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Yeo H, Seo JW, Gu H, Kim SJ. Waking qEEG in older adults with insomnia and its associations with sleep reactivity and dysfunctional beliefs about sleep. Int J Psychophysiol 2024; 202:112373. [PMID: 38844053 DOI: 10.1016/j.ijpsycho.2024.112373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
Sleep quality often deteriorates with age, and insomnia among the elderly increases the risks of both physical and psychiatric disorders. To elucidate the mechanisms and identify useful diagnostic biomarkers for insomnia in the elderly, the current study investigated the associations of waking brain activity patterns with susceptibility to stress-induced insomnia (sleep reactivity) and dysfunctional beliefs about sleep, major factors precipitating and maintaining insomnia, respectively. Forty-five participants aged 60 years or older with insomnia completed self-reported measures assessing depression, anxiety, sleep quality, dysfunctional beliefs about sleep, and sleep reactivity. Participants were then examined by quantitative electroencephalography (qEEG) during wakefulness, and spectral analysis was conducted to examine associations of regional frequency band power with these insomnia-precipitating and -maintaining factors. Dysfunctional beliefs about sleep were significantly correlated with higher beta/high-beta frequency band powers, while sleep reactivity was correlated with higher theta and delta frequency band powers. These findings suggest that sleep reactivity of older adults is associated with widespread cortical deactivation leading to poor stress coping, while their dysfunctional beliefs about sleep are associated with hyperactivation which is related to cognitive processes. These associations suggest that cognitive inflexibility and maladaptive stress-coping contribute to insomnia among the elderly.
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Affiliation(s)
- Hyewon Yeo
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jin Won Seo
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyerin Gu
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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Iannuzzo F, Garzon S, Lazzari C, Porcari I, Bosco M, Etrusco A, Laganà AS, Uccella S, Chiantera V, Celebre L, Mento C, Muscatello MRA, Bruno A. Sleep disorders and hyperarousal among patients with endometriosis: A case-control survey study. Eur J Obstet Gynecol Reprod Biol 2024; 300:287-295. [PMID: 39053089 DOI: 10.1016/j.ejogrb.2024.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 07/09/2024] [Accepted: 07/13/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Endometriosis has been associated with sleep disorders, and hyperarousal appears to be involved in their pathogenesis; however, the presence of hyperarousal in the endometriosis population was never investigated. METHODS We conducted a case-control survey study by sending a questionnaire to all endometriosis patients followed up at our Centers. Controls were recruited among the general population. The questionnaire included demographic information, symptoms and history of endometriosis, the Hyperarousal Scale (H-Scale), the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). RESULTS A total of 847 women completed the questionnaires: 430 (50.8 %) had endometriosis, and 417 (49.2 %) were controls. Endometriosis was associated with higher H-scale score (OR 2.9, 95 % CI 2.4-3.8, p = 0.000), higher PSQI score (OR 4.3, 95 % CI 3.2-5.7, p = 0.000), and higher ISI score (OR 4.6, 95 % CI 3.5-6.1, p = 0.000) in multivariable ordinal logistic regressions analysis. With path analysis, hyperarousal (H-Scale) reported a partial mediating role in the association between endometriosis and sleep disorders. The mediation effect represented 22.3-27.8 % of the entire association between endometriosis and sleep disturbances. CONCLUSION Endometriosis patients complaining sleep disorders may benefit by investigating the presence of hyperarousal given cognitive behavioral therapy was reported effective in improving hyperarousal and associated sleep disorders.
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Affiliation(s)
- Fiammetta Iannuzzo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, Contesse, Messina 98125, Italy
| | - Simone Garzon
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Cecilia Lazzari
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Irene Porcari
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, University of Palermo, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, University of Palermo, Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Stefano Uccella
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy; Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | - Laura Celebre
- Department of Mental Health and Addictions, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo 24127, Italy
| | - Carmela Mento
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, Contesse, Messina 98125, Italy
| | - Maria Rosaria Anna Muscatello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, Contesse, Messina 98125, Italy
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, Contesse, Messina 98125, Italy.
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Safavi HP, Bouzari M. Fading Focus: Addressing the Association Between Challenge Stressors, Role Blurring, Insomnia, Fatigue, and Workplace Cognitive Failure. Eval Health Prof 2024:1632787241264597. [PMID: 39025828 DOI: 10.1177/01632787241264597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
The primary goal of the present study is to inspect the plausible job-related (i.e., challenge stressors and role blurring) and individual factors (i.e., fatigue and insomnia) that potentially lead to work-related cognitive failures among healthcare staff. Through the judgmental sampling technique, data was collected from healthcare personnel in Iran. The results revealed that challenge stressors in the form of time pressure, job responsibility, and work overload are significantly related to role blurring. Moreover, role blurring increases fatigue and insomnia among medical staff, and both insomnia and fatigue cause workplace cognitive failure. The results also confirm the mediation effect of role blurring in the association between challenge stressors, insomnia, and fatigue. According to the results, insomnia and fatigue similarly mediate the role blurring on workplace cognitive failure association. Theoretical implications, useful suggestions for practitioners, and prospective research avenues are debated in the study.
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Garneau J, Savard J, Dang-Vu TT, Gouin JP. Predicting response to stepped-care cognitive behavioral therapy for insomnia using pre-treatment heart rate variability in cancer patients. Sleep Med 2024; 121:160-170. [PMID: 38991424 DOI: 10.1016/j.sleep.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE This study examined whether high frequency heart-rate variability (HF-HRV) and HF-HRV reactivity to worry moderate response to cognitive behavioural therapy for insomnia (CBT-I) within both a standard and stepped-care framework among cancer patients with comorbid insomnia. Biomarkers such as HF-HRV may predict response to CBT-I, a finding which could potentially inform patient allocation to different treatment intensities within a stepped-care framework. METHODS 177 participants (86.3 % female; Mage = 55.3, SD = 10.4) were randomized to receive either stepped-care or standard CBT-I. 145 participants had their HRV assessed at pre-treatment during a rest and worry period. Insomnia symptoms were assessed using the Insomnia Severity Index (ISI) and daily sleep diary across five timepoints from pre-treatment to a 12-month post-treatment follow-up. RESULTS Resting HF-HRV was significantly associated with pre-treatment sleep efficiency and sleep onset latency but not ISI score. However, resting HF-HRV did not predict overall changes in insomnia across treatment and follow-up. Similarly, resting HF-HRV did not differentially predict changes in sleep diary parameters across standard or stepped-care groups. HRV reactivity was not related to any of the assessed outcome measures in both cross-sectional and longitudinal analyses. CONCLUSION Although resting HF-HRV was related to initial daily sleep parameters, HF-HRV measures did not significantly predict longitudinal responses to CBT-I. These findings suggest that HF-HRV does not predict treatment responsiveness to CBT-I interventions of different intensity in cancer patients.
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Affiliation(s)
- James Garneau
- Department of Psychology, Concordia University, 7141 Sherbrooke St. W, Montréal, H4B 1R6, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS Centre-Sud-de-l'île-de-Montréal, 4565 Queen Mary Rd, Montréal, H3W 1W5, Canada.
| | - Josée Savard
- School of Psychology, Université Laval, 2325 Rue des Bibliothèques, Québec, G1V 0A6, Canada; CHU de Québec-Université Laval Research Center, 2705 Bd Laurier, Québec, G1V 4G2, Canada; Université Laval Cancer Research Center, 9 Rue McMahon, Québec, G1R 3S3, Canada.
| | - Thien Thanh Dang-Vu
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS Centre-Sud-de-l'île-de-Montréal, 4565 Queen Mary Rd, Montréal, H3W 1W5, Canada; Department of Health, Kinesiology and Applied Physiology, Concordia University, 7141 Sherbrooke St. W, Montréal, H4B 1R6, Canada.
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, 7141 Sherbrooke St. W, Montréal, H4B 1R6, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS Centre-Sud-de-l'île-de-Montréal, 4565 Queen Mary Rd, Montréal, H3W 1W5, Canada.
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Vorster APA, Erlacher D, Birrer D, Röthlin P. Sleep Difficulties in Swiss Elite Athletes. Life (Basel) 2024; 14:779. [PMID: 38929761 PMCID: PMC11204926 DOI: 10.3390/life14060779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
For athletes, sleep is essential for recovery and performance. Yet, up to two-thirds of athletes report poor sleep quality. Comprehensive data across all sports disciplines on the underlying causes of sleep problems are missing. We reanalyzed a data set of N = 1004 Swiss top athletes across an extensive array of 88 sports to gain knowledge on the specific deficits in sleep health with respect to gender, sport classes, sport-related factors, and well-being. We found that 18% of athletes were affected by at least two out of five high-risk sleep factors: 9% of athletes slept less than 6 h per day, 30% were dissatisfied with their sleep, 17% showed problems falling asleep within 30 min, 18% of athletes reported difficulty maintaining sleep more than three times a week, and 6% of athletes used sleeping pills more than once a week. We found sleep health strongly linked to overall well-being and mental health (22% showed at least moderate symptoms of either depression or anxiety). Therefore, screening and treating sleep disorders might effectively improve mental health and general well-being as well as performance among athletes around the globe.
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Affiliation(s)
- Albrecht P. A. Vorster
- Department of Neurology, University Hospital (Inselspital), University of Bern, 3010 Bern, Switzerland
- Interdisciplinary Sleep-Wake-Epilepsy-Center, University Hospital (Inselspital), University of Bern, 3010 Bern, Switzerland
| | - Daniel Erlacher
- Institute of Sport Science, University of Bern, 3012 Bern, Switzerland; (D.E.); (P.R.)
| | - Daniel Birrer
- Elite Sport Department, Swiss Federal Institute of Sport Magglingen, 2532 Magglingen, Switzerland;
| | - Philipp Röthlin
- Institute of Sport Science, University of Bern, 3012 Bern, Switzerland; (D.E.); (P.R.)
- Elite Sport Department, Swiss Federal Institute of Sport Magglingen, 2532 Magglingen, Switzerland;
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Occhionero M, Tonetti L, Giudetti F, Natale V. Activity-Based Prospective Memory in Insomniacs. SENSORS (BASEL, SWITZERLAND) 2024; 24:3612. [PMID: 38894403 PMCID: PMC11175320 DOI: 10.3390/s24113612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To investigate the activity-based prospective memory performance in patients with insomnia, divided, on the basis of actigraphic evaluation, into sleep onset, maintenance, mixed and negative misperception insomnia. METHODS A total of 153 patients with insomnia (I, 83 females, mean age + SD = 41.37 + 16.19 years) and 121 healthy controls (HC, 78 females, mean age + SD = 36.99 + 14.91 years) wore an actigraph for one week. Insomnia was classified into sleep onset insomnia (SOI), maintenance insomnia (MaI), mixed insomnia (MixI) and negative misperception insomnia (NMI). To study their activity-based prospective memory performance, all the participants were required to push the actigraph event marker button twice, at bedtime (task 1) and at get-up time (task 2). RESULTS Only patients with maintenance and mixed insomnia had a significantly lower accuracy in the activity-based prospective memory task at get-up time compared with the healthy controls. CONCLUSION The results show that maintenance and mixed insomnia involve an impaired activity-based prospective memory performance, while sleep onset and negative misperception insomnia do not seem to be affected. This pattern of results suggests that the fragmentation of sleep may play a role in activity-based prospective memory efficiency at wake-up in the morning.
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Affiliation(s)
- Miranda Occhionero
- Department of Psychology “Renzo Canestrari”, University of Bologna, 40127 Bologna, Italy; (L.T.); (F.G.); (V.N.)
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Yu BYM, Lam CS, Tam KYY, Cheung DST, Chen SC, Yeung WF. The Role of Insomnia and Exercise in COVID-19 Worries for Psychological Distress in Hong Kong Chinese: A Moderated Mediation Model. Behav Sleep Med 2024; 22:378-392. [PMID: 37842738 DOI: 10.1080/15402002.2023.2270095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To examine the role of insomnia as a mediator between worrying and mental health and whether the association between worrying and insomnia is moderated by the levels of exercise frequency. METHODS A cross-sectional online survey was conducted during the fourth wave of the COVID-19 outbreak in Hong Kong (n = 988). Participants' insomnia, psychological distress, and exercise frequency were evaluated. A mediation analysis was performed to examine the direct effect of COVID-19 worries and their indirect effect through insomnia on psychological distress. RESULTS A significant indirect effect of COVID-19 worries through insomnia was found on psychological distress (beta = 0.18, SE = 0.02, 95% CI = 0.14-0.22, p < .001). The significant index of moderated mediation supported the moderating effect of exercise frequency on the indirect effect of COVID-19 worries on psychological distress (IMM = 0.06, SE = 0.02, 95% CI = 0.02-0.10, p = .006). The conditional indirect effects of insomnia on psychological distress were significant in individuals with mean and higher exercise frequency but not in those with lower exercise frequency. CONCLUSION COVID-19 worries increased psychological distress through the worsening of sleep, and such an array of COVID-19 worries on insomnia was moderated by exercise frequency. Engaging more frequent exercise could reduce insomnia in people with less COVID-19 worries.
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Affiliation(s)
- Branda Yee-Man Yu
- Department of Psychology, the University of Hong Kong, Hong Kong, SAR, China
| | - Chun Sing Lam
- School of Pharmacy, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Katy Yuen Yan Tam
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Denise Shuk Ting Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shu Cheng Chen
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, SAR, China
| | - Wing Fai Yeung
- School of Nursing, the Hong Kong Polytechnic University, Hong Kong, SAR, China
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Vidal Bustamante CM, Coombs Iii G, Rahimi-Eichi H, Mair P, Onnela JP, Baker JT, Buckner RL. Precision Assessment of Real-World Associations Between Stress and Sleep Duration Using Actigraphy Data Collected Continuously for an Academic Year: Individual-Level Modeling Study. JMIR Form Res 2024; 8:e53441. [PMID: 38687600 PMCID: PMC11094608 DOI: 10.2196/53441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/10/2024] [Accepted: 03/07/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Heightened stress and insufficient sleep are common in the transition to college, often co-occur, and have both been linked to negative health outcomes. A challenge concerns disentangling whether perceived stress precedes or succeeds changes in sleep. These day-to-day associations may vary across individuals, but short study periods and group-level analyses in prior research may have obscured person-specific phenotypes. OBJECTIVE This study aims to obtain stable estimates of lead-lag associations between perceived stress and objective sleep duration in the individual, unbiased by the group, by developing an individual-level linear model that can leverage intensive longitudinal data while remaining parsimonious. METHODS In total, 55 college students (n=6, 11% second-year students and n=49, 89% first-year students) volunteered to provide daily self-reports of perceived stress via a smartphone app and wore an actigraphy wristband for the estimation of daily sleep duration continuously throughout the academic year (median usable daily observations per participant: 178, IQR 65.5). The individual-level linear model, developed in a Bayesian framework, included the predictor and outcome of interest and a covariate for the day of the week to account for weekly patterns. We validated the model on the cohort of second-year students (n=6, used as a pilot sample) by applying it to variables expected to correlate positively within individuals: objective sleep duration and self-reported sleep quality. The model was then applied to the fully independent target sample of first-year students (n=49) for the examination of bidirectional associations between daily stress levels and sleep duration. RESULTS Proof-of-concept analyses captured expected associations between objective sleep duration and subjective sleep quality in every pilot participant. Target analyses revealed negative associations between sleep duration and perceived stress in most of the participants (45/49, 92%), but their temporal association varied. Of the 49 participants, 19 (39%) showed a significant association (probability of direction>0.975): 8 (16%) showed elevated stress in the day associated with shorter sleep later that night, 5 (10%) showed shorter sleep associated with elevated stress the next day, and 6 (12%) showed both directions of association. Of note, when analyzed using a group-based multilevel model, individual estimates were systematically attenuated, and some even reversed sign. CONCLUSIONS The dynamic interplay of stress and sleep in daily life is likely person specific. Paired with intensive longitudinal data, our individual-level linear model provides a precision framework for the estimation of stable real-world behavioral and psychological dynamics and may support the personalized prioritization of intervention targets for health and well-being.
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Affiliation(s)
- Constanza M Vidal Bustamante
- Department of Psychology, Harvard University, Cambridge, MA, United States
- Center for Brain Science, Harvard University, Cambridge, MA, United States
| | - Garth Coombs Iii
- Department of Psychology, Harvard University, Cambridge, MA, United States
- Center for Brain Science, Harvard University, Cambridge, MA, United States
| | - Habiballah Rahimi-Eichi
- Department of Psychology, Harvard University, Cambridge, MA, United States
- Center for Brain Science, Harvard University, Cambridge, MA, United States
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Patrick Mair
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Jukka-Pekka Onnela
- Department of Biostatistics, Harvard University, Boston, MA, United States
| | - Justin T Baker
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Randy L Buckner
- Department of Psychology, Harvard University, Cambridge, MA, United States
- Center for Brain Science, Harvard University, Cambridge, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Athinoula A Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
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Herms EN, Bolbecker AR, Wisner KM. Impaired Sleep Mediates the Relationship Between Interpersonal Trauma and Subtypes of Delusional Ideation. Schizophr Bull 2024; 50:642-652. [PMID: 37315337 PMCID: PMC11059790 DOI: 10.1093/schbul/sbad081] [Citation(s) in RCA: 1] [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] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND HYPOTHESIS Trauma is a robust risk factor for delusional ideation. However, the specificity and processes underlying this relationship are unclear. Qualitatively, interpersonal traumas (i.e., trauma caused by another person) appear to have a specific relationship with delusional ideation, particularly paranoia, given the commonality of social threat. However, this has not been empirically tested and the processes by which interpersonal trauma contributes to delusional ideation remain poorly understood. Given the role of impaired sleep in both trauma and delusional ideation, it may be a critical mediator between these variables. We hypothesized that interpersonal trauma, but not non-interpersonal trauma, would be positively related to subtypes of delusional ideation, especially paranoia, and that impaired sleep would mediate these relationships. STUDY DESIGN In a large, transdiagnostic community sample (N = 478), an exploratory factor analysis of the Peter's Delusion Inventory identified three subtypes of delusional ideation, namely magical thinking, grandiosity, and paranoia. Three path models, one for each subtype of delusional ideation, tested whether interpersonal trauma and non-interpersonal trauma were related to subtypes of delusional ideation, and impaired sleep as a mediating variable of interpersonal trauma. STUDY RESULTS Paranoia and grandiosity were positively related to interpersonal trauma and unrelated to non-interpersonal trauma. Furthermore, these relationships were significantly mediated by impaired sleep, which appeared strongest for paranoia. In contrast, magical thinking was unrelated to traumatic experiences. CONCLUSIONS These findings support a specific relationship between interpersonal trauma and paranoia as well as grandiosity, with impaired sleep appearing as an important process by which interpersonal trauma contributes to both.
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Affiliation(s)
- Emma N Herms
- Department of Psychological & Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Amanda R Bolbecker
- Department of Psychological & Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Krista M Wisner
- Department of Psychological & Brain Sciences, Indiana University, Bloomington, IN, USA
- Program of Neuroscience, Indiana University, Bloomington, IN, USA
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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] [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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Dougherty EN, Bottera AR, Haedt-Matt AA. Dysphoric mood may explain the relation between sleep reactivity and binge eating but not purging. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-5. [PMID: 38579122 DOI: 10.1080/07448481.2024.2336998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
Objective: This study investigated whether sleep reactivity (i.e., a propensity to experience sleep disturbances when stressed) relates to eating disorder behavioral symptoms indirectly through dysphoric mood in a sample of college students. Participants: One hundred and ninety-eight college students (51.5% female). Methods: Participants completed self-report measures of dysphoric mood, eating disorder behavioral symptoms, and sleep reactivity. Results: Higher sleep reactivity was associated with greater binge-eating symptoms indirectly through higher dysphoric mood. Higher sleep reactivity was associated with greater purging symptoms; however, this association was not explained by dysphoric mood. Conclusions: Findings support the relevance of sleep reactivity to binge eating and purging and suggest that sleep reactivity relates to binge-eating symptoms indirectly through dysphoric mood. If replicated in prospective data, targeting stress-induced sleep and mood disturbances in college students may reduce risk for binge eating.
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Affiliation(s)
- Elizabeth N Dougherty
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
| | | | - Alissa A Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
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12
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Curtis AF, Jagannathan S, Musich M, Miller MB, McCrae CS. Mid-to-Late-Life Anxiety and Sleep during Initial Phase of COVID-19: Age- and Sex-Specific Insights to Inform Future Pandemic Healthcare. Brain Sci 2024; 14:346. [PMID: 38671998 PMCID: PMC11047835 DOI: 10.3390/brainsci14040346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/28/2024] Open
Abstract
This study examined associations between COVID-19-related anxiety and sleep in middle-aged and older adults and tested whether these varied by age or sex. In June/July 2020, middle-aged/older adults aged 50+ (n = 277, 45% women, Mage = 64.68 ± 7.83) in the United States completed measures of sleep and COVID-19-related anxiety. Multiple regressions examined whether anxiety was independently associated with or interacted with age or sex in its associations with sleep health, controlling for age, education, medical conditions, sleep/pain medication use, and COVID-19 status. Greater COVID-19 anxiety was associated with worse sleep quality and daytime dysfunction. COVID-19-related anxiety interacted with age (not sex) in associations with total sleep time and sleep efficiency. Greater anxiety was associated with shorter total sleep time and lower sleep efficiency in oldest-older adults (~73 years old) and youngest-older adults (~65 years old) but not middle-aged adults (~57 years old). In mid to late life, older adults may be most vulnerable to the impact of COVID-19-related anxiety on sleep health. Social and behavioral (e.g., knowledge on age-related vulnerability to COVID-19 risk/morbidity/mortality, uncertainty, and changes to daily routines) and physiological factors (sleep disruption and age-related autonomic dysfunction) may underlie these associations. Interventions that mitigate negative pandemic-related psychological and sleep outcomes may be particularly relevant for older adults.
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Affiliation(s)
- Ashley F. Curtis
- College of Nursing, University of South Florida, Tampa, FL 33612, USA
| | - Sadhika Jagannathan
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV 26506, USA;
| | - Madison Musich
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, MO 65211, USA;
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri-Columbia, Columbia, MO 65212, USA;
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Yu C, Liu Z, Su T, Li Z, Jiang Z, Zhong W, Xiao Z. The effect of anxiety on sleep disorders in medical students: a moderated mediation model. Front Psychol 2024; 15:1338796. [PMID: 38529089 PMCID: PMC10961465 DOI: 10.3389/fpsyg.2024.1338796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
The relationship between anxiety and sleep disorders is a key research topic in the academic community. However, evidence on the mechanism through which anxiety influences sleep disorders remains limited. The purpose of this study was to investigate the roles of flourishing and neuroticism in the mechanism through which anxiety influences sleep disorders in medical students. We constructed a moderated mediation model and tested the mediating role of flourishing and the moderating role of neuroticism in medical college students. The results showed that: (1) anxiety was significantly and positively related to sleep disorders and significantly and negatively related to flourishing; flourishing was significantly and negatively related to sleep disorders; neuroticism was significantly and positively related to sleep disorders; (2) flourishing had a mediation effect on the relationship between anxiety and sleep disorders; (3) neuroticism moderated the process through which flourishing mediated the effect of anxiety on sleep disorders. Our research expands the literature on the mechanism underlying the effects of anxiety on sleep disorders and provides insights into the potential prevention and intervention of sleep and emotional problems in medical students.
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Affiliation(s)
- Chuang Yu
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Zhiyi Liu
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Tiehong Su
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Zhongyu Li
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Zinan Jiang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Wen Zhong
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Zhongju Xiao
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
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Osao M, Okajima I, Inoue Y. Cross-sectional analyses of factors associated with the presence and aggravation of chronic insomnia by symptom subtypes. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e184. [PMID: 38868478 PMCID: PMC11114305 DOI: 10.1002/pcn5.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/06/2024] [Accepted: 03/01/2024] [Indexed: 06/14/2024]
Abstract
Aim The aim of this study was to investigate the association of psychological and chronobiological factors with the presence and severity of chronic insomnia by symptom subtypes and their impacts on daytime dysfunctions. Methods Participants of the present web-based epidemiological study were classified as follows: difficulty initiating sleep (DIS) (n = 91); difficulty maintaining sleep (DMS) (n = 13); early morning awakening (EMA) (n = 48); DIS + DMS (n = 67); DIS + EMA (n = 23); DMS + EMA (n = 24); triplet of DIS, DMS, and EMA symptoms (TRP) (n = 69); and normal sleepers (n = 4590). The Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), Munich Chronotype Questionnaire (MCTQ), insomnia-related psychological measures (including the Ford Insomnia Response to Stress Test [FIRST] and the Dysfunctional Beliefs and Attitudes about Sleep Scale [DBAS]), and the cognitive and somatic domains of the Pre-Sleep Arousal Scale (PSAS) were evaluated. Results The presence of DIS and DIS + DMS were significantly associated with an evening preference, and EMA and EMA + DMS with a morning preference, while TRP showed no significant association with either chronotype. The increase in DBAS scores was associated with higher ISI scores in all subtypes. Meanwhile, the associations of each psychological measure varied among insomnia subtypes, with the association of PSAS cognitive arousal to DIS and PSAS somatic arousal to both DMS + EMA and TRP. Pathological HADS score was associated with all subtypes. Conclusion Chronotypes may be associated with the presence of some insomnia subtypes; however, only psychological factors were speculated to contribute to the aggravation of all subtypes. All insomnia subtypes possibly contribute to the formation of depression.
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Affiliation(s)
| | - Isa Okajima
- Department of Psychological Counseling, Faculty of HumanitiesTokyo Kasei UniversityTokyoJapan
- Japan Somnology Center, Neuropsychiatric Research InstituteTokyoJapan
| | - Yuichi Inoue
- Japan Somnology Center, Neuropsychiatric Research InstituteTokyoJapan
- Department of SomnologyTokyo Medical UniversityTokyoJapan
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15
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Himelfarb M, Shatkin JP. Pediatric Insomnia. Psychiatr Clin North Am 2024; 47:121-134. [PMID: 38302201 DOI: 10.1016/j.psc.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Insomnia is the most common sleep disorder among all ages; unfortunately, however, child and adolescent insomnia is infrequently addressed. Given the importance of adequate sleep for proper brain development, pediatric populations are particularly vulnerable to the negative effects of insomnia. Therefore, proper clinical assessment and treatment of pediatric insomnia is crucial. This article is the result of a comprehensive literature review and serves as a guide to the disorder and how it presents differently across child development.
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Affiliation(s)
- Madeline Himelfarb
- Department of Child & Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Jess P Shatkin
- Department of Child & Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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16
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Jeong H, Yeo H, Lee KH, Kim N, Shin J, Seo MC, Jeon S, Lee YJ, Kim SJ. Brain structural correlates of subjective sleepiness and insomnia symptoms in shift workers. Front Neurosci 2024; 18:1330695. [PMID: 38440391 PMCID: PMC10909910 DOI: 10.3389/fnins.2024.1330695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/06/2024] [Indexed: 03/06/2024] Open
Abstract
Background Studies on the brain structures of shift workers are limited; thus, this cross-sectional study aimed to compare the brain structures and the brain structural correlates of subjective sleepiness and insomnia symptoms between shift workers and non-shift workers. Methods Shift workers (n = 63) and non-shift workers (n = 58) completed questionnaires assessing subjective sleepiness and insomnia symptoms. Cortical thickness, cortical surface area, and subcortical volumes were measured by magnetic resonance imaging. The brain morphometric measures were compared between the groups, and interaction analyses using the brain morphometric measures as the dependent variable were performed to test the interactions between the study group and measures of sleep disturbance (i.e., subjective sleepiness and insomnia symptoms). Results No differences in cortical thickness, cortical surface area, or subcortical volumes were detected between shift workers and non-shift workers. A single cluster in the left motor cortex showed a significant interaction between the study group and subjective sleepiness in the cortical surface area. The correlation between the left motor cortex surface area and the subjective sleepiness level was negative in shift workers and positive in non-shift workers. Significant interaction between the study group and insomnia symptoms was present for the left/right putamen volumes. The correlation between the left/right putamen volumes and insomnia symptom levels was positive in shift workers and negative in non-shift workers. Conclusion Left motor cortex surface area and bilateral putamen volumes were unique structural correlates of subjective sleepiness and insomnia symptoms in shift workers, respectively.
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Affiliation(s)
- Hyunwoo Jeong
- Department of Education and Training, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Hyewon Yeo
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyung Hwa Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Nambeom Kim
- Neuroscience Research Institute, Gachon University, Incheon, Republic of Korea
| | - Jiyoon Shin
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Cheol Seo
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sehyun Jeon
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
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Latief K, Akyirem S, Sithichoksakulchai S, Nurrika D, Sujarwadi M, Hasan F. The mediating effect of sleep disturbance on the association between hypertension and depression: a national data analysis. Clin Hypertens 2024; 30:5. [PMID: 38297373 PMCID: PMC10832256 DOI: 10.1186/s40885-024-00263-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Sleep disturbance is a common among people with hypertension. However, the mediating role of sleep disturbance in the association between hypertension and depression remains unclear. This study aims to investigate the mediating role of sleep disturbance in the association between hypertension and depression. MATERIALS AND METHODS This was cross-sectional study. The data were derived from the Indonesian Family Life Survey Fifth Wave (2014-2015). We include a total of 19,138 adults' participants with age range from 18 to 65 years old who completed response on the variable of hypertension, sleep disturbance, and depression. The mediating model analysis was processed using the PROCESS macro ins SPSS from Hayes model. RESULTS Depression was reported by 22% of total respondents. The group with hypertension showed a substantially higher prevalence of depression than non-hypertension group (P < 0.001). Hypertension had a significant overall effect on depression (β = 0.682; 95%CI 0.489 to 0.875, P < 0.001). The direct effect of hypertension on depression was significant (β = 0.418; 95%CI 0.244 to 0.592, P < 0.001) and the indirect effect that mediated by sleep disturbance was also significant (β = 0.264, 95%CI 0.174 to 0.356, P < 0.001). It is worth noting that sleep disturbance partially mediated the association between hypertension and depression. CONCLUSION The findings of this study indicated that sleep disturbance contributed to the etiology of depression and hypertension in adult populations. Nurses should be involved in managing sleep disturbances, such as using behavioral therapy, as it may serve as both a treatment and primary prevention measure for depression and hypertension.
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Affiliation(s)
- Kamaluddin Latief
- Global Health and Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Centre for Family Welfare, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Samuel Akyirem
- Yale School of Nursing, Yale University, New Haven, CT, USA
| | - Siriluk Sithichoksakulchai
- Department of Fundamental Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Dieta Nurrika
- Public Health Study Program, Banten School of Health Science, South Tangerang, Indonesia
- Culture, Research, and Technology, The Ministry of Education, Higher Education Service Institutions (LL-DIKTI) Region IV, Bandung, Indonesia
| | - Mokh Sujarwadi
- Faculty of Nursing, Universitas Jember, Jember, Indonesia
| | - Faizul Hasan
- Faculty of Nursing, Chulalongkorn University, Boromarajonani Srisataphat Building, 12th Floor Rama1 Road, Wang Mai, Pathum Wan, Bangkok, 10330, Thailand.
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Norton DW, Modesto O, Bennett JM, Fraser MI. Sleep disturbance mediates the link between both self-compassion and self-criticism and psychological distress during prolonged periods of stress. Appl Psychol Health Well Being 2024; 16:119-137. [PMID: 37501499 DOI: 10.1111/aphw.12474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
Poor sleep and subsequent decline in mental health often occur during times of prolonged stress, such as a pandemic. Self-compassion is linked with improved sleep and better mental health, while self-criticism is linked with poorer sleep and psychological distress. Given there is little evidence of the interrelationships of these constructs, we examined whether higher self-compassion or lower levels of self-criticism can reduce psychological distress directly and indirectly via sleep during times of prolonged stress. Structural equation modelling was used to analyse two samples (N = 722, Study 1, and N = 622, Replication Study) of university students during different stages of the pandemic. An aggregate psychological distress construct was calculated using depression, anxiety and stress measures. We created models that showed insomnia symptoms mediated the relationship between self-compassion/self-criticism and psychological distress. Sleep partially mediated both relationships, and this was the strongest effect in both samples. This suggests that improving self-compassion and reducing self-criticism will improve sleep, leading to reduced psychological distress. As our findings are robust and held at two time points, future research should investigate broader demographics and differing stress responses.
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Affiliation(s)
- David W Norton
- School of Behavioural Health Sciences, Australian Catholic University, Strathfield, Australia
| | - Oscar Modesto
- School of Behavioural Health Sciences, Australian Catholic University, Strathfield, Australia
| | - Joanne M Bennett
- School of Behavioural Health Sciences, Australian Catholic University, Strathfield, Australia
| | - Madeleine I Fraser
- School of Behavioural Health Sciences, Australian Catholic University, Strathfield, Australia
- Healthy Brain and Mind Research Centre, Australian Catholic University, Strathfield, Australia
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Hildebrand L, Huskey A, Dailey N, Jankowski S, Henderson-Arredondo K, Trapani C, Patel SI, Chen AYC, Chou YH, Killgore WDS. Transcranial Magnetic Stimulation of the Default Mode Network to Improve Sleep in Individuals With Insomnia Symptoms: Protocol for a Double-Blind Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e51212. [PMID: 38277210 PMCID: PMC10858423 DOI: 10.2196/51212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Cortical hyperarousal and ruminative thinking are common aspects of insomnia that have been linked with greater connectivity in the default mode network (DMN). Therefore, disrupting network activity within the DMN may reduce cortical and cognitive hyperarousal and facilitate better sleep. OBJECTIVE This trial aims to establish a novel, noninvasive method for treating insomnia through disruption of the DMN with repetitive transcranial magnetic stimulation, specifically with continuous theta burst stimulation (cTBS). This double-blind, pilot randomized controlled trial will assess the efficacy of repetitive transcranial magnetic stimulation as a novel, nonpharmacological approach to improve sleep through disruption of the DMN prior to sleep onset for individuals with insomnia. Primary outcome measures will include assessing changes in DMN functional connectivity before and after stimulation. METHODS A total of 20 participants between the ages of 18 to 50 years with reported sleep disturbances will be recruited as a part of the study. Participants will then conduct an in-person screening and follow-on enrollment visit. Eligible participants then conduct at-home actigraphic collection until their first in-residence overnight study visit. In a double-blind, counterbalanced, crossover study design, participants will receive a 40-second stimulation to the left inferior parietal lobule of the DMN during 2 separate overnight in-residence visits. Participants are randomized to the order in which they receive the active stimulation and sham stimulation. Study participants will undergo a prestimulation functional magnetic resonance imaging scan and a poststimulation functional magnetic resonance imaging scan prior to sleep for each overnight study visit. Sleep outcomes will be measured using clinical polysomnography. After their first in-residence study visit, participants conduct another at-home actigraphic collection before returning for their second in-residence overnight study visit. RESULTS Our study was funded in September 2020 by the Department of Defense (W81XWH2010173). We completed the enrollment of our target study population in the October 2022 and are currently working on neuroimaging processing and analysis. We aim to publish the results of our study by 2024. Primary neuroimaging outcome measures will be tested using independent components analysis, seed-to-voxel analyses, and region of interest to region of interest analyses. A repeated measures analysis of covariance (ANCOVA) will be used to assess the effects of active and sham stimulation on sleep variables. Additionally, we will correlate changes in functional connectivity to polysomnography-graded sleep. CONCLUSIONS The presently proposed cTBS protocol is aimed at establishing the initial research outcomes of the effects of a single burst of cTBS on disrupting the network connectivity of the DMN to improve sleep. If effective, future work could determine the most effective stimulation sites and administration schedules to optimize this potential intervention for sleep problems. TRIAL REGISTRATION ClinicalTrials.gov NCT04953559; https://clinicaltrials.gov/ct2/show/NCT04953559. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51212.
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Affiliation(s)
- Lindsey Hildebrand
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Alisa Huskey
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Natalie Dailey
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | - Samantha Jankowski
- Department of Psychiatry, University of Arizona, Tucson, AZ, United States
| | | | | | - Salma Imran Patel
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ, United States
| | | | - Ying-Hui Chou
- Department of Psychology, University of Arizona, Tucson, AZ, United States
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Zhang Y, Moore M, Jennings JS, Clark JD, Bayley PJ, Ashford JW, Furst AJ. The role of the brainstem in sleep disturbances and chronic pain of Gulf War and Iraq/Afghanistan veterans. Front Mol Neurosci 2024; 16:1266408. [PMID: 38260809 PMCID: PMC10800562 DOI: 10.3389/fnmol.2023.1266408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Gulf War Illness is a type of chronic multisymptom illness, that affects about 30% of veterans deployed to the 1990-91 Persian Gulf War. Veterans deployed to Iraq/Afghanistan after 2000 are reported to have a similar prevalence of chronic multisymptom illness. More than 30 years after the Persian Gulf War, Gulf War Illness still has an unexplained symptom complex, unknown etiology and lacks definitive diagnostic criteria and effective treatments. Our recent studies have found that substantially smaller brainstem volumes and lower fiber integrity are associated with increased sleep difficulty and pain intensity in 1990-91 Persian Gulf War veterans. This study was conducted to investigate whether veterans deployed to Iraq/Afghanistan present similar brainstem damage, and whether such brainstem structural differences are associated with major symptoms as in Gulf War Illness. Methods Here, we used structural magnetic resonance imaging and diffusion tensor imaging to measure the volumes of subcortices, brainstem subregions and white matter integrity of brainstem fiber tracts in 188 veterans including 98 Persian Gulf War veterans and 90 Iraq/Afghanistan veterans. Results We found that compared to healthy controls, veterans of both campaigns presented with substantially smaller volumes in brainstem subregions, accompanied by greater periaqueductal gray matter volumes. We also found that all veterans had reduced integrity in the brainstem-spinal cord tracts and the brainstem-subcortical tracts. In veterans deployed during the 1990-91 Persian Gulf War, we found that brainstem structural deficits significantly correlated with increased sleep difficulties and pain intensities, but in veterans deployed to Iraq/Afghanistan, no such effect was observed. Discussion These structural differences in the brainstem neurons and tracts may reflect autonomic dysregulation corresponding to the symptom constellation, which is characteristic of Gulf War Illness. Understanding these neuroimaging and neuropathological relationships in Gulf War and Iraq/Afghanistan veterans may improve clinical management and treatment strategies for modern war related chronic multisymptom illness.
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Affiliation(s)
- Yu Zhang
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Matthew Moore
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jennifer S. Jennings
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - J. David Clark
- Anesthesiology Service, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Peter J. Bayley
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - J. Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Ansgar J. Furst
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Zhao W, Van Someren EJW, Xu Z, Ren Z, Tang L, Li C, Lei X. Identifying the insomnia-related psychological issues associated with hyperarousal: A network perspective. Int J Psychophysiol 2024; 195:112276. [PMID: 38056632 DOI: 10.1016/j.ijpsycho.2023.112276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/30/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023]
Abstract
Hyperarousal, recognized as a fundamental characteristic of insomnia for decades, has yielded limited evidence concerning its direct psychological associations. This study aimed to explore the psychological factors linked to hyperarousal within the framework of interrelated variables. Two independent samples, comprising n = 917 and n = 652 young adults, were included in the study. Employing the first dataset as a discovery sample and the second dataset as a replication sample, network analyses were conducted using 26 variables derived from 17 scales. The objective was to estimate the direct and indirect associations between psychological issues, including hyperarousal and insomnia. Additionally, linear regression analysis was employed to assess the convergence of findings obtained from the network analysis. Network analyses in both samples converged to reveal direct associations between insomnia severity and several psychological factors, including negative sleep beliefs, physical fatigue, insomnia response to stress, hyperarousal, self-reported depression, and mental fatigue. Notably, the nodes with relative importance within the network include trait anxiety, depressive rumination, hyperarousal, perfectionism sub-dimension of concern over mistakes, and private self-consciousness. Hyperarousal is one of the key factors linking insomnia with a variety of psychological issues, including emotion-related factors (rumination, perveived stress), sleep-related factors (dysfunctional sleep beliefs and attitudes, insomnia response to stress, fatigue, chronotype), and self-related factors (self-consciousness, perfectionism). The results suggest that forthcoming strategies for enhancing the treatment efficacy of insomnia could consider supplementary interventions that specifically address hyperarousal, other factors directly linked to insomnia, or the hub nodes within the network.
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Affiliation(s)
- Wenrui Zhao
- Sleep Center, Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands; Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam UMC, Vrije Universiteit, the Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, Vrije Universiteit Amsterdam, the Netherlands
| | - Ziye Xu
- Sleep and Neuroimaging Center, Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Zhiting Ren
- Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing 400715, China
| | - Ling Tang
- Sleep Center, Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Chenyu Li
- Sleep Center, Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China.
| | - Xu Lei
- Sleep and Neuroimaging Center, Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality of the Ministry of Education, Faculty of Psychology, Southwest University, Chongqing 400715, China.
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Garcia-Borreguero D, Aragón AG, Moncada B, Romero S, Granizo JJ, Quintas S, Castillo M. Treatment of Sleep, Motor and Sensory Symptoms with the Orexin Antagonist Suvorexant in Adults with Idiopathic Restless Legs Syndrome: A Randomized Double-Blind Crossover Proof-of-Concept Study. CNS Drugs 2024; 38:45-54. [PMID: 38246901 DOI: 10.1007/s40263-023-01055-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Current treatment guidelines for restless legs syndrome (RLS) recommend treatment be initiated with non-dopaminergic drugs. Given the potential role of orexins in the pathophysiology of RLS, we performed a pilot, proof-of-concept study to investigate the therapeutic effects of suvorexant, a dual orexin receptor antagonist (DORA), on sleep and sensory/motor symptoms in individuals with idiopathic RLS. METHODS This was a randomized, double-blind, crossover and placebo-controlled study. Inclusion criteria were diagnosis with idiopathic RLS, an International RLS Study Group Severity Rating Scale (IRLS) score > 15, and the absence of significant RLS symptoms before 9 pm. Following washout from any previous central nervous system (CNS)-active drugs, patients were randomized to receive either suvorexant or placebo for two consecutive 2-week treatment periods. Treatment was administered at 9 pm at a fixed dose of 10 mg/day during the first week, and 20 mg during the second week. Primary and coprimary endpoints were wake after sleep onset (WASO) and total sleep time (TST), respectively, while IRLS rating scale score, multiple suggested immobilization tests (m-SIT), and periodic limb movements (PLMs) were secondary endpoints. RLS severity was measured weekly using the IRLS and Clinical Global Improvement (CGI) scales. m-SIT were also performed between 8 pm and midnight at the end of each treatment phase and were followed by a sleep study. RESULTS A total of 41 participants were randomized, 40 of whom completed the study. Compared with placebo, treatment with suvorexant significantly improved RLS symptoms (according to IRLS total score, CGI, and the m-SIT), PLM during sleep, and PLM with arousal. Improvement of RLS symptoms was greater in those who had not been exposed to dopaminergic agents in the past. Sleep architecture also improved with significant changes in TST, WASO, sleep onset latency, sleep efficiency, non rapid-eye movement stage 1 (N1) %, non rapid-eye movement stage 2 (N2) %, and rapid eye movement (REM) %. Suvorexant was well tolerated in RLS, with few and mild adverse events. CONCLUSIONS Our results provide the first proof of evidence of the therapeutic efficacy of DORAs in improving sleep and sensory and motor symptoms in RLS. Given orexin's role in pain and sensory processing, potential mechanisms of action are discussed. CLASSIFICATION OF EVIDENCE The study provides class II evidence supporting the therapeutic efficacy of suvorexant in patients with RLS with sleep disturbance. TRIAL REGISTRATION EudraCT#: 2017-004580-12.
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Affiliation(s)
| | | | - Brian Moncada
- Sleep Research Institute, Calle Padre Damián 44, 28036, Madrid, Spain
| | - Sofia Romero
- Sleep Research Institute, Calle Padre Damián 44, 28036, Madrid, Spain
| | | | - Sonia Quintas
- Sleep Research Institute, Calle Padre Damián 44, 28036, Madrid, Spain
| | - María Castillo
- Sleep Research Institute, Calle Padre Damián 44, 28036, Madrid, Spain
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23
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Knobbe TJ, Kremer D, Eisenga MF, van Londen M, Annema C, Bültmann U, Kema IP, Navis GJ, Berger SP, Bakker SJL. Sleep quality, fatigue, societal participation and health-related quality of life in kidney transplant recipients: a cross-sectional and longitudinal cohort study. Nephrol Dial Transplant 2023; 39:74-83. [PMID: 37418245 PMCID: PMC10730797 DOI: 10.1093/ndt/gfad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Fatigue and impaired health-related quality of life (HRQoL) are common among kidney transplant recipients (KTR). We hypothesized that both may partially be attributable to poor sleep. METHODS Cross-sectional and longitudinal data of KTR enrolled in the TransplantLines Biobank and Cohort Study were used. Sleep quality was assessed using the Pittsburgh Sleep Quality Index questionnaire. Individual strength (i.e. a composite of fatigue, concentration, motivation and physical activity), societal participation and HRQoL were assessed using validated questionnaires. RESULTS We included 872 KTR (39% female, age 56 ± 13 years) and 335 healthy controls. In total, 33% of male KTR and 49% of female KTR reported poor sleep quality, which was higher compared with male and female healthy controls (19% and 28%, respectively, P < .001 for both). In logistic regression analyses, female sex, anxiety, active smoking, low protein intake, physically inactive lifestyle, low plasma magnesium concentration, using calcineurin inhibitors, not using mTOR inhibitors and using benzodiazepine agonists were associated with poor sleep quality. In adjusted linear regression analyses, poor sleep was strongly and independently associated with lower individual strength [standardized β (st.β) = 0.59, 95% confidence interval (CI) 0.45 to 0.74, P < .001], poorer societal participation (frequency: st.β = -0.17, 95% CI -0.32 to -0.01, P = .04; restrictions: st.β = -0.36, 95% CI -0.51 to -0.21, P < .001; satisfaction: st.β = -0.44, 95% CI -0.59 to -0.28, P < .001) and lower HRQoL (physical: st.β = -0.53, 95% CI -0.68 to -0.38, P < .001; mental: st.β = -0.64, 95% CI -0.78 to -0.50, P < .001). The associations with poorer societal participation and lower HRQoL were strongly mediated by individual strength (P < .001 for all), yet the suggested direct effects of poor sleep quality on HRQoL remained significant (Pphysical = .03, Pmental = .002). Longitudinal data of 292 KTR showed that sleep quality improves after kidney transplantation in males (P < .001), but not in females (P = .9). CONCLUSIONS Poor sleep quality is common among KTR, and may be a potential target to improve fatigue, societal participation and HRQoL among KTR.
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Affiliation(s)
- Tim J Knobbe
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Coby Annema
- Department of Health Sciences, Section of Nursing Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ido P Kema
- Department of Laboratory Medicine Research, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan P Berger
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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24
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Fernandez FX, Perlis ML. Animal models of human insomnia. J Sleep Res 2023; 32:e13845. [PMID: 36748845 PMCID: PMC10404637 DOI: 10.1111/jsr.13845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/20/2023] [Indexed: 02/08/2023]
Abstract
Insomnia disorder (chronic sleep continuity disturbance) is a debilitating condition affecting 5%-10% of the adult population worldwide. To date, researchers have attempted to model insomnia in animals through breeding strategies that create pathologically short-sleeping individuals or with drugs and environmental contexts that directly impose sleeplessness. While these approaches have been invaluable for identifying insomnia susceptibility genes and mapping the neural networks that underpin sleep-wake regulation, they fail to capture concurrently several of the core clinical diagnostic features of insomnia disorder in humans, where sleep continuity disturbance is self-perpetuating, occurs despite adequate sleep opportunity, and is often not accompanied by significant changes in sleep duration or architecture. In the present review, we discuss these issues and then outline ways animal models can be used to develop approaches that are more ecologically valid in their recapitulation of chronic insomnia's natural aetiology and pathophysiology. Conditioning of self-generated sleep loss with these methods promises to create a better understanding of the neuroadaptations that maintain insomnia, including potentially within the infralimbic cortex, a substrate at the crossroads of threat habituation and sleep.
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Affiliation(s)
| | - Michael L. Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA
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25
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Rostampour M, Gharaylou Z, Rostampour A, Shahbodaghy F, Zarei M, Fadaei R, Khazaie H. Study of structural network connectivity using DTI tractography in insomnia disorder. Psychiatry Res Neuroimaging 2023; 336:111730. [PMID: 37944426 DOI: 10.1016/j.pscychresns.2023.111730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 10/01/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023]
Abstract
Most of tractography studies on insomnia disorder (ID) have reported decreased structural connectivity between cortical and subcortical structures. Tractography based on standard diffusion tensor imaging (DTI) can generate high number of false-positive streamlines connections between gray matter regions. In the present study, we employed the convex optimization modeling for microstructure informed tractography-2 (COMMIT2) to improve the accuracy of the reconstructed whole-brain connectome and filter implausible brain connections in 28 patients with ID and compared with 27 healthy controls. Then, we used NBS-predict (a prediction-based extension to the network-based statistic method) in the COMMIT2-weighted connectome. Our results revealed decreased structural connectivity between subregions of the left somatomotor, ventral attention, frontoparietal, dorsal attention and default mode networks in the insomnia group. Moreover, there is a negative correlation between sleep efficiency and structural connectivity within the left frontoparietal, visual, default mode network, limbic, dorsal attention, right dorsal attention as well as right default mode networks. By comparing with standard connectivity analysis, we showed that by removing of false-positive streamlines connections after COMMIT2 filtering, abnormal structural connectivity was reduced in patients with ID compared to controls. Our results demonstrate the importance of improving the accuracy of tractography for understanding structural connectivity networks in ID.
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Affiliation(s)
- Masoumeh Rostampour
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Ali Rostampour
- Department of Computer Engineering and Information Technology, Payame Noor University, Tehran, Iran
| | - Fatemeh Shahbodaghy
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Mojtaba Zarei
- Department of Neurology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Institute of Medical Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Reza Fadaei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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26
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Coelho J, Sanchez-Ortuño MM, Martin VP, Gauld C, Richaud A, Lopez R, Pelou M, Abi-Saab P, Philip P, Geoffroy PA, Palagini L, Micoulaud-Franchi JA. Content analysis of insomnia questionnaires: A step to better evaluate the complex and multifaceted construct of insomnia disorder. Psychiatry Res 2023; 330:115584. [PMID: 37944205 DOI: 10.1016/j.psychres.2023.115584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
Insomnia disorder is a mental disorder that includes various types of symptoms (e.g., insomnia initiating, worries, mood disturbances) and impairments (e.g., distress related to sleep alterations). Self-report questionnaires are the most common method for assessing insomnia but no systematic quantified analysis of their content and overlap has been carried out. We used content analysis and a visualization method to better identify the different types of clinical manifestations that are investigated by nine commonly used insomnia questionnaires for adults and the Jaccard index to quantify the degree to which they overlap. Content analysis found and visualized 16 different clinical manifestations classified into five dimensions ("Insomnia symptoms", "Insomnia-related symptoms", "Daytime symptoms", "Insomnia-related impairments", "Sleep behaviors"). The average Jaccard Index was 0.409 (moderate overlap in content). There is a lack of distinction between symptoms and impairments, and the assessment of sleep duration and hyperarousal symptoms remains overlooked. This preliminary analysis makes it possible to visualize the content of each of the nine questionnaires and to select the most appropriate questionnaire based on the issue to be addressed. Suggestions are made regarding the development of future questionnaires to better distinguish symptoms and impairments, and the different phenotypes of insomnia disorder.
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Affiliation(s)
- Julien Coelho
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France.
| | - Maria Montserrat Sanchez-Ortuño
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; Department of Nursing, School of Nursing, University of Murcia, Murcia, Spain
| | - Vincent P Martin
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Bordeaux, CNRS, Bordeaux INP, LaBRI, UMR 5800, Talence F-33400, France
| | - Christophe Gauld
- Service Psychopathologie du Développement de l'Enfant et de l'Adolescent, Hospices Civils de Lyon & Université de Lyon 1, France; Institut des Sciences Cognitives Marc Jeannerod, UMR 5229 CNRS & Université Claude Bernard Lyon, France
| | - Alexandre Richaud
- University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France
| | - Régis Lopez
- Institut des Neurosciences de Montpellier (INM), University Montpellier, Montpellier 34000, France; Unité des Troubles du Sommeil, Département de Neurologie, CHU Montpellier, Montpellier 34000, France
| | - Marie Pelou
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France
| | - Poeiti Abi-Saab
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France
| | - Pierre Philip
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France
| | - Pierre-Alexis Geoffroy
- Département de Psychiatrie et D'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat-Claude Bernard, Paris 75018, France; GHU Paris-Psychiatry & Neurosciences, 1 Rue Cabanis, Université de Paris, NeuroDiderot, Inserm, Paris 75019, France
| | - Laura Palagini
- Psychiatric Clinic, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana AUOP, Pisa 56126, Italy; Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara 44121, Italy
| | - Jean-Arthur Micoulaud-Franchi
- University Bordeaux, CNRS, SANPSY, UMR 6033, Bordeaux F-33000, France; University Sleep Clinic, University Hospital of Bordeaux, Place Amélie Raba-Leon, Bordeaux 33 076, France
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27
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Altena E, Ellis J, Camart N, Guichard K, Bastien C. Mechanisms of cognitive behavioural therapy for insomnia. J Sleep Res 2023; 32:e13860. [PMID: 36866434 DOI: 10.1111/jsr.13860] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 03/04/2023]
Abstract
Although much is known now about behavioural, cognitive and physiological consequences of insomnia, little is known about changes after cognitive behavioural therapy for insomnia on these particular factors. We here report baseline findings on each of these factors in insomnia, after which we address findings on their changes after cognitive behavioural therapy. Sleep restriction remains the strongest determinant of insomnia treatment success. Cognitive interventions addressing dysfunctional beliefs and attitudes about sleep, sleep-related selective attention, worry and rumination further drive effectiveness of cognitive behavioural therapy for insomnia. Future studies should focus on physiological changes after cognitive behavioural therapy for insomnia, such as changes in hyperarousal and brain activity, as literature on these changes is sparse. We introduce a detailed clinical research agenda on how to address this topic.
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Affiliation(s)
| | - Jason Ellis
- Northumbria Centre for Sleep Research, Northumbria University, Newcastle, UK
| | - Nathalie Camart
- UR CLIPSYD, UFR SPSE, Département de psychologie, Université Paris Nanterre, Nanterre, France
- Cabinet Pôle Psy République, Bordeaux, France
- Nouvelle Clinique Bel Air- PEAS, Bordeaux, France
| | - Kelly Guichard
- Nouvelle Clinique Bel Air- PEAS, Bordeaux, France
- CHU Bordeaux, Centre Hypersomnies Rares, Bordeaux, France
| | - Célyne Bastien
- Ecole de Psychologie, Université Laval, Québec, Québec, Canada
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28
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Li B, Hsieh YR, Lai WD, Tung TH, Chen YX, Yang CH, Fang YC, Huang SY. Melatonin Ameliorates Neuropsychiatric Behaviors, Gut Microbiome, and Microbiota-Derived Metabolites in Rats with Chronic Sleep Deprivation. Int J Mol Sci 2023; 24:16820. [PMID: 38069141 PMCID: PMC10706682 DOI: 10.3390/ijms242316820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
With the increasing prevalence of sleep deprivation (SD)-related disorders, the effective treatment of sleep disorders has become a critical health research topic. Thus, we hypothesized and investigated the effectiveness of a 3-week melatonin intervention on neuropsychiatric behavioral responses mediated throughout melatonin receptors, gut microbiota, and lipid metabolites in rats with chronic SD. Eighteen 6-week-old Wistar rats were used and divided into the control grup (C, n = 6), SD group (n = 6), and melatonin-supplemented group (SDM, n = 6). During weeks 0 to 6, animals were provided with the AIN-93M diet and free access to water. Four-week chronic SD was conducted from weeks 7 to 10. Exogenous melatonin administration (10 mg/kg BW) was injected intraperitoneally 1 h before the daily administration of SD for 3 weeks in the SDM group. SD rats exhibited anxiety-like behavior, depression-like behavior, and cognitive impairment. Exogenous melatonin administration ameliorated neuropsychiatric behaviors induced by chronic SD. Analysis of fecal metabolites indicated that melatonin may influence brain messaging through the microbiota-gut-brain axis by increasing the production of short-chain fatty acids (SCFA) and decreasing the production of secondary bile acids (SBA). Four-week SD reduced the cerebral cortex expression of MT1, but not in the colon. Chronic SD led to anxiety and depression-like behaviors and cognitive decline, as well as the reduced intestinal level of SCFAs and the enhanced intestinal level of SBAs in rats. In this work, we confirmed our hypothesis that a 3-week melatonin intervention on neuropsychiatric behavioral response mediated throughout melatonin receptors, gut microbiota, and lipid metabolites in rats with chronic SD.
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Affiliation(s)
- Bingcong Li
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110301, Taiwan; (B.L.); (Y.-R.H.)
| | - Yin-Ru Hsieh
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110301, Taiwan; (B.L.); (Y.-R.H.)
| | - Wen-De Lai
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110301, Taiwan; (B.L.); (Y.-R.H.)
| | - Te-Hsuan Tung
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110301, Taiwan; (B.L.); (Y.-R.H.)
| | - Yu-Xuan Chen
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110301, Taiwan; (B.L.); (Y.-R.H.)
| | - Chia-Hui Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110301, Taiwan; (B.L.); (Y.-R.H.)
| | - Yu-Chiao Fang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110301, Taiwan; (B.L.); (Y.-R.H.)
| | - Shih-Yi Huang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110301, Taiwan; (B.L.); (Y.-R.H.)
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei 110301, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110301, Taiwan
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei 110301, Taiwan
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29
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Huang FFY, Liu HT. Path Model Analysis of the Effects of Perceived Formalism, and Fear of COVID-19 on Police Officers' PTSD and Insomnia. Behav Sci (Basel) 2023; 13:867. [PMID: 37887517 PMCID: PMC10604008 DOI: 10.3390/bs13100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023] Open
Abstract
This study examines whether law enforcement officers' fear of COVID-19, job burnout, and job stress have increased their PTSD and insomnia during the epidemic. This article introduces the perceived formalism of police agencies into the causal model to explore whether perceived formalism increases the job burnout and job stress of police officers. The formalism of administrative agencies is rarely included in epidemic research. This study collected 306 Taiwanese police officers as research subjects. We used confirmatory factor analysis and SEM for hypothesis testing. The study found that perceived formalism positively affects the job burnout and job stress of police officers. Job stress, fear of COVID-19, and job burnout positively affect PTSD and insomnia.
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Affiliation(s)
- Frank Fu-Yuan Huang
- Department of Criminal Justice, Ming Chuan University, Taoyuan City 333, Taiwan
| | - Hsiang-Te Liu
- Department of Public Affairs and Administration, Ming Chuan University, Taoyuan City 333, Taiwan
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30
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Grey I. Generalized Anxiety Mediates the Relationship Between Loneliness and Sleep Quality Amongst Young Adults During the COVID-19 Pandemic. Psychol Rep 2023; 126:2141-2157. [PMID: 35343313 PMCID: PMC8958334 DOI: 10.1177/00332941221079723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Since the outbreak of COVID-19, restrictions to minimize its spread have had a profound effect. Government instigated restrictions, such as social isolation, have affected millions worldwide, and the downstream consequences of perceived loneliness upon mental health and sleep are largely unknown. A total of 1662 individuals participated in an online survey. Loneliness, anxiety, and sleep quality were assessed using the UCLA Loneliness Scale, the Generalized Anxiety Disorders scale, and the Pittsburgh Sleep Quality Index, respectively. Higher levels of perceived loneliness, as well as each one-unit increase in anxiety, were independent predictors of poor sleep quality, where OR = 1.16 (95% CI: 1.03-1.31) and 1.16 (1.11-1.21), respectively, and after adjustment. In our path analysis, we revealed significant direct effects between loneliness and sleep quality (β = 0.25, p < .001), as well as generalized anxiety and sleep quality (β = 0.28, p < .001), and generalized anxiety mediated the relationship between loneliness and sleep quality (β = 0.33, p < .001). Heightened anxiety and perceived loneliness appear to be significant drivers of poor sleep quality during the COVID-19 pandemic. Digital media platforms that encourage support groups for those experiencing social isolation are encouraged, along with self-help and meditative practices, which may minimize an increase of mental health and sleep disorder diagnoses post COVID-19.
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Affiliation(s)
- Ian Grey
- Department of Cognitive Sciences-Psychology, United Arab Emirates University, Abu Dhabi, United Arab Emirates
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31
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González-Hijón J, Kähler AK, Frans EM, Valdimarsdóttir UA, Sullivan PF, Fang F, Lovik A. Unravelling the link between sleep and mental health during the COVID-19 pandemic. Stress Health 2023; 39:828-840. [PMID: 36649144 DOI: 10.1002/smi.3223] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/18/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Abstract
The emergence of COVID-19 brought unparalleled changes in people's lifestyle, including sleep. We aimed to assess the bidirectional association between sleep quality and mental health and describe how sleep and mental health were affected in Sweden during the COVID-19 pandemic (between June 2020 and September 2021). Data were obtained from the Omtanke2020 study. Participants who completed the baseline survey and each of the 8 monthly follow-up surveys were included (N = 9035). We described the distribution of sleep and mental health in the different Swedish regions using maps and over the study period with longitudinal graphs adjusting for sex, age, recruitment type (self-recruitment or invitation), and COVID-19 status. The inner relationships between mental health, sleep and Covid infection were described through relative importance networks. Finally, we modelled how mental health affects sleep and vice versa using generalized estimating equations with different adjustments. Seasonal and north-south regional variations were found in sleep and mental health outcomes at baseline and attenuated over time. The seasonal variation of sleep and mental health correlated moderately with the incidence rate of COVID-19 in the sample. Networks indicate that the relationship between COVID-19 incidence and mental health varies over time. We observed a bidirectional relationship between sleep quality and quantity at baseline and mental health at follow-up and vice versa. Sleep quality and quantity at baseline was associated with adverse symptom trajectories of mental health at follow-up, and vice versa, during the COVID-19 pandemic. There was also a weak relationship between COVID-19 incidence, sleep, and mental health.
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Affiliation(s)
| | - Anna K Kähler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Emma M Frans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Unnur A Valdimarsdóttir
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
- Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Anikó Lovik
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
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32
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Shen Y, Gellis LA. Insomnia severity and its correlates among English as a second language (ESL) college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2286-2293. [PMID: 34449296 DOI: 10.1080/07448481.2021.1967360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/14/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Little is known about insomnia characteristics among the English as a second language (ESL) student population. This study compared insomnia severity between ESL students and English native-speaking students and identified correlates of insomnia in the ESL population. PARTICIPANTS College students (N = 352) from a private university in the Northeastern United States, including 22.4% (N = 79) ESL students. METHODS For this cross-sectional study, participants completed the Insomnia Severity Index and indices of common risk factors of insomnia along with acculturation and language anxiety. RESULTS ESL students reported higher insomnia severity than their US counterparts after controlling for depression, anxiety, and demographics. General anxiety, language anxiety, and cognitive pre-sleep arousal were selected as the strongest predictors of insomnia among the ESL population. CONCLUSIONS Findings suggest that ESL college group is vulnerable to greater insomnia, and language anxiety is unique and important correlate of insomnia in this population.
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Affiliation(s)
- Yuqi Shen
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Les A Gellis
- Department of Psychology, Syracuse University, Syracuse, New York, USA
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Xiao H, Shen Y, Zhang W, Lin R. Applicability of the cognitive model of generalized anxiety disorder to adolescents' sleep quality: A cross-sectional and longitudinal analysis. Int J Clin Health Psychol 2023; 23:100406. [PMID: 37663041 PMCID: PMC10472235 DOI: 10.1016/j.ijchp.2023.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background Poor sleep quality is a prevalent health issue among adolescents, and few studies have examined the variables affecting adolescents' sleep quality from the perspective of the co-occurrence of sleep issues and anxiety disorders. Therefore, the current study investigated whether the cognitive model of generalized anxiety disorder applies to adolescents' sleep quality. Method In Study 1, a total of 2042 adolescents were recruited and they completed questionnaires relating to worry, intolerance of uncertainty (IU), negative problem orientation (NPO), cognitive avoidance (CA), and sleep quality. In Study 2, a total of 379 adolescents participated in a six-month longitudinal survey to verify the model that was obtained in Study 1. Results Study 1 showed the modified cognitive model of generalized anxiety disorder can be applied to adolescents' sleep quality. Specifically, IU was a higher-order vulnerability factor that directly affected worry, and indirectly fostered worry via NPO and CA, where worry only mediated the relationships between IU, NPO, and sleep quality. However, CA exerted no independent effect on worry or sleep quality beyond the influences of IU and NPO, therefore, it dropped out of the final model. Study 2 partially confirmed the above model again from the longitudinal perspective. Conclusion The present study constructs a new model to explain adolescents' sleep quality, providing a foundation for future interventions.
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Affiliation(s)
- Huiwen Xiao
- School of Psychology, Fujian Normal University, Fuzhou 350117, China
- Department of Psychology, Renmin University of China, Beijing 100872, China
| | - Yilin Shen
- School of Psychology, Fujian Normal University, Fuzhou 350117, China
| | - Weizhong Zhang
- School of Psychology, Fujian Normal University, Fuzhou 350117, China
| | - Rongmao Lin
- School of Psychology, Fujian Normal University, Fuzhou 350117, China
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Dougherty EN, Johnson NK, Badillo K, Haedt-Matt AA. Sleep reactivity is associated with social anxiety and disordered-eating behaviors in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2280-2285. [PMID: 34469257 DOI: 10.1080/07448481.2021.1967359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/17/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
Objective: Investigate whether sleep reactivity was associated with social anxiety and disordered-eating behaviors in a college population. Participants: One hundred ninety-eight college-age men and women. Methods: Participants completed self-report measures of social anxiety, disordered-eating behaviors and sleep reactivity. Results: Sleep reactivity was associated with greater dietary restriction and purging, controlling for social anxiety but it was not associated with binge eating. Sleep reactivity was associated with elevated symptoms of social anxiety, controlling for disordered-eating behaviors. Conclusions: The results suggest that sleep reactivity represents a shared correlate of disordered-eating behaviors and social anxiety that may partially explain their co-occurrence. Interventions to help college students high in sleep reactivity effectively manage stress and regulate their sleep may aid in the prevention and treatment of social anxiety and disordered-eating behaviors.
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Affiliation(s)
| | - Nicole K Johnson
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Krystal Badillo
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Alissa A Haedt-Matt
- Department of Psychology, Illinois Institute of Technology, Chicago, Illinois, USA
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Lai M, Gao Y, Lu L, Huang X, Gong Q, Li J, Jiang P. Functional connectivity of the left inferior parietal lobule mediates the impact of anxiety and depression symptoms on sleep quality in healthy adults. Cereb Cortex 2023; 33:9908-9916. [PMID: 37429833 DOI: 10.1093/cercor/bhad253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/12/2023] Open
Abstract
Individuals with anxiety and depression symptoms are vulnerable to sleep disturbances. The current study aimed to explore the shared neuro-mechanisms underlying the effect of anxiety and depression symptoms on sleep quality. We recruited a cohort of 92 healthy adults who underwent functional magnetic resonance imaging scanning. We measured anxiety and depression symptoms using the Zung Self-rating Anxiety/Depression Scales and sleep quality using the Pittsburgh Sleep Quality Index. Independent component analysis was used to explore the functional connectivity (FC) of brain networks. Whole-brain linear regression analysis showed that poor sleep quality was associated with increased FC in the left inferior parietal lobule (IPL) within the anterior default mode network. Next, we extracted the covariance of anxiety and depression symptoms using principal component analysis to represent participants' emotional features. Mediation analysis revealed that the intra-network FC of the left IPL mediated the association between the covariance of anxiety and depression symptoms and sleep quality. To conclude, the FC of the left IPL may be a potential neural substrate in the association between the covariance of anxiety and depression symptoms and poor sleep quality, and may serve as a potential intervention target for the treatment of sleep disturbance in the future.
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Affiliation(s)
- Mingfeng Lai
- Mental Health Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yingxue Gao
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, 610041 Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, 610041 Chengdu, China
| | - Lu Lu
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, 610041 Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, 610041 Chengdu, China
| | - Xiaoqi Huang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, 610041 Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, 610041 Chengdu, China
| | - Qiyong Gong
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, 610041 Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, 610041 Chengdu, China
| | - Jing Li
- Mental Health Center, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ping Jiang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, 610041 Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, 610041 Chengdu, China
- West China Medical Publishers, West China Hospital, Sichuan University, 610041 Chengdu, China
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Messman BA, Slavish DC, Briggs M, Ruggero CJ, Luft BJ, Kotov R. Daily Sleep-Stress Reactivity and Functional Impairment in World Trade Center Responders. Ann Behav Med 2023; 57:582-592. [PMID: 37078921 DOI: 10.1093/abm/kaad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND How sleep is impacted by stress ("sleep reactivity to stress") and how stress is impacted by sleep ("stress reactivity to sleep") are trait-like characteristics of individuals that predict depression, anxiety, and insomnia. However, pathways between reactivity and functional impairment (e.g., impairment in social relationships and interpersonal functioning) have not been explored, which may be a critical pathway in understanding the link between reactivity and the development of psychological disorders. PURPOSE We examined associations between reactivity and changes in functional impairment among a cohort of 9/11 World Trade Center responders. METHODS Data from 452 responders (Mage = 55.22 years; 89.4% male) were collected between 2014 and 2016. Four baseline sleep and stress reactivity indices (i.e., sleep duration and efficiency reactivity to stress; stress reactivity to sleep duration and efficiency) were calculated from 14 days of sleep and stress data using random slopes from multilevel models. Functional impairment was assessed approximately 1 year and 2 years after baseline via semi-structured interviews. Latent change score analyses examined associations between baseline reactivity indices and changes in functional impairment. RESULTS Greater baseline sleep efficiency reactivity to stress was associated with decreases in functioning (β = -0.05, p = .039). In addition, greater stress reactivity to sleep duration (β = -0.08, p = .017) and sleep efficiency (β = -0.22, p < .001) was associated with lower functioning at timepoint one. CONCLUSION People who are more reactive to daily fluctuations in stress and sleep have poorer interpersonal relationships and social functioning. Identifying individuals with high reactivity who could benefit from preventative treatment may foster better social integration.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Madasen Briggs
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Benjamin J Luft
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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Caliandro M, Carbonara R, Surgo A, Ciliberti MP, Di Guglielmo FC, Bonaparte I, Paulicelli E, Gregucci F, Turchiano A, Fiorentino A. The Role of Telemedicine for Psychological Support for Oncological Patients Who Have Received Radiotherapy. Curr Oncol 2023; 30:5158-5167. [PMID: 37232848 DOI: 10.3390/curroncol30050390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
AIM In our radiation departments, all patients received psycho-oncological support during RT and during follow-up. Based on the latter, the aim of this retrospective analysis was to evaluate the role of tele-visits and in-person psychological support for cancer patients after RT, and to report a descriptive analysis pointing out the needs of psychosocial intervention in a radiation department during radiation treatment. METHODS According to our institutional care management, all patients receiving RT were prospectively enrolled to receive charge-free assessment of their cognitive, emotional and physical states and psycho-oncological support during treatment. For the whole population who accepted the psychological support during RT, a descriptive analysis was reported. For all patients who agreed to be followed up by a psycho-oncologist, at the end of RT, a retrospective analysis was conducted to evaluate the differences between tele-consultations (video-call or telephone) and on-site psychological visits. Patients were followed up by on-site psychological visit (Group-OS) or tele-consult (Group-TC) visit. For each group, to evaluate anxiety, depression and distress, the Hospital Anxiety Depression Scale (HADS), Distress Thermometer and Brief COPE (BC) were used. RESULTS From July 2019 to June 2022, 1145 cases were evaluated during RT with structured psycho-oncological interviews for a median of 3 sessions (range 2-5). During their first psycho-oncological interview, all the 1145 patients experienced the assessment of anxiety, depression and distress levels with the following results: concerning the HADS-A scale, 50% of cases (574 patients) reported a pathological score ≥8; concerning the HADS-D scale, 30% of cases (340 patients) reported a pathological score ≥8, concerning the DT scale, 60% (687 patients) reported a pathological score ≥4. Eighty-two patients were evaluated after RT: 30 in the Group-OS and 52 in the Group-TC. During follow-up, a median of 8 meetings (range 4-28) were performed. Comparing psychological data at baseline (beginning of RT) and at the last follow-up, in the entire population, a significant improvement in terms of HADS-A, global HADS and BC was shown (p 0.04; p 0.05; and p 0.0008, respectively). Compared to baseline, statistically significant differences were observed between the two groups in terms of anxiety in favor of on-site visit: Group-OS reported a better anxiety score compared with Group-TC. In each group, a statistical improvement was observed in BC (p 0.01). CONCLUSION The study revealed optimal compliance to tele-visit psychological support, even if the anxiety could be better controlled when patients were followed up on-site. However, rigorous research on this topic is needed.
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Affiliation(s)
- Morena Caliandro
- Radiation Oncology Department, General Regional Hospital F. Miulli, Strada Provinciale 127, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Roberta Carbonara
- Radiation Oncology Department, General Regional Hospital F. Miulli, Strada Provinciale 127, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Alessia Surgo
- Radiation Oncology Department, General Regional Hospital F. Miulli, Strada Provinciale 127, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Maria Paola Ciliberti
- Radiation Oncology Department, General Regional Hospital F. Miulli, Strada Provinciale 127, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Fiorella Cristina Di Guglielmo
- Radiation Oncology Department, General Regional Hospital F. Miulli, Strada Provinciale 127, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Ilaria Bonaparte
- Radiation Oncology Department, General Regional Hospital F. Miulli, Strada Provinciale 127, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Eleonora Paulicelli
- Radiation Oncology Department, General Regional Hospital F. Miulli, Strada Provinciale 127, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Fabiana Gregucci
- Radiation Oncology Department, General Regional Hospital F. Miulli, Strada Provinciale 127, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Angela Turchiano
- Radiation Oncology Department, General Regional Hospital F. Miulli, Strada Provinciale 127, Acquaviva delle Fonti, 70021 Bari, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Strada Provinciale 127, Acquaviva delle Fonti, 70021 Bari, Italy
- Department of Medicine and Surgery, LUM University, Casamassima, 70010 Bari, Italy
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Yuksel D, Kiss O, Prouty D, Arra N, Volpe L, Baker FC, de Zambotti M. Stress, hypothalamic pituitary adrenal axis activity and autonomic nervous system function in adolescents with insomnia. Int J Psychophysiol 2023; 187:43-53. [PMID: 36822502 PMCID: PMC10041935 DOI: 10.1016/j.ijpsycho.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Abnormal stress responses have been linked to the etiology of insomnia. We investigated the relationship between insomnia, stress, hypothalamic-pituitary-adrenal (HPA) axis activity, and autonomic nervous system (ANS) function in adolescence. METHODS Forty-seven post-pubertal adolescents (16-20 years old, 28 female) with (N = 16; insomnia group) and without (N = 31; control group) DSM-5 insomnia symptoms were assessed for stress levels and stress reactivity and underwent a standardized stress protocol (Trier Social Stress Test (TSST)), after an overnight laboratory stay. Cortisol was measured upon awakening and 30-minutes later to calculate the cortisol awakening response (CAR). During the TSST, perceived stress, salivary cortisol (HPA activity), heart rate (HR) and blood pressure (BP) measures were collected. RESULTS Participants in the insomnia group reported more stress from school performance and work overload, with insomnia girls experiencing more stress from peer pressure and future uncertainty than control girls (p < 0.05). No group differences were detected in the CAR and pre-TSST stress levels. All participants showed significant increases in perceived stress (~19 %), HR (~33 %), systolic (~13 %), and diastolic (~15 %) BP in response to the TSST (p < 0.05). Overall HR stress response did not differ between groups, but was lower in boys with insomnia than in girls with insomnia (p < 0.05). Cortisol stress responses were inconclusive, possibly due to a masking effect of CAR, as the task was performed shortly after awakening and larger CARs were associated with blunted cortisol stress responses. DISCUSSION Results mostly show no group difference in physiological stress responses, although some interaction effects suggest a potential sex by insomnia interaction. Larger samples are needed to understand the physiological disturbances of insomnia in adolescence.
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Affiliation(s)
- Dilara Yuksel
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Orsolya Kiss
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Devin Prouty
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Nicole Arra
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Laila Volpe
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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Almeida F, Marques DR, Gomes AA. A preliminary study on the association between social media at night and sleep quality: The relevance of FOMO, cognitive pre-sleep arousal, and maladaptive cognitive emotion regulation. Scand J Psychol 2023; 64:123-132. [PMID: 36256468 DOI: 10.1111/sjop.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 07/14/2022] [Accepted: 09/22/2022] [Indexed: 12/01/2022]
Abstract
Research shows that nighttime social media is negatively associated with sleep quality and that it might be utilized to cope with aversive psychological states related to cognitive pre-sleep arousal (i.e., transdiagnostic psychopathology variables, referring to maladaptive repetitive thought), namely Fear of Missing Out (FoMO). The use of nighttime social media to cope with other aversive cognitive states (i.e., worry/rumination), their relationship with FoMO, and these variables' association with sleep are not fully understood. This study explored the relationships between nighttime social media, sleep quality, FoMO, cognitive pre-sleep arousal, and maladaptive cognitive emotion regulation (i.e., worry/rumination). The present correlational study followed a cross-sectional design. Participants were 525 university students, ranging in age from 18 to 64 (M = 22.39, SD = 5.62). Measures of sleep quality, morningness/eveningness, cognitive pre-sleep arousal, worry, rumination, FoMO, nighttime screen, and social media use were collected online or in pencil-paper format. Multiple linear regression analyses were performed. Nighttime social media and FoMO were associated with rumination, worry (H1) and cognitive pre-sleep arousal. Both FoMO and worry predicted higher levels of cognitive pre-sleep arousal (H2) and nighttime social media use (H3). Nighttime social media use independently predicted poor sleep quality (H4). These results suggest that worry and FoMO may potentially affect sleep quality by increasing cognitive pre-sleep arousal and nighttime social media. A possible explanation for these findings is that nighttime social media might be used as a strategy to cope with aversive cognitive states. These conclusions may contribute to improving sleep intervention in this population.
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Affiliation(s)
- Filipa Almeida
- University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
| | - Daniel R Marques
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
- University of Aveiro, Department of Education and Psychology, Aveiro, Portugal
| | - Ana A Gomes
- University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal
- University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
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Cognitive behavioral therapy and acceptance and commitment therapy for insomnia: Exploring the potential benefit of psychological flexibility and self-compassion combined with behavioral strategies. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2023.101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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Frase L, Feige B, Gioia I, Loeck VK, Domschke K, Dressle RJ, Kilian H, Spiegelhalder K, Schläpfer T, Riemann D. No alterations in potential indirect markers of locus coeruleus-norepinephrine function in insomnia disorder. J Sleep Res 2023:e13872. [PMID: 36889676 DOI: 10.1111/jsr.13872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/03/2023] [Accepted: 02/24/2023] [Indexed: 03/10/2023]
Abstract
The norepinephrine locus coeruleus system (LC NE) represents a promising treatment target in patients with insomnia disorder (ID) due to its well understood links to arousal and sleep regulation. However, consistent markers of LC NE activity are lacking. This study measured three potential indirect markers of LC NE activity - REM sleep, P3 amplitude during an auditory oddball paradigm (as a marker of phasic LC activation), and baseline pupil diameter (as a marker of tonic LC activation). The parameters were then combined in a statistical model and tested to compare LC NE activity between 20 subjects with insomnia disorder (13 female; age 44.2 ± 15.1 year) and 20 healthy, good sleeping controls (GSC; 11 female; age 45.4 ± 11.6 year). No group differences regarding the primary outcome parameters were detected. Specifically, insomnia disorder did not display the hypothesised changes in markers of LC NE function. While increased LC NE function remains an interesting speculative pathway for hyperarousal in insomnia disorder, the investigated markers do not appear closely related to each other and fail to discriminate between insomnia disorder and good sleeping controls in these samples.
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Affiliation(s)
- Lukas Frase
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - Bernd Feige
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - Isabella Gioia
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - Viveka K Loeck
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany.,Center for Basics in Neuromodulation, University of Freiburg - Faculty of Medicine, Freiburg, Germany
| | - Raphael J Dressle
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - Hannah Kilian
- Division for Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - Thomas Schläpfer
- Division for Interventional Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg - Faculty of Medicine, University of Freiburg, Breisgau, Germany
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Hrozanova M, Meisingset I, Kallestad H, Pallesen S, Nordstoga AL, Skarpsno ES. Group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia in primary care: study protocol for a pragmatic, multicentre randomized controlled trial. BMC PRIMARY CARE 2023; 24:61. [PMID: 36864376 PMCID: PMC9979487 DOI: 10.1186/s12875-023-02018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Insomnia is common in the general population and is a risk factor for ill-health, which highlights the importance of treating insomnia effectively and cost-efficiently. Cognitive-behavioural therapy for insomnia (CBT-I) is recommended as first-line treatment due to its long-term effectiveness and few side-effects, but its availability is limited. The aim of this pragmatic, multicentre randomized controlled trial is to investigate the effectiveness of group-delivered CBT-I in primary care compared to a waiting-list control group. METHODS A pragmatic multicentre randomized controlled trial will be conducted with about 300 participants recruited across 26 Healthy Life Centres in Norway. Participants will complete online screening and provide consent before enrolment. Those who meet the eligibility criteria will be randomized to a group-delivered CBT-I or to a waiting list according to a 2:1 ratio. The intervention consists of four two-hour sessions. Assessments will be performed at baseline, 4 weeks, 3- and 6 months post-intervention, respectively. The primary outcome is self-reported insomnia severity at 3 months post-intervention. Secondary outcomes include health-related quality of life, fatigue, mental distress, dysfunctional beliefs and attitudes about sleep, sleep reactivity, 7-day sleep diaries, and data obtained from national health registries (sick leave, use of relevant prescribed medications, healthcare utilization). Exploratory analyses will identify factors influencing treatment effectiveness, and we will conduct a mixed-method process evaluation to identify facilitators and barriers of participants' treatment adherence. The study protocol was approved by the Regional Committee for Medical and Health Research ethics in Mid-Norway (ID 465241). DISCUSSION This large-scale pragmatic trial will investigate the effectiveness of group-delivered cognitive behavioural therapy versus waiting list in the treatment of insomnia, generating findings that are generalizable to day-to-day treatment of insomnia in interdisciplinary primary care services. The trial will identify those who would benefit from the group-delivered therapy, and will investigate the rates of sick leave, medication use, and healthcare utilization among adults who undergo the group-delivered therapy. TRIAL REGISTRATION The trial was retrospectively registered in the ISRCTN registry (ISRCTN16185698).
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Affiliation(s)
- Maria Hrozanova
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ingebrigt Meisingset
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Anne Lovise Nordstoga
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim, Norway
| | - Eivind Schjelderup Skarpsno
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
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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] [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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Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the universally recommended treatment of choice for insomnia disorder based on its safety and posttreatment durability of benefit. However, CBT-I does not help all patients achieve remission. The second most evidence-based treatment, hypnotic pharmacotherapy (PCT), does not resolve perpetuating factors of insomnia, resulting in potential waning of benefit and dependence. This article presents a rationale that supports consideration of hypnotic augmentation of CBT-I (COMB), along with a review of select randomized controlled trials relevant to clinical decision-making.
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45
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Yoo J, Slavish D, Dietch JR, Kelly K, Ruggero C, Taylor DJ. Daily reactivity to stress and sleep disturbances: unique risk factors for insomnia. Sleep 2023; 46:zsac256. [PMID: 36301838 PMCID: PMC9905776 DOI: 10.1093/sleep/zsac256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
STUDY OBJECTIVES To naturalistically measure sleep disturbances following stress exposure (i.e. sleep reactivity) and stress responses following sleep disturbances (i.e. stress reactivity) at the daily level and prospectively examine these reactivity measures as individual risk factors for insomnia. METHODS The study assessed 392 nurses' sleep and stress for 14 days using daily diaries and actigraphy. Self-reported insomnia symptoms were assessed at the end of the 14 days, as well as 6 and 11 months later. RESULTS In multilevel modeling, while negative fixed effects indicated that shorter total sleep time (TST) and lower sleep efficiency led to greater stress and vice versa, significant random effects indicated individual variability in sleep reactivity and stress reactivity. In latent score change modeling, greater sleep reactivity (lower diary-determined sleep efficiency following greater stress) and greater stress reactivity (greater stress following shorter diary-determined TST) at baseline were associated with greater insomnia symptoms at 11 months (b = 10.34, p = .026; b = 7.83, p = .03). Sleep reactivity and stress reactivity also interacted to predict insomnia symptoms, such that sleep reactivity was significantly associated with insomnia symptoms for those with high (+1 SD) stress reactivity (b = 17.23, p = .001), but not for those with low (-1 SD) stress reactivity (b = 5.16, p = .315). CONCLUSIONS Baseline stress reactivity and sleep reactivity independently as well as jointly predict greater insomnia symptoms 11 months later. The findings delineate processes underlying the stress-diathesis model of insomnia and highlight the utility of longitudinal and naturalistic measures of sleep and stress reactivity.
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Affiliation(s)
- Jiah Yoo
- Department of Psychology, University of Arizona, 1503 E University Blvd. Tucson, AZ 85721, USA
| | - Danica Slavish
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR 97331, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| | - Camilo Ruggero
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, 1503 E University Blvd. Tucson, AZ 85721, USA
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46
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Elder GJ, Altena E, Palagini L, Ellis JG. Stress and the hypothalamic-pituitary-adrenal axis: How can the COVID-19 pandemic inform our understanding and treatment of acute insomnia? J Sleep Res 2023:e13842. [PMID: 36748346 DOI: 10.1111/jsr.13842] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 02/08/2023]
Abstract
Stress and sleep are very closely linked, and stressful life events can trigger acute insomnia. The ongoing COVID-19 pandemic is highly likely to represent one such stressful life event. Indeed, a wide range of cross-sectional studies demonstrate that the pandemic is associated with poor sleep and sleep disturbances. Given the high economic and health burden of insomnia disorder, strategies that can prevent and treat acute insomnia, and also prevent the transition from acute insomnia to insomnia disorder, are necessary. This narrative review outlines why the COVID-19 pandemic is a stressful life event, and why activation of the hypothalamic-pituitary-adrenal axis, as a biological marker of psychological stress, is likely to result in acute insomnia. Further, this review outlines how sleep disturbances might arise as a result of the COVID-19 pandemic, and why simultaneous hypothalamic-pituitary-adrenal axis measurement can inform the pathogenesis of acute insomnia. In particular, we focus on the cortisol awakening response as a marker of hypothalamic-pituitary-adrenal axis function, as cortisol is the end-product of the hypothalamic-pituitary-adrenal axis. From a research perspective, future opportunities include identifying individuals, or particular occupational or societal groups (e.g. frontline health staff), who are at high risk of developing acute insomnia, and intervening. From an acute insomnia treatment perspective, priorities include testing large-scale online behavioural interventions; examining if reducing the impact of stress is effective and, finally, assessing whether "sleep vaccination" can maintain good sleep health by preventing the occurrence of acute insomnia, by preventing the transition from acute insomnia to insomnia disorder.
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Affiliation(s)
- Greg J Elder
- Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK
| | - Ellemarije Altena
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine-UMR 5287 CNRS, Team Neuroimaging and Human Cognition, Université de Bordeaux, Bordeaux, France
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, Psychiatric Section University of Ferrara, Ferrara, Italy.,Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
| | - Jason G Ellis
- Northumbria Sleep Research, Northumbria University, Newcastle upon Tyne, UK
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47
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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: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [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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48
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Perini F, Wong KF, Lin J, Hassirim Z, Ong JL, Lo J, Ong JC, Doshi K, Lim J. Mindfulness-based therapy for insomnia for older adults with sleep difficulties: a randomized clinical trial. Psychol Med 2023; 53:1038-1048. [PMID: 34193328 PMCID: PMC9975962 DOI: 10.1017/s0033291721002476] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/16/2021] [Accepted: 06/02/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Poor sleep is a modifiable risk factor for multiple disorders. Frontline treatments (e.g. cognitive-behavioral therapy for insomnia) have limitations, prompting a search for alternative approaches. Here, we compare manualized Mindfulness-Based Therapy for Insomnia (MBTI) with a Sleep Hygiene, Education, and Exercise Program (SHEEP) in improving subjective and objective sleep outcomes in older adults. METHODS We conducted a single-site, parallel-arm trial, with blinded assessments collected at baseline, post-intervention and 6-months follow-up. We randomized 127 participants aged 50-80, with a Pittsburgh Sleep Quality Index (PSQI) score ⩾5, to either MBTI (n = 65) or SHEEP (n = 62), both 2 hr weekly group sessions lasting 8 weeks. Primary outcomes included PSQI and Insomnia Severity Index, and actigraphy- and polysomnography-measured sleep onset latency (SOL) and wake after sleep onset (WASO). RESULTS Intention-to-treat analysis showed reductions in insomnia severity in both groups [MBTI: Cohen's effect size d = -1.27, 95% confidence interval (CI) -1.61 to -0.89; SHEEP: d = -0.69, 95% CI -0.96 to -0.43], with significantly greater improvement in MBTI. Sleep quality improved equivalently in both groups (MBTI: d = -1.19; SHEEP: d = -1.02). No significant interaction effects were observed in objective sleep measures. However, only MBTI had reduced WASOactigraphy (MBTI: d = -0.30; SHEEP: d = 0.02), SOLactigraphy (MBTI: d = -0.25; SHEEP: d = -0.09), and WASOPSG (MBTI: d = -0.26; SHEEP (d = -0.18). There was no change in SOLPSG. No participants withdrew because of adverse effects. CONCLUSIONS MBTI is effective at improving subjective and objective sleep quality in older adults, and could be a valid alternative for persons who have failed or do not have access to standard frontline therapies.
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Affiliation(s)
- Francesca Perini
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian Foong Wong
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jia Lin
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zuriel Hassirim
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ju Lynn Ong
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - June Lo
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jason C. Ong
- Feinberg School of Medicine, Northwestern University, Evanston, IL 60208, USA
| | - Kinjal Doshi
- Department of Psychology, Singapore General Hospital, Singapore
| | - Julian Lim
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychology, National University of Singapore, Singapore
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49
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Costa AN, Curtis AF, Musich M, Guandique AA, McCrae CS. Self-reported cognition in older adults with insomnia: Associations with sleep and domain specific cognition. J Sleep Res 2023; 32:e13751. [PMID: 36217906 DOI: 10.1111/jsr.13751] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/01/2022] [Accepted: 09/21/2022] [Indexed: 02/03/2023]
Abstract
Poor subjective evaluation of cognition and sleep are associated with cognitive decline in older adults. Relationships among self-reported cognition, sleep, and cognitive domains remain unclear. We evaluated the interactive associations of objective cognition and subjective sleep with self-reported cognition in older adults with insomnia. Fifty-one older adults (Mage = 69.19, SD = 7.95) with insomnia completed 14 days of self-reported cognition ratings (0-very poor, 100-very good), sleep (total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency), and daily cognitive tasks: Letter series (reasoning), word list delayed recall (verbal memory), Symbol Digit Modalities Test (SDMT) (attention/processing speed), and number copy (processing speed). Multiple regressions for each cognitive task determined whether average objective cognition or sleep were independently/interactively associated with average self-reported cognition, controlling for age, education, and depression. The interaction between SDMT performance and TST was associated with self-reported cognition. Specifically, the relationship between scores and self-reported cognition was congruent in those with the shortest TST. Similarly, the interactions between SDMT and WASO, as well as sleep efficiency, were associated with self-reported. Specifically, the relationship between scores and self-reported cognition was congruent in those with longest and average WASO, as well as shortest and average sleep efficiency. The findings suggest, in an older adult population with insomnia, a congruent association exists between attention/processing speed and self-reported cognition in those with worse subjective sleep (shorter TST, longer WASO, and lower SE). Insomnia symptoms should be taken into consideration when examining the relationship between objective cognition and self-reported cognition.
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Affiliation(s)
- Amy N Costa
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Ashley F Curtis
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA.,Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Madison Musich
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Alan A Guandique
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - Christina S McCrae
- Department of Psychiatry, University of Missouri-Columbia, Columbia, Missouri, USA
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50
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Kuo W, Ersig AL, Kunkul F, Brown RL, Oakley LD. Linking chronic stress to insomnia symptoms in older adults: The role of stress co-occurrence during the pandemic. Res Nurs Health 2023; 46:68-79. [PMID: 36445114 PMCID: PMC9839487 DOI: 10.1002/nur.22278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/30/2022] [Accepted: 11/06/2022] [Indexed: 12/02/2022]
Abstract
Studies examining the associations of chronic stressors with sleep health in older adults have shown conflicting results. While the COVID-19 pandemic increased perceived stress at the population level, less is known about chronic stressors experienced by older adults in the context of the COVID-19 pandemic and its impact on sleep health in an aging population. This study aims to examine the association of older adults' chronic stress with insomnia symptoms during the first year of the COVID-19 pandemic. A cross-sectional analysis was performed using early-release COVID-19 data from the Health and Retirement Study. Data on chronic stressors and insomnia symptoms in older adults (N = 2021; mean age = 68.8) were examined. Co-occurrence network analysis, latent class analysis, Rao-Scott χ2 tests, and multivariable logistic regression were used to characterize the co-occurrence of chronic stressors and associations with insomnia symptoms. The most common co-occurring chronic stressors during the first year of the COVID-19 pandemic were self-health issues, family-health issues, and financial stress. Older adults experiencing frequent stress co-occurrence had 91% higher odds of difficulty initiating sleep (p < 0.001), 40% higher odds of frequent nocturnal awakening (p = 0.028), and 83% higher odds of nonrestorative sleep (p < 0.001). However, adjustment for health risk factors and COVID-19 concerns attenuated the effects, leaving strongest association for difficulty initiating sleep (odds ratio = 1.51, p = 0.010). Frequent stress co-occurrence plays an important role linking chronic stress to insomnia symptoms in an aging population. Ongoing research is needed to examine the lingering effects of frequent stress co-occurrence on older adults' sleep health in the post COVID-19 era.
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Affiliation(s)
- Wan‐Chin Kuo
- School of Nursing University of Wisconsin–Madison Madison Wisconsin USA
| | - Anne L. Ersig
- School of Nursing University of Wisconsin–Madison Madison Wisconsin USA
| | - Fatih Kunkul
- School of Nursing University of Wisconsin–Madison Madison Wisconsin USA
| | - Roger L. Brown
- School of Nursing University of Wisconsin–Madison Madison Wisconsin USA
| | - Linda D. Oakley
- School of Nursing University of Wisconsin–Madison Madison Wisconsin USA
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