51
|
Salas J, Miller MB, Scherrer JF, Moore R, McCrae CS, Sullivan MD, Bucholz KK, Copeland LA, Ahmedani BK, Schneider FD, Lustman PJ. The association of opioid use duration and new depression episode among patients with and without insomnia. J Opioid Manag 2020; 16:317-328. [PMID: 33226089 DOI: 10.5055/jom.2020.0587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Insomnia commonly co-occurs with depression, chronic pain, and opioid use. Both insomnia and chronic opioid analgesic use (OAU) are independent risk factors for a new depression episode (NDE). This study determined if the association between longer OAU duration and NDE was stronger in those with versus without insomnia. DESIGN Retrospective cohort. SETTING Veterans Health Administration electronic medical records (2000-2012). PARTICIPANTS New opioid users in follow-up (2002-2012), free of depression for two years prior to follow-up, and aged 18-80 (n = 70,997). METHODS NDE was ≥ 2 ICD-9 codes in a 12-month period. Insomnia before OAU initiation was ≥1 ICD-9 code. Cox proportional hazard models stratified on insomnia assessed the relationship between initiating a 1-30, 31-90, or > 90 day period of OAU and NDE while controlling for confounders using inverse probability of treatment-weighted propensity scores (PS). RESULTS Compared to 1-30 day OAU, 31-90 day was associated with NDE in those without (HR = 1.20; 95 percent CI: 1.12-1.28) but not with insomnia (HR = 1.06; 95 percent CI: 0.86-1.32). Results showed a stronger effect of chronic (>90) OAU in those with insomnia (HR = 1.59; 95 percent CI: 1.27-1.98) compared to those without (HR = 1.31; 95 percent CI: 1.21-1.42). However, all stratum-specific effects were not significantly different (p = 0.136). CONCLUSIONS Although stratum-specific risks were statistically similar, there was evidence for a trend that chronic OAU is a stronger risk factor for NDE in those with versus without insomnia. Providers are encouraged to monitor sleep impairment among patients on opioid therapy, as sleep may be associated with greater risk for NDE in patients with chronic OAU.
Collapse
|
52
|
Ievers‐Landis CE, McCrae CS. Commentary on “An evaluation of cognitive behavioral therapy for insomnia: A systematic review and application of Tolin’s Criteria for empirically supported treatments”. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
53
|
McGovney KD, Curtis AF, McCrae CS. Associations between objective afternoon and evening physical activity and objective sleep in patients with fibromyalgia and insomnia. J Sleep Res 2020; 30:e13220. [PMID: 33124122 DOI: 10.1111/jsr.13220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/22/2020] [Accepted: 09/27/2020] [Indexed: 11/28/2022]
Abstract
Patients with fibromyalgia (FM) suffer from chronic pain, which limits physical activity and is associated with disturbed sleep. However, the relationship between physical activity, pain and sleep is unclear in these patients. This study examined whether actigraphic (Actiwatch-2, Philips Respironics) afternoon and evening activity and pain are associated with actigraphic sleep. Adults with FM and insomnia complaints (n = 160, mean age [Mage ] = 52, SD = 12, 94% female) completed 14 days of actigraphy. Activity levels (i.e., activity counts per minute) were recorded, and average afternoon/evening activity for intervals 12:00-3:00 PM, 3:00-6:00 PM and 6:00-9:00 PM was computed. Multiple linear regressions examined whether afternoon/evening activity, pain (daily evening diaries from 0 [no pain sensation] to 100 [most intense pain imaginable]), or their interaction, predicted sleep onset latency (SOL), wake time after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE). Greater afternoon activity was independently associated with lower SE (B = -0.08, p < .001), lower TST (β = -0.36, standard error [SE] = 0.06, p < .001) and longer WASO (B = 0.34, p < .001). Greater early evening activity was independently associated with lower SE (B = -0.06, p < .001), lower TST (β = -0.26, SE = 0.06, p < .001) and longer WASO (B = 0.23, p < .001). Self-reported pain intensity interacted with afternoon and early evening physical activity, such that associations between higher activity and lower SE were stronger for individuals reporting higher pain. Late evening activity was not associated with sleep outcomes. Results suggest that in FM, increased afternoon and early evening physical activity is associated with sleep disturbance, and this relationship is stronger in individuals with higher pain.
Collapse
|
54
|
McCrae CS, Curtis AF, Craggs J, Deroche C, Sahota P, Siva C, Staud R, Robinson M. Protocol for the impact of CBT for insomnia on pain symptoms and central sensitisation in fibromyalgia: a randomised controlled trial. BMJ Open 2020; 10:e033760. [PMID: 32933953 PMCID: PMC7493102 DOI: 10.1136/bmjopen-2019-033760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/24/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Approximately 50% of individuals with fibromyalgia (a chronic widespread pain condition) have comorbid insomnia. Treatment for these comorbid cases typically target pain, but growing research supports direct interventions for insomnia (eg, cognitive behavioural treatment for insomnia (CBT-I)) in these patients. Previous research suggests sustained hyperarousal mediated by a neural central sensitisation mechanism may underlie insomnia and chronic pain symptoms in fibromyalgia. We hypothesise CBT-I will improve insomnia symptoms, improve clinical pain and reduce central sensitisation. The trial will be the first to evaluate the short-term and long-term neural mechanisms underlying insomnia and pain improvements in fibromyalgia. Knowledge obtained from this trial might allow us to develop new or modify current treatments to better target pain mechanisms, perhaps reversing chronic pain or preventing it. METHODS AND ANALYSIS Female participants (n=130) 18 years of age and older with comorbid fibromyalgia (with pain severity of at least 50/100) and insomnia will be recruited from the University of Missouri in Columbia, Missouri, and surrounding areas. Participants will be randomised to 8 weeks (plus 4 bimonthly booster sessions) of CBT-I or a sleep hygiene control group (SH). Participants will be assessed at baseline, post-treatment, 6 and 12 months follow-ups. The following assessments will be completed: 2 weeks of daily diaries measuring sleep and pain, daily actigraphy, insomnia severity index, pain-related disability, single night of polysomnography recording, arousal (heart rate variability, cognitive affective arousal), structural and functional MRI to examine pain-related neural activity and plasticity and mood (depression, anxiety). ETHICS AND DISSEMINATION Ethics approval was obtained in July 2018 from the University of Missouri. All data are expected to be collected by 2022. Full trial results are planned to be published by 2024. Secondary analyses of baseline data will be subsequently published. TRIAL REGISTRATION NUMBER NCT03744156.
Collapse
|
55
|
Perez E, Dzierzewski JM, Aiken-Morgan AT, McCrae CS, Buman MP, Giacobbi PR, Roberts BL, Marsiske M. Anxiety and executive functions in mid-to-late life: the moderating role of sleep. Aging Ment Health 2020; 24:1459-1465. [PMID: 31512489 PMCID: PMC7065938 DOI: 10.1080/13607863.2019.1663492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 01/09/2023]
Abstract
Objectives: The goal of the study was to examine the influence of sleep efficiency on the relationship between anxiety and executive functions.Method: Secondary data analyses of 82 community-dwelling middle-aged and older adults were performed (M age = 63.00, SD = 8.64). Anxiety was measured using the trait anxiety subscale of the State-Trait Anxiety Inventory. Sleep efficiency was measured using one-week of sleep diary data. Two executive functions, cognitive flexibility and inductive reasoning, were measured using the Trail-Making Test and Letter Series task, respectively. SPSS PROCESS macro software version 2 was used to assess the moderating role of sleep efficiency in the relationship between anxiety and executive functions.Results: Sleep significantly moderated the relationship between anxiety and inductive reasoning. Among middle-aged and older adults with high anxiety, those with good sleep efficiency displayed significantly better inductive reasoning than those with poor sleep efficiency after controlling for age, gender, and education (ΔR2 = .05, p = .017). Sleep efficiency did not significantly moderate the relationship between anxiety and cognitive flexibility.Conclusion: Sleep efficiency weakened the association between anxiety and inductive reasoning in middle-aged and older adults. Evidence from the study suggests better sleep may limit the negative effects of anxiety on executive functions in mid-to-late life. Further research is needed to elucidate the impact of anxiety and sleep on executive functions in clinical populations with anxiety.
Collapse
|
56
|
Curtis AF, Roth AJ, Sears SF, Conti JB, Berry RB, Dzierzewski JM, McCrae CS. Associations between pain, objective sleep efficiency and cognition in patients with implantable cardioverter defibrillators. Sleep Med 2020; 72:122-125. [PMID: 32615460 PMCID: PMC7987212 DOI: 10.1016/j.sleep.2020.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 01/02/2020] [Accepted: 03/28/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Patients with implantable cardioverter defibrillators (ICDs) frequently experience sleep disruption. Prior work shows associations between objective (actigraphic) sleep and cognition in these patients, but whether pain affects associations between measures of sleep fragmentation (eg, sleep efficiency, SE) and cognition is unknown. The present study examined independent and interactive associations between objective SE and pain on cognitive performance in patients with ICDs. METHODS A total of 37 patients with ICDs (Mage = 60.0, SD = 12.4) and self-reported sleep disturbance completed 14 days of actigraphy. Average SE was computed [(average total sleep time/average time in bed) × 100%]. Patients completed the Short Form 36 Health Survey pain section, and computerized tasks measuring executive functioning (letter series, N-Back task), sustained attention/processing speed (symbol digit modalities test, SDMT), and simple reaction time. Multiple linear regressions examined whether SE independently predicted or interacted with pain ratings to predict cognitive performance. RESULTS SE interacted with pain to predict SDMT performance, accounting for 12% unique variance. In patients reporting worse pain, higher SE was associated with better SDMT performance. Similar patterns of association on SDMT were not observed in patients with average or low pain. SE and pain ratings did not independently predict SDMT performance. Performance on other cognitive tasks was not associated with any predictors. CONCLUSION Better sleep efficiency may play an important role in improving sustained attention/processing speed in patients with ICDs and perceived severe pain. Future research should examine whether interventions aimed at improving sleep fragmentation provide benefit to lower order cognition, particularly in patients with worse pain.
Collapse
|
57
|
Crew EC, Baron KG, Grandner MA, Ievers-Landis CE, McCrae CS, Nadorff MR, Nowakowski S, Ochsner Margolies S, Hansen K. The Society of Behavioral Sleep Medicine (SBSM) COVID-19 Task Force: Objectives and Summary Recommendations for Managing Sleep during a Pandemic. Behav Sleep Med 2020; 18:570-572. [PMID: 32538157 DOI: 10.1080/15402002.2020.1776288] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
As a response to clinical observations that the pervasive stress and social/environmental disruptions from the 2020 COVID-19 pandemic have also impacted sleep, the Society of Behavioral Sleep Medicine (SBSM) convened the COVID-19 Task Force with goals to identify and disseminate information that could be useful in addressing sleep concerns during this crisis. Participants Members of the SBSM COVID-19 Task Force. Results/Conclusions Herein is a summary of the resources developed by the SBSM COVID-19 Task force, which includes links to online materials developed for use by providers and patients, as well as brief descriptions of key recommendations by the Task Force for specific sleep conditions (e.g., acute insomnia, nightmares) and vulnerable populations (e.g., parents, essential/healthcare workers, older adults).
Collapse
|
58
|
Curtis AF, McGovney K, McCrae CS. 1026 Associations Between Physiological Arousal and Executive Function in Adults With Chronic Widespread Pain and Insomnia Complaints. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Individuals with chronic widespread pain (CWP) commonly experience increased physiological arousal, insomnia symptoms, and cognitive disturbance. Higher arousal (as measured by heart rate variability, HRV) is associated with worse executive function in healthy adults, suggesting that hyperarousal selectively disrupts prefrontal cortical activity. However, the HRV/cognition relationship in CWP, the moderating impact of insomnia severity, as well as the components of executive function affected, are unclear. The present study assessed independent associations between HRV and components of executive functioning in patients with CWP and insomnia complaints, and evaluated whether these associations depend on insomnia severity.
Methods
Forty-two adults (Mage=46.2, SD=13.7) with comorbid CWP and insomnia complaints (difficulty falling/staying asleep plus daytime dysfunction) underwent 5-minutes of Holter monitoring to assess resting HRV. The root mean standard deviation of successive normal to normal heartbeats (RMSDNN) was computed as the HRV index. Participants completed the Insomnia Severity Index (ISI). Participants also completed three computerized tasks measuring executive function: Stroop task (inhibition), Sternberg task (working memory), and the Balloon Analogue Risk Task (risk taking behavior). Multiple regressions examined whether RMSDNN independently predicted or interacted with ISI to predict cognition, controlling for age.
Results
RMSDNN independently predicted Stroop performance, with higher RMSDNN (lower arousal) associated with lower interference scores (better inhibitory function), B=-.003, SE=.001, p=.029, Full Model R2=.31. RMSDNN and ISI did not independently predict or interact to predict Sternberg/BART performance.
Conclusion
In patients with CWP and insomnia symptoms, reduced physiological arousal was associated with better inhibition, and this did not depend on insomnia severity. Findings highlight the potential underlying role of hyperarousal in a specific component of executive disruption in CWP. Results suggest that treatments aimed at reducing physiological arousal in comorbid CWP and insomnia (e.g., relaxation, HRV biofeedback) may selectively improve inhibitory function. Findings warrant further consideration in larger samples and prospective analyses.
Support
Research was supported by the National Institute of Nursing Research (NR017168; PI: McCrae). Data collected as part of clinical trial NCT02001077 Sleep and Pain Interventions (SPIN2) at the University of Missouri (PI: McCrae).
Collapse
|
59
|
McGovney KD, Curtis AF, Mazurek M, Chan WS, Deroche CB, Munoz M, Davenport M, Takamatsu S, Takahashi N, Muckerman J, McCann D, Sahota P, Mills B, McCrae CS. 0922 Nightly Associations Between Pre-Bedtime Activity, Actigraphic Light, and Sleep in Children With ASD and Insomnia. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Approximately two thirds of children with Autism Spectrum Disorder (ASD) suffer from chronic insomnia. Current behavioral interventions for insomnia in children with ASD use sleep hygiene guidelines to educate parents and their children regarding sleep promoting habits. However, the relationship between pre-bedtime physical activity/light and sleep is understudied in ASD. The current study examined daily associations between pre-bedtime actigraphically assessed activity/light levels and objective/subjective sleep outcomes in children with ASD and insomnia.
Methods
Thirty children (Mage=8.5 yrs, SD=1.78 yrs) with comorbid ASD and insomnia completed 14 days of actigraphy measuring ambient white light intensity and activity levels every 30 seconds. Validated sleep scoring algorithms (in Actiware V. 6.0.9) estimated objective sleep onset latency (SOL), total sleep time (TST), wake time after sleep onset (WASO), and average activity/light levels 30, 60, and 120 mins prior to bedtime. Additionally, average activity/light levels 120-240, and 240-360 mins prior to bedtime were computed. Children also completed 14 daily sleep diaries (with parental assistance) measuring subjective reports of the same sleep parameters. Associations between daily estimations of pre-bedtime activity levels, light, and nighttime objective and subjective sleep were examined through multilevel modelling. Bonferroni corrections were performed to account for multiple comparisons.
Results
After Bonferroni corrections (p<.025 significance level), greater activity within 30 minutes (B=0.0465, p=.0093) and 60 minutes (B=0.0681, p=.0005) of bedtime were associated with longer subjective SOL. Pre-bedtime light exposure was not a significant predictor of sleep outcomes.
Conclusion
Results suggest that in general, variations in daily pre-bedtime activity, but not light, are associated with worse nightly subjective SOL in children with ASD and insomnia. Findings support that sleep hygiene recommendations in children with ASD include avoidance of higher levels of pre-sleep physical activity. Prospective studies examining temporal causal relationships between pre-bedtime activity and sleep in ASD are warranted.
Support
Research was supported by a University of Missouri Research Board award (McCrae, PI; Mazurek, Co-PI). Data collected as part of clinical trial NCT02755051 Targeting Sleep in Kids with Autism Spectrum Disorder at the University of Missouri (PI: McCrae).
Collapse
|
60
|
Miller M, Freeman LB, Park CJ, Hall N, Sahota PK, McCrae CS. 0528 Insomnia as a Mechanism for Improvement in Alcohol Problems Among Young Adults. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
More than half of heavy-drinking young adults report symptoms of insomnia, which have been associated with alcohol-related problems. This study examined improvement in insomnia (via Cognitive Behavioral Therapy for Insomnia; CBT-I) as a mechanism for improvement in alcohol-related problems.
Methods
Fifty-six heavy-drinking young adults with insomnia (ages 18-30y) were randomized to CBT-I (n=28) or single-session sleep hygiene control (SH; n=28). Of those, 43 (77%) completed post-treatment (24 SH, 19 CBT-I) and 48 (86%) completed 1-month follow-up (25 SH, 23 CBT-I). Multiple imputation was used to estimate missing data. Treatment outcomes were assessed using multilevel models. Mediation was tested using bootstrapped confidence intervals for indirect effects in the PROCESS macro.
Results
CBT-I participants reported greater decreases in insomnia severity than those in the sleep hygiene group [group X time interaction, F(2,59)=11.29, p<.001], both post-treatment and at 1-month follow-up. Both groups decreased significantly in diary-assessed sleep quality [time, F(2,55)=40.30, p<.001], with a marginally significant interaction in favor of the CBT-I group [F(2,55)=2.69, p=.08]. There were no significant group by time interactions in the prediction of actigraphy-assessed sleep variables, although again, there was a marginally significant interaction in the prediction of actigraphy-assessed sleep efficiency [F(2,66)=2.75, p=.07]. Both groups reported significant decreases in drinking quantity over time [time, F(2,58=13.88, p<.001]. However, CBT-I participants reported greater decreases in alcohol-related consequences than those in the sleep hygiene group [F(2,67)=4.13, p=.02]. In the mediation model, CBT-I did not have a direct effect on change in alcohol-related consequences (B=1.49, SE=1.06, 95%CI=-0.65, 3.62); however, it influenced change in 1-month alcohol-related consequences indirectly through its influence on post-treatment insomnia symptoms (B=-1.09, SE=0.57, 95%CI=-2.30, -0.05).
Conclusion
CBT-I is effective in treating insomnia among heavy-drinking young adults and may be associated with reductions in alcohol-related problems due to its impact on insomnia symptoms.
Support
This work was supported by funding from the University of Missouri System Research Board Office (PI Miller). Mary Beth Miller’s contribution to this project was also supported by the National Institute on Alcohol Abuse and Alcoholism [grant number K23AA026895].
Collapse
|
61
|
McCrae CS, Curtis AF, Miller MB, Nair N, Rathinakumar H, Davenport M, Berry JR, McGovney K, Staud R, Berry R, Robinson M. Effect of cognitive behavioural therapy on sleep and opioid medication use in adults with fibromyalgia and insomnia. J Sleep Res 2020; 29:e13020. [PMID: 32126156 DOI: 10.1111/jsr.13020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 01/24/2023]
Abstract
Sleep and opioid medications used to treat insomnia and chronic pain are associated with adverse side effects (falls and cognitive disturbance). Although behavioural treatments such as cognitive behavioral therapy for insomnia (CBT-I) and pain (CBT-P) improve sleep and clinical pain, their effects on sleep and opioid medication use are unclear. In this secondary analysis of published trial data, we investigated whether CBT-I and CBT-P reduced reliance on sleep/opioid medication in patients with fibromyalgia and insomnia (FMI). Patients with FMI (n = 113, Mage = 53.0, SD = 10.9) completed 8 weeks of CBT-I (n = 39), CBT-P (n = 37) or waitlist control (WLC; n = 37). Participants completed 14 daily diaries at baseline, post-treatment and 6-month follow-up, assessing sleep and opioid medication usage. Multilevel modelling examined group by time effects on days of medication use. A significant interaction revealed CBT-P reduced the number of days of sleep medication use at post-treatment, but usage returned to baseline levels at follow-up. There were no other significant within- or between-group effects. CBT-P led to immediate reductions in sleep medication usage, despite lack of explicit content regarding sleep medication. CBT-I and CBT-P may be ineffective as stand-alone treatments for altering opioid use in FMI. Future work should explore CBT as an adjunct to other behavioural techniques for opioid reduction.
Collapse
|
62
|
McCrae CS, Curtis AF, Williams JM, Dautovich ND, McNamara JPH, Stripling A, Dzierzewski JM, Berry RB, McCoy KM, Marsiske M. Effects of Brief Behavioral Treatment for Insomnia on Daily Associations between Self-Reported Sleep and Objective Cognitive Performance in Older Adults. Behav Sleep Med 2020; 18:577-588. [PMID: 31203649 PMCID: PMC7981847 DOI: 10.1080/15402002.2019.1632201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Behavioral treatments for insomnia improve sleep in older adults, but research documenting their effects on cognitive performance is mixed. We explored whether a brief behavioral treatment for insomnia (BBTi) impacts daily associations between sleep parameters and next day cognition. METHODS Sixty-two older adults (Mage = 69.45 years, SD = 7.71) with insomnia completed either 4 weeks of BBTi or self-monitoring control (SMC). At baseline, post-treatment, and 3 month follow-up, participants completed 14 days of diaries measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE), as well as daily cognitive tests measuring processing speed (i.e., symbol digit modalities test, SDMT), and reasoning (i.e., letter series). At each time period, associations between sleep parameters and daily cognition, controlling for age, education, insomnia duration, use of sleep medications, and depression (i.e., Beck Depression Inventory-2nd Edition scores), were examined through multilevel modeling. RESULTS At post-treatment, we observed an interactive fixed effect of treatment condition (i.e., BBTi/SMC) and TST on daily SDMT and letter series performance. For BBTi, longer TST was associated with better letter series performance, and did not predict SDMT performance. For SMC, longer TST was associated with worse SDMT, and was not associated with letter series performance. Greater WASO (regardless of group) was associated with better SDMT performance at post-treatment. Associations were not maintained at follow-up. CONCLUSIONS Sleep duration may play an important role in BBTi-related improvements in daily higher order cognition. Maintenance of these associations may be facilitated by booster sessions following post-treatment. CLINICAL TRIAL IDENTIFIER NCT02967185.
Collapse
|
63
|
Kirsch JL, Robinson ME, McCrae CS, Kacel EL, Wong SS, Patidar S, Sannes TS, Garey S, Castagno JC, Pereira DB. Associations Among Sleep Latency, Subjective Pain, and Thermal Pain Sensitivity in Gynecologic Cancer. PAIN MEDICINE 2020; 21:5-12. [PMID: 30481329 DOI: 10.1093/pm/pny236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Pain is common among women with gynecologic cancer and contributes to depressed mood, sleep disturbances, and likelihood of future chronic pain. Little is known about how psychosocial factors are associated with central sensitization of pain in gynecologic cancer. This study examined relations among depressive symptoms, sleep, subjective pain, and aftersensation pain (a proxy for central sensitization of pain) in gynecologic cancer. METHODS Participants were 42 women (mean age [SD] = 59.60 [10.11] years) enrolled in a randomized clinical trial examining psychological intervention effects on sleep, pain, mood, and stress hormones/cytokines in gynecologic cancer. Six to eight weeks after surgery, participants completed an assessment of depressive symptoms, sleep, and subjective pain and a temporal summation of pain protocol via quantitative sensory testing (QST). RESULTS Controlling for recent chemotherapy, history of chronic pain, and analgesic medication use, regression analyses revealed that longer sleep onset latency (SOL; B = 3.112, P = 0.039, bias-corrected and accelerated (BCa) 95% confidence interval [CI] = 0.371 to 6.014) and greater sensory pain (B = 0.695, P = 0.023, BCa 95% CI = 0.085 to 1.210) were associated with greater aftersensation pain at 15 seconds. Greater sensory pain scores were associated with greater aftersensation pain at 30 seconds (B = 0.286, P = 0.045, BCa 95% CI = 0.008 to 0.513). Depression was not associated with aftersensation pain. The overall models accounted for 44.5% and 40.4% of the variance in aftersensation pain at 15 and 30 seconds, respectively. Conclusions. Longer SOL and higher subjective sensory pain were related to greater aftersensation of experimentally induced pain in women postsurgery for gynecologic cancers. Interventions that improve sleep and subjective sensory pain during the perisurgical period may reduce risk for central sensitization of pain.
Collapse
|
64
|
McCrae CS, Chan WS, Curtis AF, Deroche CB, Munoz M, Takamatsu S, Muckerman JE, Takahashi N, McCann D, McGovney K, Sahota P, Mazurek MO. Cognitive behavioral treatment of insomnia in school‐aged children with autism spectrum disorder: A pilot feasibility study. Autism Res 2019; 13:167-176. [DOI: 10.1002/aur.2204] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 08/22/2019] [Indexed: 11/06/2022]
|
65
|
Ravyts SG, Dzierzewski JM, Grah SC, Buman MP, Aiken-Morgan AT, Giacobb PR, Roberts BL, Marsiske M, McCrae CS. Pain inconsistency and sleep in mid to late-life: the role of depression. Aging Ment Health 2019; 23:1174-1179. [PMID: 30215277 PMCID: PMC6417978 DOI: 10.1080/13607863.2018.1481929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/24/2018] [Indexed: 12/20/2022]
Abstract
Objectives: Inconsistency in pain may lead to depression, which may then influence sleep. Thus, the purpose of this study was to examine whether depression mediates the relationship between day-to-day inconsistency in pain and sleep in middle aged to older adults. Methods: Baseline measures from the Active Adult Mentoring Project were used for secondary data analysis. Participants included 82 adults in mid- to late-life. Pain was assessed for seven consecutive days on an 11-point Likert-scale, with pain inconsistency defined as the seven-day individual standard deviation. A self-report daily diary was used to assess sleep efficiency (SE), total wake time (TWT), total sleep time (TST), and sleep quality (SQ), and depression was assessed using the BDI-II. Results: Mediation analyses revealed that depression partially mediated the relationship between pain inconsistency and SE, TWT, and SQ but not TST. Conclusions: Results indicate that depression may be an important factor through which pain inconsistency influences sleep. Although further research is warranted, these preliminary findings suggest that intervening on both pain inconsistency and depression may be one way to improve sleep in older adults.
Collapse
|
66
|
Kacel EL, Kirsch JL, Sannes TS, Patidar S, Postupack R, Jensen S, Wong S, Garey S, Dodd S, Ulfig CM, McCrae CS, Robinson ME, Castagno J, Schultz GS, Pereira DB. Interleukin-6 and body mass index, tobacco use, and sleep in gynecologic cancers. Health Psychol 2019; 38:866-877. [PMID: 31368718 DOI: 10.1037/hea0000775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Elevated body mass index (BMI), tobacco use, and sleep disturbance are common health concerns among women with gynecologic cancers. The extent to which these factors are associated with systemic inflammation in gynecologic cancers is unknown. This is a significant literature gap given that (a) chronic, systemic inflammation may mediate relationships between behavioral health factors and cancer outcomes; and (b) elevated BMI, tobacco use, and sleep disturbances can be modified via behavioral interventions. This study examined Interleukin-6 (IL-6) relations with BMI, tobacco use history, and sleep disturbances in patients undergoing surgery for suspected gynecologic cancer. METHOD Participants were 100 women (M age = 58.42 years, SD = 10.62 years) undergoing surgery for suspected gynecologic cancer. Smoking history was determined by participant self-report. Sleep quality/disturbance was assessed via the Pittsburgh Sleep Quality Index. BMI was abstracted from electronic health records. Presurgical serum IL-6 concentrations were determined using Enzyme-Linked Immunosorbent Assay. RESULTS Controlling for the cancer type and stage, regression analyses revealed higher BMI, β = 0.258, p = .007, and former/current smoking status, β = 0.181, p = .046, were associated with higher IL-6. IL-6 did not differ between former and current smokers, β = 0.008, p = .927. Global sleep quality, sleep latency, and sleep efficiency were not associated with IL-6. CONCLUSIONS Higher BMI and any history of tobacco use predicted higher IL-6 among women undergoing surgery for suspected gynecologic cancers. Cognitive-behavioral interventions targeting primary and secondary obesity and tobacco use prevention may reduce systemic inflammation and optimize cancer outcomes in this population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
67
|
Curtis AF, Roth AJ, Sears SF, Conti JB, Berry RB, Dzierzewski JM, Rathinakumar H, McCrae CS. Cognitive performance in patients with implantable cardioverter defibrillators: Associations with objective sleep duration, age and anxiety. J Sleep Res 2019; 28:e12810. [PMID: 30549143 PMCID: PMC6565521 DOI: 10.1111/jsr.12810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 12/31/2022]
Abstract
Sleep disturbance and anxiety are highly prevalent in patients with implantable cardiac defibrillators (ICDs). There is limited research, however, on the associations between cognitive performance and sleep parameters, age and anxiety. Forty-one patients with ICDs and self-reported sleep disturbance completed 14 days of actigraphy (Mage = 60.3, SD = 12.3) measuring total sleep time (TST), and a computerized cognitive test battery measuring processing speed and attention (i.e. simple reaction time and symbol digit modality task [SDMT]) and executive function (i.e. flanker task, letter series task and N-back task). Multiple regressions determined whether independent effects of TST, age and anxiety, as well as interactive effects of TST and age, predicted cognitive performance. TST predicted performance on two tasks of executive function (i.e. letter series and N-back task), as well as an attentional vigilance and processing speed task (i.e. SDMT), and this did not depend on patient age. On letter series, N-back and SDMT, longer TST predicted better performance. Increasing age was a predictor of worse performance on SDMT and flanker tasks. No other predictors were associated with task performance. Results show that sleep duration, not anxiety, may be an important predictor of higher-order cognitive functioning and lower-order tasks measuring processing speed and attention in ICD patients, with longer sleep duration showing greater benefit for performance.
Collapse
|
68
|
Miller MB, Yurasek AM, Pritshmann R, Curtis AF, McCrae CS. 0332 Negative Mood as a Mediator of the Association between Insomnia Symptoms and Marijuana Problems in Young Adults. Sleep 2019. [DOI: 10.1093/sleep/zsz067.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
69
|
Curtis AF, Roth AJ, Conti JB, Sears SF, Dzierzewski JM, Berry RB, McCrae CS. 0856 Higher Sleep Efficiency Improves Attention and Processing Speed in Patients with Severe Pain and Implantable Cardioverter Defibrillators. Sleep 2019. [DOI: 10.1093/sleep/zsz067.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
70
|
Curtis AF, Miller MB, Rathinakumar H, Robinson M, Staud R, Berry RB, McCrae CS. 0846 Opioid Use and Sleep Architecture in Fibromyalgia. Sleep 2019. [DOI: 10.1093/sleep/zsz067.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
71
|
McGovney KD, Curtis AF, McCann D, McCrae CS. 0847 Associations between Objective Afternoon and Evening Physical Activity and Objective Sleep in Fibromyalgia. Sleep 2019. [DOI: 10.1093/sleep/zsz067.845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
72
|
Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, Carden KA. 0328 Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Clinical Practice Guideline. Sleep 2019. [DOI: 10.1093/sleep/zsz067.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
73
|
McGovney KD, Curtis AF, McCann D, McCrae CS. 0425 Actigraphy Assessment in Fibromyalgia: A Standardized Protocol to Reduce Discrepancies between Subjective and Objective Sleep. Sleep 2019. [DOI: 10.1093/sleep/zsz067.424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
74
|
McCrae CS, Williams J, Roditi D, Anderson R, Mundt JM, Miller MB, Curtis AF, Waxenberg LB, Staud R, Berry RB, Robinson ME. Cognitive behavioral treatments for insomnia and pain in adults with comorbid chronic insomnia and fibromyalgia: clinical outcomes from the SPIN randomized controlled trial. Sleep 2019; 42:zsy234. [PMID: 30496533 PMCID: PMC6424087 DOI: 10.1093/sleep/zsy234] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 10/25/2018] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To examine the effects of cognitive behavioral treatments for insomnia (CBT-I) and pain (CBT-P) in patients with comorbid fibromyalgia and insomnia. METHODS One hundred thirteen patients (Mage = 53, SD = 10.9) were randomized to eight sessions of CBT-I (n = 39), CBT-P (n = 37), or a waitlist control (WLC, n = 37). Primary (self-reported sleep onset latency [SOL], wake after sleep onset [WASO], sleep efficiency [SE], sleep quality [SQ], and pain ratings) and secondary outcomes (dysfunctional beliefs and attitudes about sleep [DBAS]; actigraphy and polysomnography SOL, WASO, and SE; McGill Pain Questionnaire; Pain Disability Index; depression; and anxiety) were examined at posttreatment and 6 months. RESULTS Mixed effects analyses revealed that both treatments improved self-reported WASO, SE, and SQ relative to control at posttreatment and follow-up, with generally larger effect sizes for CBT-I. DBAS improved in CBT-I only. Pain and mood improvements did not differ by group. Clinical significance analyses revealed the proportion of participants no longer reporting difficulties initiating and maintaining sleep was higher for CBT-I posttreatment and for both treatments at 6 months relative to control. Few participants achieved >50% pain reductions. Proportion achieving pain reductions of >30% (~1/3) was higher for both treatments posttreatment and for CBT-I at 6 months relative to control. CONCLUSIONS CBT-I and CBT-P improved self-reported insomnia symptoms. CBT-I prompted improvements of larger magnitude that were maintained. Neither treatment improved pain or mood. However, both prompted clinically meaningful, immediate pain reductions in one third of patients. Improvements persisted for CBT-I, suggesting that CBT-I may provide better long-term pain reduction than CBT-P. Research identifying which patients benefit and mechanisms driving intervention effects is needed. CLINICAL TRIAL Sleep and Pain Interventions in Fibromyalgia (SPIN), clinicaltrials.gov, NCT02001077.
Collapse
|
75
|
Miller MB, Chan WS, Curtis AF, Boissoneault J, Robinson M, Staud R, Berry RB, McCrae CS. Pain intensity as a moderator of the association between opioid use and insomnia symptoms among adults with chronic pain. Sleep Med 2018; 52:98-102. [PMID: 30296735 PMCID: PMC6246793 DOI: 10.1016/j.sleep.2018.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/02/2018] [Accepted: 08/27/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Research documenting the impact of opioid use on sleep among individuals with chronic pain has been mixed. This study aimed to determine if pain intensity moderates the association between opioid use and insomnia symptoms among adults with comorbid symptoms of insomnia and chronic widespread pain. METHODS Participants (N = 144; 95% female; mean age = 51.6, SD = 11.4) completed assessments of insomnia symptoms, pain and use of sleep/pain medication. Multiple regression was used to determine if pain intensity moderates the association between opioid use (yes/no) sleep onset latency (SOL), wake after sleep onset (WASO), sleep quality, or time in bed. Analyses controlled for gender, symptoms of sleep apnea, symptoms of depression, use of sleep medication (yes/no), and use of non-opioid pain medication (yes/no). RESULTS Stronger pain intensity was associated with longer self-reported WASO and worse sleep quality, independent of opioid use. Conversely, opioid use was associated with longer time in bed, independent of pain intensity. Opioid use and pain intensity interacted in the prediction of SOL, such that opioid use (vs. non-use) was associated with longer SOL in the context of mild but not moderate to severe pain intensity. CONCLUSIONS Opioid use was associated with more difficulty falling asleep among adults with chronic pain; however, this cross-sectional effect was only significant among those reporting lower pain intensity. Authors speculate that this effect is masked among those with severe pain because the pain-related sleep debt they acquire throughout the night then facilitates sleep onset the next day.
Collapse
|