions designed to increase self-efficacy and administered prior to CPAP initiation, repeated in the early stages of CPAP therapy, and combined with a comprehensive follow-up regime are likely to improve CPAP use. Sustained improvement in CPAP use is the ultimate goal but remains to be investigated.
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Affiliation(s)
- Julie Tolson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia; Institute for Breathing and Sleep, Heidelberg, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia.
| | - Delwyn J Bartlett
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Glebe, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Heidelberg, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia; Department of Medicine, The University of Melbourne, Parkville, Australia
| | | | - Amy S Jordan
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, Australia; Institute for Breathing and Sleep, Heidelberg, Australia
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Heidelberg, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
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12
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Honn KA, Morris MB, Jackson ML, Van Dongen HPA, Gunzelmann G. Effects of Sleep Deprivation on Performance during a Change Signal Task with Adaptive Dynamics. Brain Sci 2023; 13:1062. [PMID: 37508994 PMCID: PMC10377671 DOI: 10.3390/brainsci13071062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Augmented cognition, which refers to real-time modifications to a human-system interface to improve performance and includes dynamic task environments with automated adaptations, can serve to protect against performance impairment under challenging work conditions. However, the effectiveness of augmented cognition as a countermeasure for performance impairment due to sleep loss is unknown. Here, in a controlled laboratory study, an adaptive version of a Change Signal task was administered repeatedly to healthy adults randomized to 62 h of total sleep deprivation (TSD) or a rested control condition. In the computerized task, a left- or right-facing arrow was presented to start each trial. In a subset of trials, a second arrow facing the opposite direction was presented after a delay. Subjects were to respond within 1000 ms of the trial start by pressing the arrow key corresponding to the single arrow (Go trials) or to the second arrow when present (Change trials). The Change Signal Delay (CSD)-i.e., the delay between the appearance of the first and second arrows-was shortened following incorrect responses and lengthened following correct responses so that subsequent Change trials became easier or harder, respectively. The task featured two distinct CSD dynamics, which produced relatively stable low and high error rates when subjects were rested (Low and High Error Likelihood trials, respectively). During TSD, the High Error Likelihood trials produced the same, relatively high error rate, but the Low Error Likelihood trials produced a higher error rate than in the rested condition. Thus, sleep loss altered the effectiveness of the adaptive dynamics in the Change Signal task. A principal component analysis revealed that while subjects varied in their performance of the task along a single dominant dimension when rested, a second inter-individual differences dimension emerged during TSD. These findings suggest a need for further investigation of the interaction between augmented cognition approaches and sleep deprivation in order to determine whether and how augmented cognition can be relied upon as a countermeasure to performance impairment in operational settings with sleep loss.
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Affiliation(s)
- Kimberly A Honn
- Sleep and Performance Research Center & Department of Translational Medicine and Physiology, Washington State University, Spokane, WA 99202, USA
| | - Megan B Morris
- Air Force Research Laboratory, Wright Patterson Air Force Base, OH 45433, USA
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Hans P A Van Dongen
- Sleep and Performance Research Center & Department of Translational Medicine and Physiology, Washington State University, Spokane, WA 99202, USA
| | - Glenn Gunzelmann
- Air Force Research Laboratory, Wright Patterson Air Force Base, OH 45433, USA
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13
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Rajaratnam SM, Czeisler CA. Association of Chronotype and Shiftwork with COVID-19 Infection. medRxiv 2023:2023.07.06.23292337. [PMID: 37461617 PMCID: PMC10350136 DOI: 10.1101/2023.07.06.23292337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Objective This study assesses whether chronotype is related to COVID-19 infection and whether there is an interaction with shift work. Methods Cross-sectional survey of 19,821 U.S. adults. Results COVID-19 infection occurred in 40% of participants, 32.6% morning and 17.2% evening chronotypes. After adjusting for demographic and socioeconomic factors, shift work, sleep duration and comorbidities, morning chronotype was associated with a higher (aOR: 1.15, 95% CI 1.10-1.21) and evening chronotype with a lower (aOR: 0.82, 95% CI: 0.78-0.87) prevalence of COVID-19 infection in comparison to an intermediate chronotype. Working exclusively night shifts was not associated with higher prevalence of COVID-19. Morning chronotype and working some evening shifts was associated with the highest prevalence of previous COVID-19 infection (aOR: 1.87, 95% CI: 1.28-2.74). Conclusion Morning chronotype and working a mixture of shifts increase risk of COVID-19 infection.
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Affiliation(s)
- Stuart F. Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Mark É. Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, MA
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Lauren A. Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon I. Lane
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
| | - Christine F. McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M.W. Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
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14
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane R, McDonald CF, Ridgers A, Robbins R, Varma P, Rajaratnam SM, Czeisler CA. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among US adults. J Clin Sleep Med 2023; 19:1303-1311. [PMID: 37279079 PMCID: PMC10315594 DOI: 10.5664/jcsm.10588] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES Medical comorbidities increase the risk of severe COVID-19 infection. In some studies, obstructive sleep apnea (OSA) has been identified as a comorbid condition that is associated with an increased prevalence of COVID-19 infection and hospitalization, but few have investigated this association in a general population. This study aimed to answer the following research question: In a general population, is OSA associated with increased odds of COVID-19 infection and hospitalization and are these altered with COVID-19 vaccination? METHODS This was a cross-sectional survey of a diverse sample of 15,057 US adults. RESULTS COVID-19 infection and hospitalization rates in the cohort were 38.9% and 2.9%, respectively. OSA or OSA symptoms were reported in 19.4%. In logistic regression models adjusted for demographic, socioeconomic, and comorbid medical conditions, OSA was positively associated with COVID-19 infection (adjusted odds ratio: 1.58, 95% CI: 1.39-1.79) and COVID-19 hospitalization (adjusted odds ratio: 1.55, 95% CI: 1.17-2.05). In fully adjusted models, boosted vaccination status was protective against both infection and hospitalization. Boosted vaccination status attenuated the association between OSA and COVID-19 related hospitalization but not infection. Participants with untreated or symptomatic OSA were at greater risk for COVID-19 infection; those with untreated but not symptomatic OSA were more likely to be hospitalized. CONCLUSIONS In a general population sample, OSA is associated with a greater likelihood of having had a COVID-19 infection and a COVID-19 hospitalization with the greatest impact observed among persons experiencing OSA symptoms or who were untreated for their OSA. Boosted vaccination status attenuated the association between OSA and COVID-19-related hospitalization. CITATION Quan SF, Weaver MD, Czeisler MÉ, et al. Associations between obstructive sleep apnea and COVID-19 infection and hospitalization among U.S. adults. J Clin Sleep Med. 2023;19(7):1303-1311.
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Affiliation(s)
- Stuart F. Quan
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Matthew D. Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Mark É. Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, Massachusetts
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K. Barger
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lauren A. Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E. Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon Lane
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Christine F. McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M.W. Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Charles A. Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
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15
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Quan SF, Weaver MD, Czeisler MÉ, Barger LK, Booker LA, Howard ME, Jackson ML, Lane RI, McDonald CF, Ridgers A, Robbins R, Varma P, Wiley JF, Rajaratnam SMW, Czeisler CA. Insomnia, Poor Sleep Quality and Sleep Duration and Risk for COVID-19 Infection and Hospitalization. Am J Med 2023:S0002-9343(23)00248-6. [PMID: 37075878 PMCID: PMC10108572 DOI: 10.1016/j.amjmed.2023.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Medical comorbidities increase the risk of severe acute COVID-19 illness. Although sleep problems are common after COVID-19 infection, it is unclear whether insomnia, poor sleep quality and extremely long or short sleep increase risk of developing COVID-19 infection or hospitalization. METHODS Cross-sectional survey of a diverse sample of 19,926 U.S. adults RESULTS: COVID-19 infection and hospitalization prevalence rates were 40.1% and 2.9% respectively. Insomnia and poor sleep quality were reported in 19.8% and 40.1% respectively. In logistic regression models adjusted for comorbid medical conditions and sleep duration but excluding participants who reported COVID-19 associated sleep problems, poor sleep quality but not insomnia was associated with COVID-19 infection (aOR: 1.16, 95%CI: 1.07-1.26) and COVID-19 hospitalization (aOR: 1.50, 95% CI: 1.18-1.91). In comparison to habitual sleep duration of 7-8 hours, sleep durations less than 7 hours (aOR: 1.14, 95% CI: 1.06-1.23) and sleep duration of 12 hours (aOR: 1.61, 95% CI: 1.12-2.31) were associated with increased odds of COVID-19 infection. Overall, the relationship between COVID-19 infection and hours of sleep followed a quadratic (U shaped) pattern. No association between sleep duration and COVID-19 hospitalization was observed. CONCLUSION In a general population sample, poor sleep quality and extremes of sleep duration are associated with greater odds of having had a COVID-19 infection; poor sleep quality was associated with an increased requirement of hospitalization for severe COVID-19 illness. These observations suggest that inclusion of healthy sleep practices in public health messaging may reduce the impact of the COVID-19 pandemic.
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Affiliation(s)
- Stuart F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA.
| | - Matthew D Weaver
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Mark É Czeisler
- Francis Weld Peabody Society, Harvard Medical School, Boston, MA; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Laura K Barger
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Lauren A Booker
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; University Department of Rural Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Melinda L Jackson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Rashon I Lane
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA
| | - Christine F McDonald
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Faculty of Medicine, Monash University, Melbourne, Australia
| | - Anna Ridgers
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Robbins
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Prerna Varma
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Joshua F Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Shantha M W Rajaratnam
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA
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16
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Gnoni V, Mesquita M, O’Regan D, Delogu A, Chakalov I, Antal A, Young AH, Bucks RS, Jackson ML, Rosenzweig I. Distinct cognitive changes in male patients with obstructive sleep apnoea without co-morbidities. Front Sleep 2023; 2:1097946. [PMID: 38213473 PMCID: PMC7615516 DOI: 10.3389/frsle.2023.1097946] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Introduction Obstructive sleep apnoea (OSA) is a multisystem, debilitating, chronic disorder of breathing during sleep, resulting in a relatively consistent pattern of cognitive deficits. More recently, it has been argued that those cognitive deficits, especially in middle-aged patients, may be driven by cardiovascular and metabolic comorbidities, rather than by distinct OSA-processes, such as are for example ensuing nocturnal intermittent hypoxaemia, oxidative stress, neuroinflammation, and sleep fragmentation. Methods Thus, we undertook to define cognitive performance in a group of 27 middle-aged male patients with untreated OSA, who had no concomitant comorbidities, compared with seven matched controls (AHI mean ± S.D.: 1.9 ± 1.4 events/h; mean age 34.0 ± 9.3 years; mean BMI 23.8 ± 2.3 kg/m2). Of the 27 patients, 16 had mild OSA (AHI mean ± S.D.:11.7 ± 4.0 events/h; mean age 42.6 ± 8.2 years; mean BMI 26.7 ± 4.1 kg/m2), and 11 severe OSA (AHI 41.8 ± 20.7 events/h; age: 46.9 ± 10.9 years, BMI: 28.0 ± 3.2 kg/m2). Results In our patient cohort, we demonstrate poorer executive-functioning, visuospatial memory, and deficits in vigilance sustained attention, psychomotor and impulse control. Remarkably, we also report, for the first time, effects on social cognition in this group of male, middle-aged OSA patients. Conclusion Our findings suggest that distinct, OSA-driven processes may be sufficient for cognitive changes to occur as early as in middle age, in otherwise healthy individuals.
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Affiliation(s)
- Valentina Gnoni
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | | | - David O’Regan
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London, United Kingdom
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Alessio Delogu
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ivan Chakalov
- Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley National Health Service (NHS) Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom
| | - Romola S. Bucks
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
- The Raine Study, School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Sleep Disorder Centre, Nuffield House, Guy’s Hospital, London, United Kingdom
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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17
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Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Beyond Stress: Altered Sleep-Wake Patterns are a Key Behavioral Risk Factor for Acute Insomnia During Times of Crisis. Behav Sleep Med 2023; 21:208-225. [PMID: 35604338 DOI: 10.1080/15402002.2022.2074996] [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
BACKGROUND Stress is a common precipitant of acute insomnia; however, reducing stress during times of crisis is challenging. This study aimed to determine which modifiable factors, beyond stress, were associated with acute insomnia during a major crisis, the COVID-19 pandemic. PARTICIPANTS/METHODS A global online survey assessed sleep/circadian, stress, mental health, and lifestyle factors between April-May 2020. Logistic regression models analyzed data from 1319 participants (578 acute insomnia, 731 good sleepers), adjusted for demographic differences. RESULTS Perceived stress was a significant predictor of acute insomnia during the pandemic (OR 1.23, 95% CI1.19-1.27). After adjusting for stress, individuals who altered their sleep-wake patterns (OR 3.36, CI 2.00-5.67) or increased technology use before bed (OR 3.13, CI 1.13-8.65) were at increased risk of acute insomnia. Other sleep factors associated with acute insomnia included changes in dreams/nightmares (OR 2.08, CI 1.32-3.27), increased sleep effort (OR 1.99, CI1.71-2.31) and cognitive pre-sleep arousal (OR 1.18, CI 1.11-1.24). For pandemic factors, worry about contracting COVID-19 (OR 3.08, CI 1.18-8.07) and stringent government COVID-19 restrictions (OR 1.12, CI =1.07-1.18) were associated with acute insomnia. Anxiety (OR 1.02, CI 1.01-1.05) and depressive (OR 1.29, CI 1.22-1.37) symptoms were also risk factors. A final hierarchical regression model revealed that after accounting for stress, altered sleep-wake patterns were a key behavioral predictor of acute insomnia (OR 2.60, CI 1.68-5.81). CONCLUSION Beyond stress, altered sleep-wake patterns are a key risk factor for acute insomnia. Modifiable behaviors such as maintaining regular sleep-wake patterns appear vital for sleeping well in times of crisis.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Moira F Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,The Sleep Health Foundation, Blacktown, New South Wales, Australia
| | - Prerna Varma
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Wendy A Finck
- Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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18
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Wu Y, Levis B, Daray FM, Ioannidis JPA, Patten SB, Cuijpers P, Ziegelstein RC, Gilbody S, Fischer FH, Fan S, Sun Y, He C, Krishnan A, Neupane D, Bhandari PM, Negeri Z, Riehm KE, Rice DB, Azar M, Yan XW, Imran M, Chiovitti MJ, Boruff JT, McMillan D, Kloda LA, Markham S, Henry M, Ismail Z, Loiselle CG, Mitchell ND, Al-Adawi S, Beck KR, Beraldi A, Bernstein CN, Boye B, Büel-Drabe N, Bunevicius A, Can C, Carter G, Chen CK, Cheung G, Clover K, Conroy RM, Costa-Requena G, Cukor D, Dabscheck E, De Souza J, Downing M, Feinstein A, Ferentinos PP, Flint AJ, Gallagher P, Gandy M, Grassi L, Härter M, Hernando A, Jackson ML, Jenewein J, Jetté N, Julião M, Kjærgaard M, Köhler S, König HH, Krishna LKR, Lee Y, Löbner M, Loosman WL, Love AW, Löwe B, Malt UF, Marrie RA, Massardo L, Matsuoka Y, Mehnert A, Michopoulos I, Misery L, Nelson CJ, Ng CG, O'Donnell ML, O'Rourke SJ, Öztürk A, Pabst A, Pasco JA, Peceliuniene J, Pintor L, Ponsford JL, Pulido F, Quinn TJ, Reme SE, Reuter K, Riedel-Heller SG, Rooney AG, Sánchez-González R, Saracino RM, Schellekens MPJ, Scherer M, Benedetti A, Thombs BD, Et Al. Comparison of the accuracy of the 7-item HADS Depression subscale and 14-item total HADS for screening for major depression: A systematic review and individual participant data meta-analysis. Psychol Assess 2023; 35:95-114. [PMID: 36689386 DOI: 10.1037/pas0001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The seven-item Hospital Anxiety and Depression Scale Depression subscale (HADS-D) and the total score of the 14-item HADS (HADS-T) are both used for major depression screening. Compared to the HADS-D, the HADS-T includes anxiety items and requires more time to complete. We compared the screening accuracy of the HADS-D and HADS-T for major depression detection. We conducted an individual participant data meta-analysis and fit bivariate random effects models to assess diagnostic accuracy among participants with both HADS-D and HADS-T scores. We identified optimal cutoffs, estimated sensitivity and specificity with 95% confidence intervals, and compared screening accuracy across paired cutoffs via two-stage and individual-level models. We used a 0.05 equivalence margin to assess equivalency in sensitivity and specificity. 20,700 participants (2,285 major depression cases) from 98 studies were included. Cutoffs of ≥7 for the HADS-D (sensitivity 0.79 [0.75, 0.83], specificity 0.78 [0.75, 0.80]) and ≥15 for the HADS-T (sensitivity 0.79 [0.76, 0.82], specificity 0.81 [0.78, 0.83]) minimized the distance to the top-left corner of the receiver operating characteristic curve. Across all sets of paired cutoffs evaluated, differences of sensitivity between HADS-T and HADS-D ranged from -0.05 to 0.01 (0.00 at paired optimal cutoffs), and differences of specificity were within 0.03 for all cutoffs (0.02-0.03). The pattern was similar among outpatients, although the HADS-T was slightly (not nonequivalently) more specific among inpatients. The accuracy of HADS-T was equivalent to the HADS-D for detecting major depression. In most settings, the shorter HADS-D would be preferred. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Federico M Daray
- Institute of Pharmacology, School of Medicine, University of Buenos Aires
| | | | - Scott B Patten
- Department of Community Health Sciences, University of Calgary
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit
| | | | - Simon Gilbody
- Department of Health Sciences, Hull York Medical School, University of York
| | - Felix H Fischer
- Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin
| | - Suiqiong Fan
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | | | - Zelalem Negeri
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Xin Wei Yan
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | | | - Jill T Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University
| | - Dean McMillan
- Department of Health Sciences, Hull York Medical School, University of York
| | | | - Sarah Markham
- Department of Biostatistics and Health Informatics, King's College London
| | - Melissa Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Zahinoor Ismail
- Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary
| | | | | | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine & Health Sciences, Sultan Qaboos University
| | - Kevin R Beck
- Department of Psychiatry, Singapore General Hospital, Singapore
| | - Anna Beraldi
- kbo Lech-Mangfall-Klinik für Psychatrie, Psychotherapie und Psychsomatik, Garmisch-Partenkirchen
| | | | - Birgitte Boye
- Department of Behavioural Medicine, University of Oslo
| | | | | | - Ceyhun Can
- Adana City Training and Research Hospital
| | - Gregory Carter
- School of Medicine and Public Health, University of Newcastle
| | - Chih-Ken Chen
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Gary Cheung
- Department of Psychological Medicine, University of Auckland
| | - Kerrie Clover
- Centre for Brain and Mental Health Research, University of Newcastle
| | - Ronán M Conroy
- Division of Population Health Sciences, Royal College of Surgeons in Ireland
| | - Gema Costa-Requena
- Department of Psychiatry, Clinical Psychology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Centro de Investigacióo Biomédica en Red de Salud Mental
| | | | | | | | | | | | - Panagiotis P Ferentinos
- 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens
| | | | | | - Milena Gandy
- The School of Psychological Sciences, Macquarie University
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg, University of Hamburg
| | | | | | - Josef Jenewein
- Department of Medical Psychology and Psychotherapy, Medical University of Graz
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra
| | - Marie Kjærgaard
- Endocrinology Research Group, Medical Clinic, University Hospital of North Norway
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf
| | | | - Yu Lee
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig
| | | | | | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf
| | - Ulrik F Malt
- Department of Research and Education Division of Surgery and Clinical Neuroscience, University of Oslo
| | - Ruth Ann Marrie
- Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia, Universidad San Sebastián
| | - Yutaka Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University of Leipzig
| | - Ioannis Michopoulos
- 2nd Department of Psychiatry, Attikon General Hospital, National and Kapodistrian University of Athens
| | | | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya
| | | | | | | | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig
| | - Julie A Pasco
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University
| | - Jurate Peceliuniene
- Faculty of Medicine, Clinic of Internal Diseases, Family Medicine and Oncology, Vilnius University
| | - Luis Pintor
- Instituto de Investigaciones Biomédicas Augusto Pi i Sunyer
| | | | | | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow
| | - Silje E Reme
- Department of Psychology, Faculty of Social Sciences, University of Oslo
| | - Katrin Reuter
- Private Practice for Psychotherapy and Psycho-oncology, Freiburg, Baden-Württemberg
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig
| | | | - Roberto Sánchez-González
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Centre Emili Mira, Parc de Salut Mar
| | - Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | | | - Martin Scherer
- Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital
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Meaklim H, Saunders WJ, Byrne ML, Junge MF, Varma P, Finck WA, Jackson ML. Insomnia is a key risk factor for persistent anxiety and depressive symptoms: A 12-month longitudinal cohort study during the COVID-19 pandemic. J Affect Disord 2023; 322:52-62. [PMID: 36372131 DOI: 10.1016/j.jad.2022.11.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/26/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Insomnia is a risk factor for affective disorders. This study examined whether individuals with insomnia symptoms early in the pandemic, either pre-existing or new-onset, were more vulnerable to anxiety and depressive symptoms over time than those who maintained normal sleep. Additionally, sleep-related factors such as pre-sleep arousal were assessed for their influence on clinically significant anxiety and depression risk. METHODS Using a global online survey with 3-, 6-, and 12-month follow-ups between April 2020 and May 2021, data from 2069 participants (M = 46.16 ± 13.42 years; 75.3 % female) with pre-existing, new-onset, or no insomnia symptoms was examined using mixed-effects and logistic regression models. RESULTS New-onset and pre-existing insomnia predicted persistent anxiety and depressive symptoms longitudinally (p's < 0.001), over other known risk factors, including age, sex, and previous psychiatric diagnoses. Anxiety and depressive symptoms in both insomnia groups remained above clinically significant thresholds at most time points, whereas normal sleepers remained subclinical. Pre-sleep arousal was found to increase the risk of clinically significant anxiety (OR = 1.05) and depressive symptoms (OR = 1.09) at 12-months. Sleep effort contributed to anxiety (OR = 1.06), whereas dysfunctional sleep-related beliefs and attitudes predicted clinically significant depression (OR = 1.22). LIMITATIONS Insomnia group categorization was based on self-report at baseline supported by a validated measure. High participant attrition was observed at 3-months (53 %; n = 971), but retention remained steady till 12-months (63 %, n = 779). CONCLUSIONS Insomnia is a modifiable risk factor for persistent anxiety and depressive symptoms that needs to be addressed in mental healthcare. Additionally, pre-sleep arousal may be an important transdiagnostic process linking insomnia with affective disorders.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - William J Saunders
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Michelle L Byrne
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia; Department of Psychology, University of Oregon, Eugene, OR, USA; The Sleep Health Foundation, Blacktown, New South Wales, Australia
| | - Moira F Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia; School of Educational Psychology and Counselling, Faculty of Education, Monash University, Victoria, Australia
| | - Prerna Varma
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Wendy A Finck
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Victoria, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.
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20
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Cavuoto MG, Robinson SR, O'Donoghue FJ, Barnes M, Howard ME, Tolson J, Stevens B, Schembri R, Rosenzweig I, Rowe CC, Jackson ML. Associations Between Amyloid Burden, Hypoxemia, Sleep Architecture, and Cognition in Obstructive Sleep Apnea. J Alzheimers Dis 2023; 96:149-159. [PMID: 37742634 DOI: 10.3233/jad-221049] [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: 09/26/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with an increased risk of amyloid-β (Aβ) burden, the hallmark of Alzheimer's disease, and cognitive decline. OBJECTIVE To determine the differential impacts of hypoxemia and slow-wave sleep disruption on brain amyloid burden, and to explore the effects of hypoxemia, slow-wave sleep disruption, and amyloid burden on cognition in individuals with and without OSA. METHODS Thirty-four individuals with confirmed OSA (mean±SD age 57.5±4.1 years; 19 males) and 12 healthy controls (58.5±4.2 years; 6 males) underwent a clinical polysomnogram, a NAV4694 positron emission tomography (PET) scan for Aβ burden, assessment of APOEɛ status and cognitive assessments. Linear hierarchical regressions were conducted to determine the contributions of demographic and sleep variables on amyloid burden and cognition. RESULTS Aβ burden was associated with nocturnal hypoxemia, and impaired verbal episodic memory, autobiographical memory and set shifting. Hypoxemia was correlated with impaired autobiographical memory, and only set shifting performance remained significantly associated with Aβ burden when controlling for sleep variables. CONCLUSIONS Nocturnal hypoxemia was related to brain Aβ burden in this sample of OSA participants. Aβ burden and hypoxemia had differential impacts on cognition. This study reveals aspects of sleep disturbance in OSA that are most strongly associated with brain Aβ burden and poor cognition, which are markers of early Alzheimer's disease. These findings add weight to the possibility that hypoxemia may be causally related to the development of dementia; however, whether it may be a therapeutic target for dementia prevention in OSA is yet to be determined.
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Affiliation(s)
- Marina G Cavuoto
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Stephen R Robinson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Fergal J O'Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- The University of Melbourne, Parkville, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- The University of Melbourne, Parkville, Australia
| | - Mark E Howard
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- The University of Melbourne, Parkville, Australia
| | - Julie Tolson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- The University of Melbourne, Parkville, Australia
| | - Bronwyn Stevens
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Rachel Schembri
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Ivana Rosenzweig
- Department of Neuroimaging, Sleep and Brain Plasticity Centre, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), London, UK
| | - Christopher C Rowe
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
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Fitzgerald ES, Stout JC, Glikmann-Johnston Y, Anderson C, Jackson ML. Sleep, Circadian Rhythms, and Cognitive Dysfunction in Huntington's Disease. J Huntingtons Dis 2023; 12:293-304. [PMID: 37599535 DOI: 10.3233/jhd-230578] [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: 08/22/2023]
Abstract
BACKGROUND In healthy people, sleep and circadian disruption are linked to cognitive deficits. People with Huntington's disease (HD), who have compromised brain function and sleep and circadian disturbances, may be even more susceptible to these cognitive effects. OBJECTIVE To conduct a comprehensive review and synthesis of the literature in HD on the associations of cognitive dysfunction with disturbed sleep and circadian rhythms. METHODS We searched MEDLINE via OVID, CINAHL Plus, EMBASE via OVID, and PubMed in May 2023. The first author then screened by title and abstract and conducted a full review of remaining articles. RESULTS Eight studies investigating the influence of sleep and/or circadian rhythms on cognitive function in HD were found. In manifest HD, poorer sleep was associated with worse cognitive function. For behavioral 24-hour (circadian) rhythms, two studies indicated that later wake times correlated with poorer cognitive function. No reported studies in HD examined altered physiological 24-hour (circadian) rhythms and cognitive impairment. CONCLUSION Some associations exist between poor sleep and cognitive dysfunction in manifest HD, yet whether these associations are present before clinical diagnosis is unknown. Whether circadian disturbances relate to cognitive impairment in HD also remains undetermined. To inform sleep and circadian interventions aimed at improving cognitive symptoms in HD, future research should include a range of disease stages, control for external factors, and utilize robust cognitive batteries targeted to the aspects of cognitive function known to be adversely affected in HD.
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Affiliation(s)
- Emily S Fitzgerald
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Julie C Stout
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Yifat Glikmann-Johnston
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Clare Anderson
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Melinda L Jackson
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
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Varma P, Jackson ML, Junge M, Conduit R. Actigraphy‐measured sleep concordance, night‐wakings, intraindividual sleep variability in parents and their children—Associations with childhood sleep disturbances. J Sleep Res 2022; 32:e13773. [PMID: 36345126 DOI: 10.1111/jsr.13773] [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] [Received: 05/06/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
The relationship between the sleep of parents and their children has primarily been studied using self-reported measures, but data using objective sleep assessments are limited. In particular, objective assessments of sleep disturbance and night-wakings in parents in relation to their children's night-wakings is underexamined. This pilot study employed actigraphy to determine concordance in sleep-wake patterns between parents and their children, and examine temporal links between their wakings lasting five min or longer. The study also explored individual variability in parents' sleep based on parent-reported sleep disturbances in children. A total of 20 parents and children (aged 2-12 years, no co-sleepers) contributed actigraphy data for the 14-night study, totalling 280 nights of data. Parents reported their sleep quality using the Pittsburgh Sleep Quality Index, and children's sleep using the Children Sleep Habits Questionnaire. Concordance analysis of actigraphy data revealed an average of 70.6% match in sleep/wake state between parents and children. Parents were three times more likely to have an awakening within 10 min of their child waking than vice versa. Parent-reported sleep disturbances in children were associated with poorer actigraphic sleep outcomes for both the parent and child. Parents of poorly sleeping children demonstrated greater variability in their bedtime, and wake after sleep onset. Further examination of temporal links between parent-child sleep can improve our understanding of factors that predispose or precipitate sleep disturbances across families. Given the high concordance in parent-child sleep and poorer actigraphy sleep outcomes in parents of children with sleep disturbances, there is a need to deliver efficacious sleep interventions at the family level.
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Affiliation(s)
- Prerna Varma
- School of Health and Biomedical Sciences RMIT University Melbourne Victoria Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences Monash University Clayton Victoria Australia
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences Monash University Clayton Victoria Australia
| | - Moira Junge
- Sleep Health Foundation Blacktown New South Wales Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences RMIT University Melbourne Victoria Australia
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Meaklim H, Burge M, Le F, Bains SK, Saunders W, Ghosh S, Junge MF, Varma P, Rehm IC, Jackson ML. Strange themes in pandemic dreams: Insomnia was associated with more negative, anxious and death-related dreams during the COVID-19 pandemic. J Sleep Res 2022; 32:e13655. [PMID: 35699296 PMCID: PMC9350044 DOI: 10.1111/jsr.13655] [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: 01/08/2022] [Revised: 05/03/2022] [Accepted: 05/08/2022] [Indexed: 02/03/2023]
Abstract
Dreaming and insomnia are important markers of distress in times of crisis. Here, we present a longitudinal, mixed-methods study examining changes in dreaming between individuals with and without insomnia symptoms and their relationship to mental health during the COVID-19 pandemic. A global survey examining insomnia symptoms, dreams and mental health was launched in April 2020 and followed participants over 12 months. Of 2240 participants, 1009 (45%) reported dream changes at baseline. A higher proportion of participants with new-onset insomnia reported dream changes (55%) than those with pre-existing insomnia (45%) or good sleepers (36%). Overall, thematic analysis identified key dream change themes of increased dream activity, with participants dreaming vividly, in high-definition, and with a strong negative charge. Themes around survival, adjusting to pandemic life, meaning-making and poor sleep quality were also noted. Linguistic Inquiry Word Count showed that individuals with insomnia used more negative words to describe their dream changes than good sleepers. Specifically, the new-onset insomnia group used more anxious and death-related words than those who slept well. Notably, all groups experienced a significant reduction in dream activity by 3-month follow-up. Lastly, dream changes were associated with worse mental health symptoms over time, and this effect was more pronounced in individuals with insomnia. Our results highlight that insomnia symptoms, especially new-onset insomnia, are associated with more negative dream changes during collective stressful events, potentially compounding daytime distress and mental health symptoms over time. During times of crisis, dreaming and insomnia may reveal an important target for mental health interventions.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityMonashVictoriaAustralia
| | - Malisa Burge
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityMonashVictoriaAustralia
| | - Flora Le
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityMonashVictoriaAustralia
| | - Sukjhit K. Bains
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityMonashVictoriaAustralia
| | - William Saunders
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityMonashVictoriaAustralia
| | - Stephen Ghosh
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityMonashVictoriaAustralia
| | - Moira F. Junge
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityMonashVictoriaAustralia,The Sleep Health FoundationBlacktownNew South WalesAustralia
| | - Prerna Varma
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityMonashVictoriaAustralia
| | - Imogen C. Rehm
- College of Health and BiomedicineVictoria UniversityMelbourneVictoriaAustralia
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological SciencesMonash UniversityMonashVictoriaAustralia
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24
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Lee VV, Schembri R, Jordan AS, Jackson ML. The independent effects of sleep deprivation and sleep fragmentation on processing of emotional information. Behav Brain Res 2022; 424:113802. [PMID: 35181390 DOI: 10.1016/j.bbr.2022.113802] [Citation(s) in RCA: 5] [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: 08/15/2021] [Revised: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 11/16/2022]
Abstract
Disrupted sleep through sleep deprivation or sleep fragmentation has previously been shown to impair cognitive processing. Nevertheless, limited studies have examined the impact of disrupted sleep on the processing of emotional information. The current study aimed to use an experimental approach to generate sleep disruption and examine whether SD and SF in otherwise healthy individuals would impair emotional facial processing. Thirty-five healthy individuals participated in three-day/two-night laboratory study which consisted of two consecutive overnight polysomnograms and cognitive testing during the day. The first night was an adaptation night of normal sleep while the second was an experimental night where participants underwent either a night of 1) normal sleep, 2) no sleep (SD) or 3) fragmented sleep (SF). The emotional Go/No-Go task was completed in the morning following each night. Data from 33 participants (14 females, mean age = 24.6 years) were included in the final analysis. Following a night of SD or SF, participants performed significantly poorer with emotional (fearful and happy) targets, while no significant changes occurred after a night of normal sleep. Further, sleep deprived individuals experienced additional impairments with notably poorer performance with neutral targets and slower reaction time for all targets, suggesting an overall slowing of cognitive processing speed. These findings suggest that facial recognition in socio-emotional contexts may be impaired in individuals who experience disrupted sleep.
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Affiliation(s)
- V Vien Lee
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia; Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia
| | - Rachel Schembri
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia; Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia; Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia
| | - Melinda L Jackson
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.
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25
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O’Regan D, Jackson ML, Young AH, Rosenzweig I. Understanding the Impact of the COVID-19 Pandemic, Lockdowns and Social Isolation on Sleep Quality. Nat Sci Sleep 2021; 13:2053-2064. [PMID: 34795545 PMCID: PMC8593898 DOI: 10.2147/nss.s266240] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/17/2021] [Indexed: 12/15/2022] Open
Abstract
The uncertain, ever-changing and an ongoing nature of the COVID-19 pandemic means that it may take some time before we can fully appreciate the negative effect of the pandemic and lockdown on our sleep and mental health. It is increasingly recognised that in the aftermath of pandemic, several persistent sleep, neuropsychiatric and physical sequelae may continue long after the pandemic is over. A body of evidence to date also highlights a significant disparity in sleep and mental health difficulties in specific vulnerable groups in the community, with different temporal profiles and sleep issues that are reported. In this perspective, we argue for a possible mechanistic impact of the COVID-19 pandemic, with its imposed restrictions and social isolation on sleep quality. We similarly discuss some of the potential international differences, as well as similarities, behind reported idiosyncratic biological vulnerabilities that may have contributed to the genesis of sleep issues. Lastly, we propose some possible implementations and innovations that may be needed in restructuring of sleep disorders services in order to benefit recovering COVID-19 patients.
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Affiliation(s)
- David O’Regan
- Sleep Disorders Centre, Guy’s and St Thomas’ Hospital, GSTT NHS, London, UK
- Faculty of Life and Sciences Medicine, King’s College London, London, UK
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Allan H Young
- School of Academic Psychiatry, IoPPN, King’s College London, London, UK
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy’s and St Thomas’ Hospital, GSTT NHS, London, UK
- Sleep and Brain Plasticity Centre, CNS, IoPPN, King’s College London, London, UK
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26
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Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med 2021; 17:2085-2097. [PMID: 33985647 PMCID: PMC8494096 DOI: 10.5664/jcsm.9354] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 12/24/2020] [Accepted: 04/15/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has led to an increased prevalence of insomnia and mental health symptoms globally. However, most studies to date have not examined mental health symptoms between individuals with insomnia, either pre-existing or developing post-pandemic compared with good sleepers. This study examined differences in stress, anxiety, and depression between individuals with pre-existing insomnia symptoms, post-pandemic insomnia symptoms, and no insomnia symptoms in response to the COVID-19 pandemic. METHODS A cross-sectional survey was completed by 2724 participants from 67 countries during the COVID-19 pandemic. Perceived stress, anxiety, and depressive symptoms were compared between individuals with post-pandemic insomnia symptoms (n = 1007), pre-existing insomnia symptoms (n = 804), and no insomnia symptoms (n = 913). RESULTS Post-pandemic insomnia symptoms were associated with higher levels of stress, anxiety, and depression than pre-existing or no insomnia symptoms (P < .001). Pre-existing insomnia symptoms were also associated with higher levels of stress, anxiety, and depression than no insomnia symptoms (P < .001). Individuals who met likely criteria for acute insomnia also reported higher stress, anxiety, and depression than those with insomnia disorder (P < .001). Across all groups, individuals reporting a previous mental health diagnosis had worse stress, anxiety, and depression than those without a previous mental health diagnosis (P < .001). Last, individuals from South Africa reported higher levels of stress, anxiety, and depression than other countries (P < .01). CONCLUSIONS Internationally, individuals with pre-existing and post-pandemic insomnia symptoms may be more susceptible to stress, anxiety, and depression during the COVID-19 pandemic. Public health initiatives should include insomnia management to improve mental health during the pandemic. CITATION Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med. 2021;17(10):2085-2097.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Moira F. Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- The Sleep Health Foundation, Blacktown, New South Wales, Australia
| | - Prerna Varma
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Wendy A. Finck
- Faculty of Education, Monash University, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
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27
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Cori JM, Gordon C, Jackson ML, Collins A, Philip R, Stevens D, Naqvi A, Hosking R, Anderson C, Barnes M, Howard ME, Vakulin A. The impact of aging on driving performance in patients with untreated obstructive sleep apnea. Sleep Health 2021; 7:652-660. [PMID: 34479826 DOI: 10.1016/j.sleh.2021.07.005] [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: 12/17/2020] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the influence of age on sleepiness-related driving performance in individuals with obstructive sleep apnea (OSA). DESIGN Extended wakefulness protocol comparing simulated driving performance in younger and older individuals with OSA. PARTICIPANTS Fifty-two individuals with OSA (15 female) were median split into younger (≤55 years, n = 26) and older (>55 years, n = 26) groups. MEASUREMENTS Participants underwent polysomnography to derive sleep parameters and confirm OSA diagnosis. One-to-2 weeks following polysomnography, participants completed a 60-minute driving simulation 4 hours prior to their habitual bedtime. Participants remained awake to 3 hours post habitual bedtime before repeating the task. RESULTS Median age was 44.5 years (25th, 75th centiles = 37.0, 48.0) for the younger group and 64.5 years (60.0, 70.0) for the older group. When comparing the performance change between baseline and extended wakefulness, the younger patients had greater deterioration on all driving simulator parameters (crashes, standard deviation of lateral position, speed deviation and braking reaction time, all p < .05), compared to the older group. Linear regression found a 10-year age increase was associated with an a ∼30%-41% reduction in crash occurrence when accounting for covariates (p = .023). Age also predicted standard deviation of lateral position deviation, but not when sleep efficiency and self-reported sleepiness were included as covariates. CONCLUSION Older participants with OSA were less vulnerable than younger participants to sleepiness-related driving simulator impairment when assessed at night-time following extended wakefulness. Future work should assess naturalistic on-road driving to determine if this extends to a variety of challenging driving scenarios.
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Affiliation(s)
- Jennifer M Cori
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.
| | - Christopher Gordon
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Allison Collins
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rohit Philip
- Adelaide Institute for Sleep Health/Flinders Health and Medical Research Institute Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - David Stevens
- Adelaide Institute for Sleep Health/Flinders Health and Medical Research Institute Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Aqsa Naqvi
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Ruth Hosking
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Clare Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia; Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew Vakulin
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, New South Wales, Australia; Adelaide Institute for Sleep Health/Flinders Health and Medical Research Institute Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
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28
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Meaklim H, Rehm IC, Monfries M, Junge M, Meltzer LJ, Jackson ML. Wake up psychology! Postgraduate psychology students need more sleep and insomnia education. Australian Psychologist 2021. [DOI: 10.1080/00050067.2021.1955614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Imogen C. Rehm
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Melissa Monfries
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Moira Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- The Sleep Health Foundation, Blacktown, Australia
| | - Lisa J. Meltzer
- Department of Pediatrics, National Jewish Health, Denver, USA
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
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29
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Varma P, Junge M, Meaklim H, Jackson ML. Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey. Prog Neuropsychopharmacol Biol Psychiatry 2021; 109:110236. [PMID: 33373680 PMCID: PMC7834119 DOI: 10.1016/j.pnpbp.2020.110236] [Citation(s) in RCA: 290] [Impact Index Per Article: 96.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has had far-ranging consequences for general physical and mental health. Country-specific research reveals a general reduction in mental and physical well-being, due to measures undertaken to stop the spread of COVID-19 disease. However, research is yet to examine the impact of the pandemic on global psychological distress and its effects upon vulnerable groups. Exploration of the factors that potentially mediate the relationship between stress and mental health during this period is needed, to assist in undertaking concrete measures to mitigate psychological distress and support vulnerable groups. Therefore, this study examined the impact of the COVID-19 pandemic on psychological distress globally, and identified factors that may exacerbate decline in mental health. N = 1653 participants (mean age 42.90 ± 13.63 years; 30.3% males) from 63 countries responded to the survey. Depression and anxiety were assessed using the Patient Health Questionnaire and State Trait Anxiety Inventory, respectively. Other measures included the Perceived Stress Scale, the Pittsburgh Sleep Quality Index, 3-item UCLA Loneliness Scale and the Brief Resilient Coping Scale. Globally, consistently high levels of stress, anxiety, depression and poor sleep were observed regardless of number of COVID-19 cases. Over 70% of the respondents had greater than moderate levels of stress, with 59% meeting the criteria for clinically significant anxiety and 39% reporting moderate depressive symptoms. People with a prior mental health diagnosis experienced greater psychological distress. Poor sleep, lower levels of resilience, younger age and loneliness significantly mediated the links between stress and depression, and stress and anxiety. Age-based differences revealed that younger age-groups were more vulnerable to stress, depression and anxiety symptoms. Results show that these vulnerable individuals need more support. Age-specific interventions for modifiable factors that mediate the psychological distress need to urgently deployed to address the global mental health pandemic.
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30
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Jackson ML, Tolson J, Schembri R, Bartlett D, Rayner G, Lee VV, Barnes M. Does continuous positive airways pressure treatment improve clinical depression in obstructive sleep apnea? A randomized wait-list controlled study. Depress Anxiety 2021; 38:498-507. [PMID: 33368782 DOI: 10.1002/da.23131] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder that is associated with a range of adverse daytime sequelae, including significantly higher rates of clinical depression than is seen in the general community. Improvements in depressive symptoms occur after treatment of the primary sleep disorder, suggesting that comorbid depression might be an intrinsic feature of OSA. However, there are limited data on whether treatment for OSA in patients diagnosed with clinical depression improves mood symptoms meaningfully enough to lead to the remission of the psychiatric diagnosis. METHODS N = 121 untreated OSA patients were randomized to either continuous positive airway pressure (CPAP) treatment or waitlist control, and depressive symptoms, sleepiness and clinical depression (using a structured clinical interview) were assessed at baseline and 4 months. Linear and logistic regression analyses were conducted, controlling for baseline scores, stratification factors and antidepressant use. RESULTS Depressive symptoms (odds ratio [OR] = -4.19; 95% confidence interval [CI] = -7.25, -1.13; p = .008) and sleepiness (OR = -4.71; 95% CI = -6.26, -3.17; p < .001) were significantly lower at 4 months in the CPAP group compared to waitlist. At 4 months, there was a significant reduction in the proportion of participants in the CPAP group meeting criteria for clinical depression, compared to the waitlist controls (OR = 0.06, 95% CI = 0.01, 0.37; p = .002). CONCLUSION Treatment of OSA may be a novel approach for the management and treatment of clinical depression in those with comorbid sleep disordered breathing. Larger trials of individuals with clinical depression and comorbid OSA are needed.
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Affiliation(s)
- Melinda L Jackson
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia
| | - Julie Tolson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Rachel Schembri
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Australia
| | - Delwyn Bartlett
- CIRUS Centre for Sleep and Chronobiology - NHMRC Centre of Research Excellence, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Genevieve Rayner
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - V Vien Lee
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Melbourne, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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31
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Honn KA, Halverson T, Jackson ML, Krusmark M, Chavali VP, Gunzelmann G, Van Dongen HPA. New insights into the cognitive effects of sleep deprivation by decomposition of a cognitive throughput task. Sleep 2021; 43:5813478. [PMID: 32227081 DOI: 10.1093/sleep/zsz319] [Citation(s) in RCA: 12] [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] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/09/2019] [Indexed: 12/16/2022] Open
Abstract
STUDY OBJECTIVES A cognitive throughput task known as the Digit Symbol Substitution Test (DSST) (or Symbol Digit Modalities Test) has been used as an assay of general cognitive slowing during sleep deprivation. Here, the effects of total sleep deprivation (TSD) on specific cognitive processes involved in DSST performance, including visual search, spatial memory, paired-associate learning, and motor response, were investigated through targeted task manipulations. METHODS A total of 12 DSST variants, designed to manipulate the use of specific cognitive processes, were implemented in two laboratory-based TSD studies with N = 59 and N = 26 subjects, respectively. In each study, the Psychomotor Vigilance Test (PVT) was administered alongside the DSST variants. RESULTS TSD reduced cognitive throughput on all DSST variants, with response time distributions exhibiting rightward skewing. All DSST variants showed practice effects, which were however minimized by inclusion of a pause between trials. Importantly, TSD-induced impairment on the DSST variants was not uniform, with a principal component analysis revealing three factors. Diffusion model decomposition of cognitive processes revealed that inter-individual differences during TSD on a two-alternative forced choice DSST variant were different from those on the PVT. CONCLUSIONS While reduced cognitive throughput has been interpreted to reflect general cognitive slowing, such TSD-induced impairment appears to reflect cognitive instability, like on the PVT, rather than general slowing. Further, comparisons between task variants revealed not one, but three distinct underlying processes impacted by sleep deprivation. Moreover, the practice effect on the task was found to be independent of the TSD effect and minimized by a task pacing manipulation.
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Affiliation(s)
- Kimberly A Honn
- Sleep and Performance Research Center, Washington State University, Spokane, WA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - T Halverson
- Cognitive Models and Agents Branch, Air Force Research Laboratory, Wright-Patterson Air Force Base, OH.,Aptima, Inc., Woburn, MA
| | - M L Jackson
- Sleep and Performance Research Center, Washington State University, Spokane, WA.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | | | - V P Chavali
- Sleep and Performance Research Center, Washington State University, Spokane, WA.,University of Washington School of Medicine, Seattle, WA
| | - G Gunzelmann
- Cognitive Models and Agents Branch, Air Force Research Laboratory, Wright-Patterson Air Force Base, OH
| | - H P A Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA.,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
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32
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Khan WAA, Jackson ML, Kennedy GA, Conduit R. A field investigation of the relationship between rotating shifts, sleep, mental health and physical activity of Australian paramedics. Sci Rep 2021; 11:866. [PMID: 33441601 PMCID: PMC7806923 DOI: 10.1038/s41598-020-79093-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/27/2020] [Indexed: 12/29/2022] Open
Abstract
Paramedics working on a rotating shift are at an increased risk of developing chronic health issues due to continuous circadian rhythm disruption. The acute effects of shift rotation and objectively measured sleep have rarely been reported in paramedics. This study investigated the relationships between a rotating shift schedule and sleep (using actigraphy), subjective reports of sleepiness, mood, stress and fatigue. Galvanic Skin Response, energy expenditure and physical activity (BodyMedia SenseWear Armband) were also recorded across the shift schedule. Paramedics were monitored for a period of eight consecutive days across pre-shift, day shift, night shift, and 2 days off. Fifteen paramedics (M age = 39.5 and SD = 10.7 years) who worked rotational shifts experienced sleep restriction during night shift compared to pre-shift, day shift and days off (p < 0.001). Night shift was also associated with higher levels of stress (p < 0.05), fatigue (p < 0.05), and sleepiness (p < 0.05). One day off was related to a return to pre-shift functioning. Such shift-related issues have a compounding negative impact on an already stressful occupation with high rates of physical and mental health issues. Therefore, there is an urgent need to investigate methods to reduce rotating shift burden on the health of paramedics. This could be through further research aimed at providing recommendations for shift work schedules with sufficient periods for sleep and recovery from stress.
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Affiliation(s)
- Wahaj Anwar A Khan
- Occupational Health Department, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia.,Psychology Discipline, School of Health and Biomedical Sciences, College of Science, Engineering and Health, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Gerard A Kennedy
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia.,School of Health and Life Sciences, Federation University, Ballarat, Australia.,Psychology Discipline, School of Health and Biomedical Sciences, College of Science, Engineering and Health, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia
| | - Russell Conduit
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia. .,Psychology Discipline, School of Health and Biomedical Sciences, College of Science, Engineering and Health, RMIT University, PO Box 71, Bundoora, VIC, 3083, Australia.
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33
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Shergis JL, Hyde A, Meaklim H, Varma P, Da Costa C, Jackson ML. Medicinal seeds Ziziphus spinosa for insomnia: A randomized, placebo-controlled, cross-over, feasibility clinical trial. Complement Ther Med 2020; 57:102657. [PMID: 33385511 DOI: 10.1016/j.ctim.2020.102657] [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: 03/30/2020] [Revised: 11/27/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of implementing a clinical trial protocol of the herbal seeds Ziziphus spinosa (ZS) for people with insomnia. DESIGN AND SETTING A randomized, double-blind, placebo controlled, cross-over feasibility trial in Melbourne, Australia. INTERVENTIONS After two-week run-in participants were randomized to either ZS (encapsulated granules; 2 g daily) or placebo for four weeks. After four-weeks wash-out, participants swapped to the other treatment for four weeks. MAIN OUTCOME MEASURES Sleep quality assessed by the Insomnia Severity Index and Pittsburgh Sleep Quality Index (PSQI). Quality of life, mood, functional impairment and sleep parameters were also assessed. RESULTS Twelve participants were randomized and completed both periods of cross-over (six in each sequence). Feasibility endpoints were acceptable. Improvements for sleep quality measured on the PSQI were statistically significant during the ZS treatment periods compared to placebo (t = -2.276, df = 10, 95 % CI -3.3 to -0.04, p = 0.046). There was no evidence of any significant carryover effects. However, there were period effects. Other outcomes showed no statistically significant difference between the treatments. Subjective sleep parameters measured on sleep diaries showed improvements after ZS in terms of total sleep time, sleep efficiency and sleep onset latency, but not after placebo. ZS was well tolerated with only minor adverse events. CONCLUSIONS ZS is an acceptable and well-tolerated herbal candidate for the treatment of insomnia. The feasibility objectives of this study were achieved and ZS improved both subjective sleep quality and quantity compared to placebo. ZS should be explored in future clinical trials.
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Affiliation(s)
- Johannah L Shergis
- School of Health and Biomedical Sciences, RMIT University, PO BOX 71, Bundoora, Victoria 3083, Australia.
| | - Anna Hyde
- School of Health and Biomedical Sciences, RMIT University, PO BOX 71, Bundoora, Victoria 3083, Australia.
| | - Hailey Meaklim
- School of Health and Biomedical Sciences, RMIT University, PO BOX 71, Bundoora, Victoria 3083, Australia.
| | - Prerna Varma
- School of Health and Biomedical Sciences, RMIT University, PO BOX 71, Bundoora, Victoria 3083, Australia.
| | - Cliff Da Costa
- School of Science, RMIT University, PO BOX 71, Bundoora, Victoria 3083, Australia.
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria 3800, Australia.
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Jackson ML, Cavuoto M, Schembri R, Doré V, Villemagne VL, Barnes M, O’Donoghue FJ, Rowe CC, Robinson SR. Severe Obstructive Sleep Apnea Is Associated with Higher Brain Amyloid Burden: A Preliminary PET Imaging Study. J Alzheimers Dis 2020; 78:611-617. [DOI: 10.3233/jad-200571] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Obstructive sleep apnea (OSA) has been linked to an increase risk of dementia. Few studies have cross-sectionally examined whether clinically-confirmed OSA is associated with a higher brain amyloid burden. Objective: The aim of this study was to compare brain amyloid burden in individuals with untreated OSA and healthy controls, and explore associations between amyloid burden and polysomnographic and subjective measures of sleep, demographics, and mood. Methods: Thirty-four individuals with OSA (mean age 57.5±4.1 y; 19 males) and 12 controls (mean age 58.5±4.2 y; 6 males) underwent a clinical polysomnogram and a 11C-PiB positron emission tomography (PET) scan to quantify amyloid burden. Results: Amyloid burden was elevated in the OSA group relative to controls, and was significantly higher in those with severe OSA relative to mild/moderate OSA. Correlation analyses indicated that higher amyloid burden was associated with a higher Non-REM apnea hypopnea index, poorer sleep efficiency, and less time spent in stage N3 sleep, when controlling for age. Conclusion: Severe OSA is associated with a modest elevation of brain amyloid, the significance of which should be further investigated to explore the implications for dementia risk.
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Affiliation(s)
- Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Marina Cavuoto
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Rachel Schembri
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Vincent Doré
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, Australia
- CSIRO Health and Biosecurity Flagship, Melbourne, Australia
| | - Victor L. Villemagne
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Fergal J. O’Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Christopher C. Rowe
- Department of Molecular Imaging & Therapy, Austin Health, Heidelberg, Australia
| | - Stephen R. Robinson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
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Abstract
OBJECTIVE The current study examined sleep and mood associations in parents of children with sleep disturbances across a sample of typically developing children and children with neurodevelopmental disorders. The mediating effect of children's sleep on the relationship between parents' sleep and mood was also assessed. The study explored differences in parents' sleep based on whether 1) the child had a sleep disturbance, and 2) the child was typically developing or had a neurodevelopmental disorder. METHODS A total of 293 parents of children aged 2-12 years completed an online questionnaire. Parental sleep was examined using the Pittsburgh Sleep Quality Index, the Glasgow Sleep Effort Scale and the Pre-sleep Arousal Scale, and mood was assessed using the Profile of Mood States-short form. Measures for children included the Child's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire. RESULTS Across the overall sample, children's sleep disturbances were associated with parents' sleep disturbances, accounting for 22% of the change in parental sleep quality. Children's sleep partially mediated parents' sleep and mood. Significant differences were observed for sleep and mood outcomes in parents of children with sleep disturbances (CSHQ scores ≥41). However, no significant differences were reported for children's sleep disturbances and parents' sleep quality based on whether the child was typically developing or had a neurodevelopmental disorder. CONCLUSION Parents of children with sleep disturbances experience poor sleep and high pre-sleep arousal, indicative of insomnia. Given that these parents experience cognitive arousal and insomnia, it is recommended that parents' sleep problems are addressed and treated in clinical settings.
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Affiliation(s)
- Prerna Varma
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Moira Junge
- Sleep Health Foundation, Blacktown, Sydney, Australia
| | - Melinda L Jackson
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Melbourne, Australia
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Meaklim H, Jackson ML, Bartlett D, Saini B, Falloon K, Junge M, Slater J, Rehm IC, Meltzer LJ. Sleep education for healthcare providers: Addressing deficient sleep in Australia and New Zealand. Sleep Health 2020; 6:636-650. [DOI: 10.1016/j.sleh.2020.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/15/2020] [Accepted: 01/18/2020] [Indexed: 12/24/2022]
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Low T, Conduit R, Varma P, Meaklim H, Jackson ML. Treating subclinical and clinical symptoms of insomnia with a mindfulness-based smartphone application: A pilot study. Internet Interv 2020; 21:100335. [PMID: 32939342 PMCID: PMC7479350 DOI: 10.1016/j.invent.2020.100335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND/OBJECTIVES Emerging research suggests that face-to-face group mindfulness-based therapies are an effective intervention for insomnia. This pilot study examined the effectiveness of a mindfulness-based smartphone application for improving objectively-measured sleep, self-reported sleep, insomnia severity, pre-sleep arousal and daytime mood. METHOD A community sample of 23 adults with subclinical to moderately severe symptoms of insomnia were randomized to either a mindfulness or progressive muscle relaxation (PMR) smartphone application for 40 or 60 days. Objective sleep outcomes assessed using actigraphy, and self-report measures of total wake time, cognitive and somatic pre-sleep arousal, and daytime positive and negative affect were assessed for 14 nights at baseline and post-intervention. Insomnia severity was recorded at baseline and post-intervention. RESULTS A greater reduction in sleep onset latency was observed in the mindfulness group over time, relative to the PMR group. The mindfulness group also reported medium effect size improvements for sleep efficiency. No significant interaction effects were found for self-reported sleep measures, however, main effects of time were found for both groups for total wake time, insomnia severity, cognitive pre-sleep arousal, and daytime positive and negative affect. CONCLUSIONS These preliminary findings suggest that both mindfulness and PMR smartphone applications have the potential to improve symptoms of insomnia. In particular, this mindfulness-based smartphone application may improve sleep onset latency and reduce the duration of night-awakenings. Further research exploring digital therapeutics as a self-help option for those with insomnia is needed.
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Key Words
- ANOVA, analysis of variance
- ISI, Insomnia Severity Index
- MBSR, mindfulness-based stress reduction
- Mindfulness
- NA, negative affect
- PA, positive affect
- PMR, progressive muscle relaxation
- PSAS (Cog), cognitive subscale of Pre-Sleep Arousal Scale
- PSAS (Som), somatic subscale of Pre-Sleep Arousal Scale
- PSAS, Pre-Sleep Arousal Scale
- Pre-sleep arousal
- Progressive muscle relaxation
- SFI, sleep fragmentation index
- SOL, sleep onset latency
- Sleep
- Smartphone applications
- TIB, time in bed
- TST, total sleep time
- TWT, total wake time
- WASO, wake after sleep onset
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Affiliation(s)
- Tiffany Low
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Russell Conduit
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Prerna Varma
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Hailey Meaklim
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Melinda L. Jackson
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
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Satterfield BC, Savenkova MI, Karatsoreos IN, Jackson ML, Belenky G, Van Dongen HPA. Interleukin-6 (IL-6) response to a simulated night-shift schedule is modulated by brain-derived neurotrophic factor (BDNF) genotype. Chronobiol Int 2020; 37:1452-1456. [DOI: 10.1080/07420528.2020.1803901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Brieann C. Satterfield
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Elson S. Floyd College of Medicine, Washington State University Health Sciences Spokane, Spokane, WA, USA
| | - Marina I. Savenkova
- Department of Integrated Physiology and Neuroscience, Washington State University, Pullman, WA, USA
| | - Ilia N. Karatsoreos
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Department of Integrated Physiology and Neuroscience, Washington State University, Pullman, WA, USA
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
| | - Melinda L. Jackson
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Gregory Belenky
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Elson S. Floyd College of Medicine, Washington State University Health Sciences Spokane, Spokane, WA, USA
| | - Hans P. A. Van Dongen
- Sleep and Performance Research Center, Washington State University, Spokane, WA, USA
- Elson S. Floyd College of Medicine, Washington State University Health Sciences Spokane, Spokane, WA, USA
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Jackson ML, Rayner G, Wilson S, Schembri R, Sommers L, O'Donoghue FJ, Jackson GD, Tailby C. Integrity of Multiple Memory Systems in Individuals With Untreated Obstructive Sleep Apnea. Front Neurosci 2020; 14:580. [PMID: 32670007 PMCID: PMC7326947 DOI: 10.3389/fnins.2020.00580] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/12/2020] [Indexed: 02/03/2023] Open
Abstract
Obstructive sleep apnea (OSA) is associated with working- and autobiographical-memory impairments, and high rates of mood disorder. This study aimed to examine (i) behavioral responses and (ii) neural activation patterns elicited by autobiographical and working memory tasks in moderate-severe untreated OSA patients and healthy controls, and (iii) whether variability in autobiographical and working memory activation are associated with task performance, OSA severity and psychological symptomatology (depression, anxiety). In order to control for the potential confounding effect of elevated rates of clinical depression in OSA, we excluded individuals with a current psychiatric condition. Seventeen untreated OSA participants and 16 healthy controls were comparable with regards to both activation and behavioral performance. OSA was associated with worse subclinical mood symptoms and poorer personal semantic memory. Higher levels of nocturnal hypoxia were associated with increased activation in the occipital cortex and right cerebellum during the working memory task in OSA participants, however, no significant relationships between activation and task performance or depressive/anxiety symptomatology were observed. The neurocognitive substrates supporting autobiographical recall of recent events and working memory in younger, recently diagnosed individuals with OSA appear to be indistinguishable from healthy age-matched individuals. These findings point to the importance of early diagnosis and treatment of OSA in order to preserve cognitive function.
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Affiliation(s)
- Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia
| | - Genevieve Rayner
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Sarah Wilson
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Schembri
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Lucy Sommers
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia
| | - Fergal J O'Donoghue
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Graeme D Jackson
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Chris Tailby
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
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Khan WAA, Conduit R, Kennedy GA, Abdullah Alslamah A, Ahmad Alsuwayeh M, Jackson ML. Sleep and Mental Health among Paramedics from Australia and Saudi Arabia: A Comparison Study. Clocks Sleep 2020; 2:246-257. [PMID: 33089203 PMCID: PMC7445850 DOI: 10.3390/clockssleep2020019] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Paramedics face many challenges while on duty, one of which is working different types of shifts. Shift work has been linked to a number of health issues such as insomnia, depression, and anxiety. Besides shift work, Saudi paramedics, a group that has not been investigated for sleep or mental health issues previously, may be facing more demands than Australian paramedics due to lower numbers of paramedics in comparison to the general population. The aim of this study was to investigate the prevalence of sleep and mental health disorders among paramedics in Saudi Arabia and Australia. Paramedics were invited to complete a survey to assess stress, post-traumatic stress disorder (PTSD), depression, anxiety, daytime sleepiness, insomnia, sleep quality, shift work disorder, obstructive sleep apnoea, fatigue, and general health. A total of 104 males Saudi paramedics (M age = 32.5 ± 6.1 years) and 83 males paramedics from Australia (M age = 44.1 ± 12.1 years) responded to the survey. Significantly higher rates of depression, PTSD, insomnia, and fatigue, along with significantly poorer physical functioning were observed among Saudi paramedics in comparison with Australian paramedics. However, Australian paramedics reported significantly poorer sleep quality and general health in comparison to Saudi paramedics. After removing the effect of driving and working durations, outcomes were no longer significant. The higher burden of depression and PTSD among Saudi paramedics may be explained by longer hours spent driving and longer work durations reported by this group. Taking into consideration the outcomes reported in this study, more investigations are needed to study their possible effects on paramedics' cognition, performance, and safety.
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Affiliation(s)
- Wahaj Anwar A Khan
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
- Occupational Health Department, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, P.O. Box 715, Saudi Arabia
| | - Russell Conduit
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
| | - Gerard A Kennedy
- Psychology Discipline, College of Science, Engineering & Health, School of Health and Biomedical Sciences, RMIT University, P.O. Box 71, Bundoora, VIC 3083, Australia; (R.C.); (G.A.K.)
- Psychology, Federation University Australia, Ballarat, VIC 3353, Australia
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC 3084, Australia;
| | - Ahmed Abdullah Alslamah
- General Supervisor of Emergency Medical Services Affairs, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
| | - Mohammad Ahmad Alsuwayeh
- General Director of Training Department, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
| | - Melinda L Jackson
- General Director of Training Department, Saudi Red Crescent Authority, Riyadh 11129, Saudi Arabia;
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3800, Australia
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Meaklim H, Monfries M, Rehm IC, Junge M, Meltzer LJ, Jackson ML. 1171 Commonly Encountered Yet Not Confident: Graduate Psychology Students’ Experience and Confidence Managing Sleep Disturbances. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1165] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Trainee psychologists receive minimal sleep education during graduate psychology training programs, despite the frequent co-occurrence of sleep disturbances in mental health conditions. This study aimed to explore graduate psychology students’ experience working with sleep disturbances and their perceived skills and confidence to assess and treat sleep problems in clinical practice.
Methods
Australian graduate psychology students (N = 163) completed a novel survey developed specifically for the study, inquiring about their experience, skills and confidence to manage sleep disturbances in clinical practice. Students perceived skills to manage sleep disturbances were recorded on a 7-point Likert scale, where 1 = ‘strongly disagree’ and 7 = ‘strongly agree’. Students’ confidence to treat specific sleep disorders was also recorded.
Results
Sixty-eight percent of students reported having already worked with a client who experienced a sleep disturbance as part of their training. However, students’ perceived skills to assess and treat sleep disturbances were low. Only 14.9% ‘agreed’ or ‘strongly agreed’ that they had the skills to assess and diagnose common sleep disorders (M = 3.22, SD = 1.75). Similarly, less than a quarter of students ‘agreed’ or ‘strongly agreed’ that they felt comfortable using common sleep-related assessments (23.7%; M = 3.56, SD = 1.96) or empirically-supported interventions for sleep disturbances (22.6%; M = 3.71, SD = 1.83). The majority of students reported they were ‘not confident at all’ to treat parasomnias (80.3%); hypersomnias (77.9%); OSA (71.3%); circadian rhythm disorders (50%) or insomnia (41%).
Conclusion
Graduate psychology students report low levels of confidence in assessing and managing sleep disturbances in clinical practice, despite over two-thirds of students already working with clients experiencing sleep difficulties. Clinical training in the management of sleep disturbances is required for graduate psychology students.
Support
N/A
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Affiliation(s)
- H Meaklim
- RMIT University, Bundoora, AUSTRALIA
| | | | - I C Rehm
- RMIT University, Bundoora, AUSTRALIA
| | - M Junge
- Sleep Health Foundation, Blacktown, AUSTRALIA
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Abstract
Background: University students have high levels of poor sleep quality (SQ) and mental health, and low adherence to healthy nutrition and physical activity (PA). Objective: This study examined what clusters of self-care behaviors (SCB) were associated with SQ and mental health in Australian university students. Method: 355 Australian university students, ranging in age from 18 to 24 years (M = 20, SD = 1.5, 286 females) completed surveys relating to fruit and vegetable consumption, alcohol binge behavior, PA, mental health measured by the Depression Anxiety Stress Scales 21, and SQ measured by the Pittsburgh SQ Index (PSQI). Fruit and vegetable consumption, alcohol binge behavior, and PA were assessed according to current Australian guidelines. Results: Almost two thirds of participants (62.0%) met the criteria for poor SQ. Good SQ was significantly associated with meeting PA guideline levels (rb = .14) and inversely associated with higher levels of depression (rpb = -.34), anxiety (rpb = -.36), and stress levels (rpb = -.42). Four distinct SCB and mental health risk clusters were created. The "healthiest SCB" cluster had 1.6 times better SQ than the average. This cluster had higher levels of moderate and vigorous PA, higher levels of fruit consumption, and less binge drinking, the least sedentary behavior, and the lowest levels of depression, anxiety, and stress compared to the other clusters. Conclusion: This research corroborates with previous literature on the importance of regular vigorous PA as a lifestyle intervention to facilitate better sleep outcomes and improved mental health outcomes in university students.
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Affiliation(s)
| | - Cameron J Towt
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Melinda L Jackson
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
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Khan WAA, Conduit R, Kennedy GA, Jackson ML. The relationship between shift-work, sleep, and mental health among paramedics in Australia. Sleep Health 2020; 6:330-337. [PMID: 32223969 DOI: 10.1016/j.sleh.2019.12.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/13/2019] [Accepted: 12/01/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study aimed to investigate the prevalence of sleep and mental health issues, the role of chronotype, and the relationship between these variables in Australian paramedics. DESIGN A cross-sectional study. SETTINGS Cross-sectional survey. MEASUREMENTS Paramedics were invited to complete an online survey to assess stress, posttraumatic stress disorder (PTSD), depression, anxiety, daytime sleepiness, insomnia, sleep quality, shift-work disorder, bruxism, obstructive sleep apnea, narcolepsy, chronotype, fatigue, and well-being. PARTICIPANTS A total of 136 paramedics responded to the survey (age, 39.1 ± 12.1 years; 45.8% men and 54.2% women; 85.4% rotating shift-workers, 7% rural shift-workers, and 7.6% fixed rosters). RESULTS Paramedics reported significantly higher levels of depression symptoms, anxiety symptoms, fatigue, PTSD symptoms, insomnia symptoms, narcolepsy, and significantly poorer sleep quality and general well-being than norms from the general population of Australia and Western countries (all p < .05). From regression analyses, insomnia explained the greatest amount of variance in depression and anxiety scores, followed by fatigue and PTSD (adjusted R-squared for depression and anxiety models = .58 and = .44, respectively, p < .001). The majority of participants were intermediate chronotype (57%), followed by morning (32%) and evening type (11%). Evening chronotypes showed significantly higher depression scores (p < .001), anxiety (p < .05), PTSD symptoms (p < .05), poorer sleep quality (p < .05), and general well-being (p < .001) compared with morning types. CONCLUSION Addressing sleep issues and matching chronotype to shift preference in paramedics may help to reduce depression, anxiety, and improve well-being.
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Affiliation(s)
- Wahaj Anwar A Khan
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia; Occupational Health Department, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Russell Conduit
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia.
| | - Gerard A Kennedy
- Psychology Discipline, School of Health and Biomedical Sciences, RMIT University, Bundoora, Australia
| | - Melinda L Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
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Wilkinson VE, Jackson ML, Westlake J, Stevens B, Barnes M, Cori J, Swann P, Howard ME. Assessing the validity of eyelid parameters to detect impairment due to benzodiazepines. Hum Psychopharmacol 2020; 35:e2723. [PMID: 32022371 DOI: 10.1002/hup.2723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 10/15/2018] [Revised: 11/20/2019] [Accepted: 01/06/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Benzodiazepines impair driving ability and psychomotor function. Eyelid parameters accurately reflect drowsiness; however, the effects of benzodiazepines on these measures have not been extensively studied. The aim of this study was to investigate the effect of benzodiazepines on eyelid parameters and evaluate their accuracy for detecting psychomotor impairment. METHODS Eyelid parameters were recorded during a psychomotor vigilance task (PVT) and driving simulation over 2 days, baseline, and after 20-mg oral temazepam. The utility of eyelid parameters for detecting PVT lapses was evaluated using receiver operating characteristic curves, and cut-off levels indicating impairment (≥1 and ≥2 PVT lapses per min) were identified. The accuracy of these cut-off levels for detecting driving simulator crashes was then examined. RESULTS PVT and driving simulator performance was significantly impaired following benzodiazepine administration (p < .05). Average eyelid closure duration (inter-event duration) was a reliable indicator of PVT lapses (area under the curve [AUC] of 0.87-0.90). The cut-off value of eyelid closure duration derived from PVT AUC was able to predict driving simulator crashes with moderately high sensitivity and specificity (76.23% and 75.00%). CONCLUSIONS Eyelid parameters were affected by benzodiazepines and accurately detected the psychomotor impairment. In particular, eyelid closure duration is a promising real-time indicator of benzodiazepine impairment.
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Affiliation(s)
- Vanessa E Wilkinson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.,School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Justine Westlake
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Bronwyn Stevens
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Jennifer Cori
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Philip Swann
- Department of Road Safety, VicRoads, Kew, Victoria, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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45
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Pittaway I, Ishkova A, Bean H, McCarthy S, Lay I, Avraam J, Dawson A, Thornton T, Nicholas CL, Trinder J, O'Donoghue FJ, Jackson ML, Jordan AS. Does Nasal Obstruction Induce Obstructive Sleep Apnea in Healthy Women? Nat Sci Sleep 2020; 12:347-355. [PMID: 32607034 PMCID: PMC7319502 DOI: 10.2147/nss.s254473] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/11/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Obstructive sleep apnea (OSA) is less prevalent among women and is associated with different symptoms and consequences to OSA in men. The reasons for these differences are unknown and difficult to tease apart in clinical populations. If OSA could be temporarily induced in healthy men and women, the causes of some of these differences could be investigated. Nasal blocking has been used to induce OSA in healthy men but its effect in women has not been reported. PATIENTS AND METHODS A total of 14 healthy individuals (10 women) underwent in-laboratory diagnostic sleep studies on two occasions separated by a week. On one occasion, the nasal passages were blocked, whereas on the other occasion, participants slept naturally. In both conditions, a full-face mask was used to monitor respiratory events. Participants' self-reported sleepiness, mood and performance on a motor learning task were assessed in the evening and morning of both sleep studies. Furthermore, endothelial function and self-reported sleep quality were assessed in the morning following each study. RESULTS Nasal blockage induced OSA in healthy young (age=22±3 years) and slim (BMI=22.2±3.2 kg/m2) women (control AHI=2.0±2.6, blocked AHI=33.1±36.7 events/hr, p=0.02). One night of OSA was associated with poorer self-reported sleep quality (p<0.001) and increased self-reported snoring (p<0.04), choking and gasping during sleep (p<0.001) but was not associated with alterations in mood, neurocognitive or endothelial function on the following morning. CONCLUSION Nasal blockage induces OSA in healthy, young, and normal weight women. However, whether the induced OSA is representative of naturally occurring OSA and the technique useful for future studies is unclear.
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Affiliation(s)
- Islay Pittaway
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Anna Ishkova
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Helena Bean
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Stephanie McCarthy
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Isabella Lay
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Joanne Avraam
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Andrew Dawson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Therese Thornton
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC 3084, Australia
| | - John Trinder
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Fergal J O'Donoghue
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC 3084, Australia.,Department of Medicine, The University of Melbourne, Austin Hospital, Heidelberg, VIC 3084, Australia
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC 3084, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC 3164, Australia
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC 3010, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC 3084, Australia
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46
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Bubu OM, Andrade AG, Umasabor-Bubu OQ, Hogan MM, Turner AD, de Leon MJ, Ogedegbe G, Ayappa I, Jean-Louis G G, Jackson ML, Varga AW, Osorio RS. Obstructive sleep apnea, cognition and Alzheimer's disease: A systematic review integrating three decades of multidisciplinary research. Sleep Med Rev 2019; 50:101250. [PMID: 31881487 DOI: 10.1016/j.smrv.2019.101250] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 12/29/2022]
Abstract
Increasing evidence links cognitive-decline and Alzheimer's disease (AD) to various sleep disorders, including obstructive sleep apnea (OSA). With increasing age, there are substantial differences in OSA's prevalence, associated comorbidities and phenotypic presentation. An important question for sleep and AD researchers is whether OSA's heterogeneity results in varying cognitive-outcomes in older-adults compared to middle-aged adults. In this review, we systematically integrated research examining OSA and cognition, mild cognitive-impairment (MCI) and AD/AD biomarkers; including the effects of continuous positive airway pressure (CPAP) treatment, particularly focusing on characterizing the heterogeneity of OSA and its cognitive-outcomes. Broadly, in middle-aged adults, OSA is often associated with mild impairment in attention, memory and executive function. In older-adults, OSA is not associated with any particular pattern of cognitive-impairment at cross-section; however, OSA is associated with the development of MCI or AD with symptomatic patients who have a higher likelihood of associated disturbed sleep/cognitive-impairment driving these findings. CPAP treatment may be effective in improving cognition in OSA patients with AD. Recent trends demonstrate links between OSA and AD-biomarkers of neurodegeneration across all age-groups. These distinct patterns provide the foundation for envisioning better characterization of OSA and the need for more sensitive/novel sleep-dependent cognitive assessments to assess OSA-related cognitive-impairment.
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Affiliation(s)
- Omonigho M Bubu
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA; Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA; Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA.
| | - Andreia G Andrade
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA
| | | | - Megan M Hogan
- Department of Applied Health Sciences, Wheaton College, Wheaton, IL, USA
| | - Arlener D Turner
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Human Services and Psychology, National Louis University, Chicago, IL, USA
| | - Mony J de Leon
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Radiology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA
| | - Indu Ayappa
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girardin Jean-Louis G
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA; Department of Population Health, New York University School of Medicine, Center for Healthful Behavior Change, New York, USA
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Andrew W Varga
- Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ricardo S Osorio
- Center for Brain Health, Department of Psychiatry, NYU Langone Medical Center, New York, NY, USA.
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47
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Affiliation(s)
- Prerna Varma
- Casual Academic and PhD Candidate RMIT Sleep Laboratory, Discipline of Psychology, School of Biomedical and Health Sciences RMIT University Melbourne Australia
- Co‐Chair Insomnia and Sleep Health Council for the Australasian Sleep Association Blacktown Australia
| | - Melinda L. Jackson
- Senior Lecturer, Turner Institute for Brain and Mental Health School of Psychological Sciences, Monash University Clayton/Melbourne Australia
- Co‐Chair Chronobiology Council for the Australasian Sleep Association Blacktown Australia
| | - Hailey Meaklim
- Casual Academic and PhD Candidate RMIT Sleep Laboratory, Discipline of Psychology, School of Biomedical and Health Sciences RMIT University Melbourne Australia
- Co‐Chair Insomnia and Sleep Health Council for the Australasian Sleep Association Blacktown Australia
- Sleep Centre, Department of Respiratory and Sleep Medicine St Vincent’s Hospital Melbourne Australia
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48
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Cori JM, Anderson C, Shekari Soleimanloo S, Jackson ML, Howard ME. Narrative review: Do spontaneous eye blink parameters provide a useful assessment of state drowsiness? Sleep Med Rev 2019; 45:95-104. [DOI: 10.1016/j.smrv.2019.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/10/2019] [Accepted: 03/14/2019] [Indexed: 12/20/2022]
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49
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Konjarski M, Murray G, Lee VV, Jackson ML. Reciprocal relationships between daily sleep and mood: A systematic review of naturalistic prospective studies. Sleep Med Rev 2018; 42:47-58. [DOI: 10.1016/j.smrv.2018.05.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 05/01/2018] [Accepted: 05/29/2018] [Indexed: 11/16/2022]
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50
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Cori JM, Jackson ML, Barnes M, Westlake J, Emerson P, Lee J, Galante R, Hayley A, Wilsmore N, Kennedy GA, Howard M. The Differential Effects of Regular Shift Work and Obstructive Sleep Apnea on Sleepiness, Mood and Neurocognitive Function. J Clin Sleep Med 2018; 14:941-951. [PMID: 29852909 DOI: 10.5664/jcsm.7156] [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: 10/13/2017] [Accepted: 02/20/2018] [Indexed: 01/05/2023]
Abstract
STUDY OBJECTIVES To assess whether poor sleep quality experienced by regular shift workers and individuals with obstructive sleep apnea (OSA) affects neurobehavioral function similarly, or whether the different etiologies have distinct patterns of impairment. METHODS Thirty-seven shift workers (> 24 hours after their last shift), 36 untreated patients with OSA, and 39 healthy controls underwent assessment of sleepiness (Epworth Sleepiness Scale [ESS]), mood (Beck Depression Index, State Trait Anxiety Inventory [STAI], Profile of Mood States), vigilance (Psychomotor Vigilance Task [PVT], Oxford Sleep Resistance Test [OSLER], driving simulation), neurocognitive function (Logical Memory, Trails Making Task, Digit Span Task, Victoria Stroop Test) and polysomnography. RESULTS Sleepiness (ESS score; median, interquartile range) did not differ between the OSA (10.5, 6.3-14) and shift work (7, 5-11.5) groups, but both had significantly elevated scores relative to the control group (5, 3-6). State anxiety (STAI-S) was the only mood variable that differed significantly between the OSA (35, 29-43) and shift work (30, 24-33.5) groups, however both demonstrated several mood deficits relative to the control group. The shift work and control groups performed similarly on neurobehavioral tasks (simulated driving, PVT, OSLER and neurocognitive tests), whereas the OSA group performed worse. On the PVT, lapses were significantly greater for the OSA group (3, 2-6) than both the shift work (2, 0-3.5) and control (1, 0-4) groups. CONCLUSIONS Shift workers and patients with OSA had similar sleepiness and mood deficits relative to healthy individuals. However, only the patients with OSA showed deficits on vigilance and neurocognitive function relative to healthy individuals. These findings suggest that distinct causes of sleep disturbance likely result in different patterns of neurobehavioral dysfunction.
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Affiliation(s)
- Jennifer M Cori
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia
| | - Melinda L Jackson
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Justine Westlake
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia
| | - Paul Emerson
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia
| | - Jacen Lee
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Hong Kong Clinical Neuropsychology Service, Hong Kong SAR, China
| | - Rosa Galante
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Department of Psychology, Victoria University, St. Albans, Victoria, Australia
| | - Amie Hayley
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Centre for Human Psychopharmacology, Faculty of Health Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia.,School of Clinical Sciences at Monash Health, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Nicholas Wilsmore
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Gerard A Kennedy
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Mark Howard
- Institute for Breathing and Sleep and Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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