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Zhaoyang H, Feng C, Mei F, Jingjing L, Jiyang P. Negative perfectionism and sleep quality in Chinese international students under COVID-19 epidemic: A moderated mediation. Front Psychol 2022; 13:937816. [PMID: 35978773 PMCID: PMC9377220 DOI: 10.3389/fpsyg.2022.937816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
Objective This study used a moderated mediation model to test the mediating effect of anxiety on the relationship between negative perfectionism and sleep quality and the moderating effect of COVID-19 epidemic risk perception during the COVID-19 pandemic in Chinese international students. Materials and methods A sample of 239 Chinese international students from the south of China, was surveyed with the Negative and Positive Perfectionism Scale, the Pittsburgh Sleep Quality Index, the General Anxiety Disorder Scale, and the COVID-19 Epidemic Risk Perception Inventory. Version 23.0 of SPSS and version 3.4 of PROCESS were used to perform the correlation analyses, mediation analysis, and moderated mediation analysis. Results (1) Negative perfectionism was significantly correlated with anxiety (r = 0.371, p < 0.01) and poor sleep quality (r = 0.291, p < 0.01). Anxiety was significantly correlated with poor sleep quality (r = 0.594, p < 0.01). (2) The mediating effect test showed that anxiety had a mediating effect between negative perfectionism and poor sleep quality (β = 0.157, p < 0.01). (3) Epidemic risk perception moderated the mediating effect of anxiety between negative perfectionism and poor sleep quality (β = 0.070, p < 0.01). Conclusion Negative perfectionism affected sleep quality indirectly through anxiety. In particular, COVID-19 epidemic risk perception moderated the relationship between anxiety and sleep quality, such that the association was stronger when the COVID-19 epidemic risk perception was high. These results provide a more comprehensive understanding of the negative link between negative perfectionism and poor sleep quality.
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Affiliation(s)
- Huang Zhaoyang
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
- School of Management, Jinan University, Guangzhou, China
| | - Chen Feng
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Fan Mei
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lin Jingjing
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Pan Jiyang
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Pan Jiyang,
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Uygur OF, Uygur H, Chung S, Ahmed O, Demiroz D, Aydin EF, Hursitoglu O. Validity and reliability of the Turkish version of the Glasgow Sleep Effort Scale. Sleep Med 2022; 98:144-151. [PMID: 35853331 DOI: 10.1016/j.sleep.2022.06.022] [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: 05/17/2022] [Revised: 06/25/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE We aimed to assess the validity and reliability of a Turkish adaptation of the Glasgow Sleep Effort Scale (GSES). METHODS We randomly divided the data into two: one set (n = 374) was used for exploratory factor analysis (EFA) and the other (n = 373) for confirmatory factor analysis (CFA). The psychometric properties were assessed using the item response theory approach. Reliability analyses were assessed. Convergent validity of the GSES with the Dysfunctional Beliefs and Attitudes About Sleep Scale-16 (DBAS-16), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Depression Anxiety Stress Scale-21 (DASS-21) were explored. For the predictive validity, we used an independent-samples t-test for comparing the total score of the GSES between poor sleepers and good sleepers following the PSQI, and between clinical insomnia and non-clinical insomnia groups according to the ISI. The cut-off score of the GSES was examined. RESULTS A single factor structure explaining 49.2% of the total variance was detected using the EFA. The CFA also found single-factor good fit indices. Cronbach's alpha and omega values were 0.82 and 0.83, respectively. There were statistically significant correlations between the GSES and DBAS-16, ISI, PSQI, and DASS-21 in convergent validity. In the Graded Response Model, the GSES was more efficient and provided reasonable information at the -0.75 to 2.25 theta level. The GSES cut-off score was 6 points for clinical insomnia and 3 points for poor sleepers. CONCLUSIONS The GSES is valid and reliable for measuring sleep effort among Turkish university students.
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Affiliation(s)
- Omer Faruk Uygur
- Department of Psychiatry, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey.
| | - Hilal Uygur
- Department of Psychiatry, Dr. Ersin Arslan Training and Research Hospital, Gaziantep, Turkey
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Oli Ahmed
- Department of Psychology, University of Chittagong, Chattogram, Bangladesh
| | - Dudu Demiroz
- Department of Psychiatry, Karaman Training and Research Hospital, Karaman, Turkey
| | - Esat Fahri Aydin
- Department of Psychiatry, Ataturk University School of Medicine, Erzurum, Turkey
| | - Onur Hursitoglu
- Department of Psychiatry, Sular Academy Hospital, Kahramanmaras, Turkey
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Maccora J, Bean HR, Diggens J, Ftanou M, Alexander M, Lu Q, Stafford L, Francis PA, Bei B, Wiley JF. Mechanisms of Cognitive Behavioral Therapy and Light Therapy for Cancer-Related Insomnia: A Randomized Clinical Trial during Chemotherapy for Breast Cancer. Behav Sleep Med 2022; 21:227-241. [PMID: 35580165 DOI: 10.1080/15402002.2022.2075364] [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
STUDY OBJECTIVES This study aimed to investigate the mechanisms of a combined brief cognitive behavioral plus bright light therapy (CBT-I+Light) in women receiving chemotherapy. METHODS Women (N = 101) were randomly assigned to CBT-I+Light or treatment as usual plus relaxation audios (TAU+). Participants completed sleep diaries and wore an actigraph during the 6-week intervention period. Patient-reported outcomes were assessed at baseline, mid-point (week 3), and later (week 6). Cognitive (i.e., dysfunctional sleep beliefs, pre-sleep cognitions, and arousal) and behavioral (i.e., time in bed awake and day-to-day out-of-bedtime variability) mechanisms were examined. RESULTS Cognitively, both groups declined significantly in overall dysfunctional sleep beliefs from pre- to post-intervention (both p< .04); however, they did not differ on sleep-related beliefs nor pre-sleep cognitions and arousal at post-intervention (both p> .50). Dysfunctional beliefs sleep expectations subscale was lower in CBT-I+Light versus TAU+ (p= .01). Behaviorally, CBT-I+Light reported less overall time in bed awake after the start of the intervention (p< .05) and significantly less time in bed during the morning until the final week of the intervention period. Out-of-bedtime day-to-day variability was lower in the CBT-+Light vs TAU+ at the final intervention day. CONCLUSION Mechanisms of CBT-I+Light during chemotherapy remain to be shown. Our results suggest that changes in behavioral mechanisms may be associated with sleep improvements within this cohort. Future studies should assess the role of additional mechanisms (e.g., sleep effort) within larger samples. Whilst intervention brevity is important, more potent interventions may be required to achieve robust changes in target mechanisms.
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Affiliation(s)
- Jordan Maccora
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Helena R Bean
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | | | - Maria Ftanou
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Marliese Alexander
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Qian Lu
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Centre, Houston, United States of America
| | - Lesley Stafford
- Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | | | - Bei Bei
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Centre for Women's Mental Health, Royal Women's Hospital, Melbourne, Australia
| | - Joshua F Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
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Riemann D, Benz F, Dressle RJ, Espie CA, Johann AF, Blanken TF, Leerssen J, Wassing R, Henry AL, Kyle SD, Spiegelhalder K, Van Someren EJW. Insomnia disorder: State of the science and challenges for the future. J Sleep Res 2022; 31:e13604. [PMID: 35460140 DOI: 10.1111/jsr.13604] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 12/25/2022]
Abstract
Insomnia disorder comprises symptoms during night and day that strongly affect quality of life and wellbeing. Prolonged sleep latency, difficulties to maintain sleep and early morning wakening characterize sleep complaints, whereas fatigue, reduced attention, impaired cognitive functioning, irritability, anxiety and low mood are key daytime impairments. Insomnia disorder is well acknowledged in all relevant diagnostic systems: Diagnostic and Statistical Manual of the American Psychiatric Association, 5th revision, International Classification of Sleep Disorders, 3rd version, and International Classification of Diseases, 11th revision. Insomnia disorder as a chronic condition is frequent (up to 10% of the adult population, with a preponderance of females), and signifies an important and independent risk factor for physical and, especially, mental health. Insomnia disorder diagnosis primarily rests on self-report. Objective measures like actigraphy or polysomnography are not (yet) part of the routine diagnostic canon, but play an important role in research. Disease concepts of insomnia range from cognitive-behavioural models to (epi-) genetics and psychoneurobiological approaches. The latter is derived from knowledge about basic sleep-wake regulation and encompass theories like rapid eye movement sleep instability/restless rapid eye movement sleep. Cognitive-behavioural models of insomnia led to the conceptualization of cognitive-behavioural therapy for insomnia, which is now considered as first-line treatment for insomnia worldwide. Future research strategies will include the combination of experimental paradigms with neuroimaging and may benefit from more attention to dysfunctional overnight alleviation of distress in insomnia. With respect to therapy, cognitive-behavioural therapy for insomnia merits widespread implementation, and digital cognitive-behavioural therapy may assist delivery along treatment guidelines. However, given the still considerable proportion of patients responding insufficiently to cognitive-behavioural therapy for insomnia, fundamental studies are highly necessary to better understand the brain and behavioural mechanisms underlying insomnia. Mediators and moderators of treatment response/non-response and the associated development of tailored and novel interventions also require investigation. Recent studies suggest that treatment of insomnia may prove to add significantly as a preventive strategy to combat the global burden of mental disorders.
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Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fee Benz
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Raphael J Dressle
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Colin A Espie
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Ltd, London, UK.,Big Health Ltd, San Francisco, California, USA
| | - Anna F Johann
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.,Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tessa F Blanken
- Department of Psychological Methods, University of Amsterdam, Amsterdam, The Netherlands
| | - Jeanne Leerssen
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Rick Wassing
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alasdair L Henry
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Big Health Ltd, London, UK.,Big Health Ltd, San Francisco, California, USA
| | - Simon D Kyle
- Sir Jules Thorn Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
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Volunteer participation differentially moderates the association between insomnia and poor subjective well-being in community-dwelling older adults: the Yilan study, Taiwan. BMC Geriatr 2022; 22:324. [PMID: 35418018 PMCID: PMC9009056 DOI: 10.1186/s12877-022-03004-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 03/31/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives We aimed to elucidate the moderating effect of volunteer participation on the association between insomnia and subjective well-being. Methods This was a community-based, cross-sectional study that targeted community-dwelling older adults aged ≥ 65 years in Yilan city, Taiwan. Whether individuals had volunteered in the past month was asked. Insomnia was measured using the Athens Insomnia Scale-5. Subjective well-being was evaluated using self-rated health, self-rated happiness, the physical component summary (PCS), and the mental component summary (MCS) of Short-form 12. Interaction terms between volunteer participation and insomnia were examined to test the moderating effect of volunteer participation on subjective well-being. Results In total, 3,875 participants were included in the study. After controlling for confounders, older adults with insomnia were more likely to have poor subjective well-being, except with respect to PCS. By contrast, volunteering was associated with a low risk of association between self-rated health and happiness. The interaction terms for volunteering with self-rated happiness (p = 0.03) and the MCS (p = 0.02) were significant. The association between insomnia and poor self-rated happiness among volunteers (odds ratio [OR] = 3.91, 95% confidence interval [CI] = 1.85–8.28) was significantly stronger than that in non-volunteers (OR = 1.48, 95% CI = 1.18–1.86). However, insomnia was linked with poor MCS in non-volunteers (OR = 1.53, 95% CI = 1.21–1.94), but not in volunteers (OR = 0.64, 95% CI = 0.27–1.50). Discussion Volunteer participation moderated the association between insomnia and subjective well-being; specifically, volunteering strengthened the association between insomnia and poor self-rated happiness but mitigated the relationship between insomnia and poor MCS. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03004-8.
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56
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Blackman J, Love S, Sinclair L, Cain R, Coulthard E. APOE ε4, Alzheimer's disease neuropathology and sleep disturbance, in individuals with and without dementia. Alzheimers Res Ther 2022; 14:47. [PMID: 35354468 PMCID: PMC8969347 DOI: 10.1186/s13195-022-00992-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/20/2022] [Indexed: 12/20/2022]
Abstract
Background Apolipoprotein E epsilon 4 (APOE-ε4) carrier status is an established risk factor for Alzheimer’s disease (AD) dementia. It has also been linked with sleep disturbance in healthy older adults and increased insomnia risk. This association may be driven by the effect of APOE-ε4 on AD pathological change, itself associated with sleep abnormalities. To assess this relationship, we have evaluated post-mortem neuropathological findings in patients with and without cognitive impairment and AD pathology, who had extensive clinical assessment within 12 months of death. Methods This retrospective cohort study used UK Brain Banks Network data. Eligible subjects were aged over 50, with pre-mortem neuropsychiatry inventory scores of sleep disturbance (NPI-K), neurocognitive testing and functional cognitive status assessment (Clinical Dementia Rating scale). Neuropathological data included Thal phase, Braak stage and CERAD scores (measures of Aβ plaque distribution, tangle distribution and neuritic plaque density, respectively) combined to form the National Institute on Aging Alzheimer’s Association (NIA-AA) ABC score reflecting AD neuropathology. Participants with other significant intracerebral pathology or pathological features of non-AD dementia were excluded. Multivariate linear regression was performed with NPIK Global Score (NPIK frequency score multiplied by severity score) as the dependent variable and APOE-ε4 heterozygosity or homozygosity as independent variables. Covariates included age, gender, APOE-ε2 status and ABC NPI measures reflecting depression and anxiety. Further models stratified by ABC score and functional cognitive status were also produced. Results Seven hundred twenty-eight records were identified. Two hundred two participants were included in the final analysis: mean (SD) age 84.0 (9.2) and MMSE 14.0 (11.8). Mean sleep disturbance scores were highest in ε4 homozygosity (n=11), 4.55 (5.4); intermediate in ε4 heterozygosity (n=95), 2.03 (4.0); and lowest in non-ε4 carriers (n=96), 1.36 (3.3). Within the full sample, controlling for pathological status, age, gender, depression, anxiety and CDR-SOB status, APOE-ε4 homozygosity was associated with sleep disturbance (β 2.53, p=0.034). APOE-ε4 heterozygosity was similarly associated in individuals without dementia (β 1.21, p=0.048). Conclusion These findings lend weight to the hypothesis that APOE-ε4 affects sleep by mechanisms independent of AD pathological change. Evaluation of those mechanisms would enhance understanding of sleep disturbance pathways and potentially provide treatment targets. Supplementary Information The online version contains supplementary material available at 10.1186/s13195-022-00992-y.
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Affiliation(s)
| | - Seth Love
- Learning and Research, University of Bristol, Southmead, Bristol, BS10 5NB, UK
| | - Lindsey Sinclair
- Learning and Research, University of Bristol, Southmead, Bristol, BS10 5NB, UK
| | - Richard Cain
- Learning and Research, University of Bristol, Southmead, Bristol, BS10 5NB, UK
| | - Elizabeth Coulthard
- Learning and Research, University of Bristol, Southmead, Bristol, BS10 5NB, UK.
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Beck J, Loretz E, Rasch B. Stress dynamically reduces sleep depth: temporal proximity to the stressor is crucial. Cereb Cortex 2022; 33:96-113. [PMID: 35196708 PMCID: PMC9758584 DOI: 10.1093/cercor/bhac055] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 11/12/2022] Open
Abstract
The anticipation of a future stressor can increase worry and cognitive arousal and has a detrimental effect on sleep. Similarly, experiencing a stressful event directly before sleep increases physiological and cognitive arousal and impairs subsequent sleep. However, the effects of post- vs. pre-sleep stress on sleep and their temporal dynamics have never been directly compared. Here, we examined the effect of an anticipated psychosocial stressor on sleep and arousal in a 90-min daytime nap, in 33 healthy female participants compared to an anticipated within-subject relaxation task. We compared the results to an additional group (n = 34) performing the same tasks directly before sleep. Anticipating stress after sleep reduced slow-wave activity/beta power ratio, slow-wave sleep, sleep spindles, and slow-wave parameters, in particular during late sleep, without a concomitant increase in physiological arousal. In contrast, pre-sleep psychosocial stress deteriorated the same parameters during early sleep with a concomitant increase in physiological arousal. Our results show that presleep cognitions directly affect sleep in temporal proximity to the stressor. While physiological arousal mediates the effects of presleep stress on early sleep, we suggest that effects during late sleep originate from a repeated reactivation of mental concepts associated with the stressful event during sleep.
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Affiliation(s)
- Jonas Beck
- Department of Psychology, University of Fribourg, Rue P.-A-de-Faucigny 2, CH-1700 Fribourg, Switzerland
| | - Erna Loretz
- The Siesta Group Schlafanalyse GmbH, Schlosshofer Strasse 11, 1210 Vienna, Austria
| | - Björn Rasch
- Corresponding author: Department of Psychology, University of Fribourg, Rue P.-A-de-Faucigny 2, CH-1700 Fribourg, Switzerland.
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Stricker J, Kröger L, Küskens A, Gieselmann A, Pietrowsky R. No perfect sleep! A systematic review of the link between multidimensional perfectionism and sleep disturbance. J Sleep Res 2022; 31:e13548. [DOI: 10.1111/jsr.13548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Johannes Stricker
- Department of Experimental Psychology Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Lasse Kröger
- Department of Psychology University of Trier Trier Germany
| | - Anna Küskens
- Department of Experimental Psychology Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Annika Gieselmann
- Department of Experimental Psychology Heinrich Heine University Düsseldorf Düsseldorf Germany
| | - Reinhard Pietrowsky
- Department of Experimental Psychology Heinrich Heine University Düsseldorf Düsseldorf Germany
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Quin N, Lee JJ, Pinnington DM, Newman L, Manber R, Bei B. Differentiating perinatal Insomnia Disorder and sleep disruption: a longitudinal study from pregnancy to 2 years postpartum. Sleep 2022; 45:6497951. [PMID: 34989808 PMCID: PMC9013000 DOI: 10.1093/sleep/zsab293] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/07/2021] [Indexed: 01/07/2023] Open
Abstract
STUDY OBJECTIVES Insomnia Disorder diagnoses require persistent sleep complaints despite "adequate sleep opportunity." Significant Perinatal Sleep Disruption makes this diagnosis challenging. This longitudinal study distinguished between Insomnia Disorder and Perinatal Sleep Disruption and their sleep and mental health correlates. METHODS One hundred sixty-three nulliparous females (age M ± SD = 33.35 ± 3.42) participating in a randomized controlled trial repeated the Insomnia Disorder module of the Duke Structured Interview for Sleep Disorders and Patient-Reported Outcome Measurement Information System measures for sleep and mental health at 30- and 35-weeks' gestation, and 1.5, 3, 6, 12, and 24 months postpartum (944 interviews, 1009 questionnaires completed). We compared clinical features when Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Insomnia Disorder criteria (without the Duration criterion) were: (1) met (Insomnia Disorder), (2) not met only because of the sleep opportunity criteria (Perinatal Sleep Disruption), and (3) not met due to other criteria (Low Complaint). RESULTS Proportions of Insomnia Disorder were 16.0% and 19.8% during early and late third trimester, and ranged 5.3%-11.7% postpartum. If the sleep opportunity criteria were not considered, rates of Insomnia would be 2-4 times higher (21.4%-40.4%) across time-points. Mixed-effects models adjusting for covariates showed that compared to Low Complaint, both Insomnia Disorder and Perinatal Sleep Disruption scored significantly higher on insomnia and sleep disturbance scales, sleep effort, and sleep-related impairments (p values < .01), but depression and anxiety were comparable (p values > .12). CONCLUSION Assessing sleep complaints without considering sleep opportunities can result in over-diagnosis of Insomnia Disorder in the perinatal periods. Insomnia Disorder and Perinatal Sleep Disruption were both associated with adverse sleep and mood outcomes, and need to be carefully differentiated and appropriately addressed. Clinical Trial Registration: The SEED Project (Sleep, Eat, Emotions, and Development): A randomized controlled pilot study of a perinatal sleep intervention on sleep and wellbeing in mothers and infants. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371634, Australian New Zealand Clinical Trials Registry: ACTRN12616001462471.
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Affiliation(s)
- Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Jin Joo Lee
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Donna M Pinnington
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia,Women’s Mental Health Service, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Louise Newman
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Bei Bei
- Corresponding author. Bei Bei, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Clayton Campus, VIC 3800, Australia.
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Li Y, Zou G, Shao Y, Yao P, Liu J, Zhou S, Hu S, Xu J, Guo Y, Gao JH, Zou Q, Sun H. Sleep discrepancy is associated with alterations in the salience network in patients with insomnia disorder: An EEG-fMRI study. NEUROIMAGE: CLINICAL 2022; 35:103111. [PMID: 35863180 PMCID: PMC9421431 DOI: 10.1016/j.nicl.2022.103111] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/31/2022] [Accepted: 07/10/2022] [Indexed: 01/27/2023] Open
Abstract
Simultaneous EEG-fMRI was used to clarify the association between the brain functional connectivity and sleep discrepancy between self-report and polysomnography in patients with insomnia disorder. An altered anterior insula-based connectivity across wakefulness and all NREM stages. Sleep discrepancy was significantly associated with anterior insula–putamen/thalamus connectivity during wakefulness.
Background Positron emission tomography – computed tomography (PET-CT) research has shown that sleep discrepancy recorded by self-report and polysomnography (PSG) may be related to the altered metabolic rate of the anterior insula (aINS) during non-rapid eye movement (NREM) sleep in patients with insomnia disorder. We aim to explore the functional connectivity of aINS across wake and NREM sleep in the patients and to reveal the association between aINS connectivity and sleep discrepancy. Methods Patients with insomnia disorder (n = 33) and healthy controls (n = 31) underwent simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) during nighttime sleep, and aINS-based connectivity was calculated across wake and NREM sleep. A linear mixed-effects model was used to assess the main effect of group and group-by-stage (wake, NREM stages 1–3) interaction effect on aINS connectivity. Similar mixed models were used to assess the potential correlation between aINS connectivity and the sleep misperception index (MI). Results A significant group-by-stage interaction effect on aINS-based connectivity was observed in the bilateral frontal gyrus, right inferior temporal gyrus, bilateral middle occipital gyrus and right postcentral gyrus (p < 0.05, corrected). There was also a significant group-by-MI interaction effect on aINS connectivity with the putamen and thalamus during wakefulness (p < 0.05 corrected); MI was significantly associated with aINS–putamen/thalamus connectivity in the control group, whereas the association was weak or even nonsignificant in the patient group. There was no significant main effect of group. Conclusion The waking activity of a neural pathway containing the aINS, putamen, and thalamus may underlie sleep perception, potentially providing important perspectives to reveal complex mechanisms of sleep discrepancy between self-report and PSG.
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Affiliation(s)
- Yuezhen Li
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, Beijing, China; Department of Neuropsychiatry, Behavioral Neurology and Clinical Psychology, Sleep Center, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Guangyuan Zou
- Beijing City Key Laboratory for Medical Physics and Engineering, Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing, China; Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Yan Shao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Ping Yao
- Department of Physiology, College of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Jiayi Liu
- Beijing City Key Laboratory for Medical Physics and Engineering, Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing, China; Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Shuqin Zhou
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Sifan Hu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jing Xu
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China; Laboratory of Applied Brain and Cognitive Sciences, College of International Business, Shanghai International Studies University, Shanghai, China
| | - Yupeng Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jia-Hong Gao
- Beijing City Key Laboratory for Medical Physics and Engineering, Institute of Heavy Ion Physics, School of Physics, Peking University, Beijing, China; Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China; McGovern Institute for Brain Research, Peking University, Beijing, China.
| | - Qihong Zou
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, Beijing, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
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Paulos-Guarnieri L, Linares IMP, El Rafihi-Ferreira R. Evidence and characteristics of Acceptance and Commitment Therapy (ACT)-based interventions for insomnia: A systematic review of randomized and non-randomized trials. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Mao ZX, Yang X, Wang HY, Guo WJ. Case report: Chronological symptom profile after cessation of overdose zolpidem in a patient with comorbid bipolar disorder-from anxiety, craving, paresthesia and influenza-like symptoms to seizures and hallucinations. Front Psychiatry 2022; 13:962836. [PMID: 36061292 PMCID: PMC9428267 DOI: 10.3389/fpsyt.2022.962836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/25/2022] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Insomnia is a major public health problem that determines the quality of life. Among the many causes of insomnia, psychological factors have an important influence on the process, duration of insomnia, help-seeking behavior, and treatment choice. Regarding medical treatment, zolpidem is always chosen to treat acute and transient insomnia due to its few side effects. Although some randomized controlled trials have verified its safety, zolpidem abuse and withdrawal reactions have been reported in recent years. CASE REPORT A 25-year-old unmarried man with a college degree who worked as a graphic designer was referred and admitted to the inpatient ward for a chief complaint of "alternative episodes of lowering and elevation of mood for 10 years, overdosage use of zolpidem for two years." He underwent a time-dependent withdrawal reaction after admission. It was characterized by rebound insomnia, anxiety, craving, skin paresthesia, influenza-like symptoms, tonic-clonic-type seizures, and hallucinations. At the 1-year follow-up, he did not exhibit any remaining withdrawal symptoms. DISCUSSION The acute cessation of overdosage zolpidem use causes a series of withdrawal symptoms that manifest in chronological order. Additionally, long-term benzodiazepine exposure has potential influences on zolpidem dependence/tolerance. However, patients with a history of abuse or dependence, or mental disorders seem to be at risk of drug abuse. Clinicians should be alert to the potential for zolpidem dependence and addiction. Once the acute cessation of overdosage zolpidem use occurs, the potential of the withdrawal reaction needs to be considered and addressed properly.
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Affiliation(s)
- Zi-Xin Mao
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Xia Yang
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Hui-Yao Wang
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Wan-Jun Guo
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China.,Department of Neurobiology, Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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63
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Barbato M, Arora T, Al Hemeiri S, AlJassmi MA. Looking within: Interoceptive sensibility in young adults with psychotic-like experiences. Early Interv Psychiatry 2021; 15:1705-1712. [PMID: 33442933 DOI: 10.1111/eip.13117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/13/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
AIM Interoception is the ability to sense internal bodily changes and research indicates that it may play a role in the development of mental illness. In recent years, preliminary evidence has shown that interoception is impaired in people with psychosis. Interoceptive sensibility, a meta-cognitive aspect of interoception, has never been studied across the psychosis continuum. The present study aimed at assessing interoceptive sensibility in youth with psychotic-like experiences. METHOD We invited a sample of young adults (N = 609; age 19-21 years) to complete an online survey that included a measure of interoceptive sensibility (the Multidimensional Assessment of Interoceptive Awareness-2) and the Community Assessment of Psychotic Experiences-Positive Scale -15 (CAPE-P15). Using the recommended cutoff for the CAPE-P15, the overall sample was divided into two groups (high/low risk for psychosis). RESULTS Significant group differences were observed in several dimensions of interoceptive sensibility. A logistic regression analysis indicated that scores in the subscales of Not-Distracting, Not-Worrying, Attention-Regulation, Emotional Awareness, Body Listening, and Trusting significantly predicted increased risk for psychosis. CONCLUSION Abnormal interoceptive sensibility may be a vulnerability marker for psychosis. These results, however, await further validation from additional comprehensive, longitudinal studies. Enhanced interoceptive sensibility has been reported following contemplative training, thus creating opportunities for future interventions to delay or prevent psychotic illness.
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Affiliation(s)
- Mariapaola Barbato
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | - Teresa Arora
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
| | | | - Maryam A AlJassmi
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates
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64
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Malloggi S, Conte F, De Rosa O, Righi S, Gronchi G, Ficca G, Giganti F. False memories formation is increased in individuals with insomnia. J Sleep Res 2021; 31:e13527. [PMID: 34854152 PMCID: PMC9285031 DOI: 10.1111/jsr.13527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022]
Abstract
Previous studies suggest that sleep can influence false memories formation. Specifically, acute sleep loss has been shown to promote false memories production by impairing memory retrieval at subsequent testing. Surprisingly, the relationship between sleep and false memories has only been investigated in healthy subjects but not in individuals with insomnia, whose sleep is objectively impaired compared to healthy subjects. Indeed, this population shows several cognitive impairments involving prefrontal functioning that could affect source monitoring processes and contribute to false memories generation. Moreover, it has been previously reported that subjects with insomnia differentially process sleep‐related versus neutral stimuli. Therefore, the aim of the present study was to compare false memories production between individuals with insomnia symptoms and good sleepers, and to evaluate the possible influence of stimulus category (neutral versus sleep‐related) in the two groups. The results show that false memories are globally increased in participants reporting insomnia symptoms compared to good sleepers. A reduction in source monitoring ability was also observed in the former group, suggesting that an impairment of this executive function could be especially involved in false memories formation. Moreover, our data seem to confirm that false memories production in individuals with insomnia symptoms appears significantly modulated by stimulus category.
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Affiliation(s)
- Serena Malloggi
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Francesca Conte
- Department of Psychology, University of Campania L. Vanvitelli, Caserta, Italy
| | - Oreste De Rosa
- Department of Psychology, University of Campania L. Vanvitelli, Caserta, Italy
| | - Stefania Righi
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Giorgio Gronchi
- Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Gianluca Ficca
- Department of Psychology, University of Campania L. Vanvitelli, Caserta, Italy
| | - Fiorenza Giganti
- Department of NEUROFARBA, University of Florence, Florence, Italy
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65
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Gorgoni M, Scarpelli S, Mangiaruga A, Alfonsi V, Bonsignore MR, Fanfulla F, Ferini-Strambi L, Nobili L, Plazzi G, De Gennaro L. Pre-sleep arousal and sleep quality during the COVID-19 lockdown in Italy. Sleep Med 2021; 88:46-57. [PMID: 34731828 PMCID: PMC8577578 DOI: 10.1016/j.sleep.2021.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/18/2021] [Accepted: 10/09/2021] [Indexed: 02/08/2023]
Abstract
Objective The COVID-19 pandemic has strongly affected daily habits and psychological wellbeing, and many studies point to large modifications in several sleep and sleep-related domains. Nevertheless, pre-sleep arousal during the pandemic has been substantially overlooked. Since hyperarousal represents one of the main factors for the development and the perpetuation of chronic insomnia disorder, the assessment of variables associated with high levels of pre-sleep arousal during the pandemic is clinically relevant. The study aimed to assess the prevalence and predictors of perceived sleep quality and pre-sleep arousal in an Italian sample during the COVID-19 lockdown. Methods We used an online survey to collect self-reported sociodemographic, environmental, clinical, sleep, and sleep-related data. Our final sample included 761 participants. Results Beyond a high frequency of poor sleep quality, depressive and stress symptoms, our results show that almost half of the sample suffered from clinically relevant levels of at least one component (ie, cognitive, somatic) of pre-sleep arousal. Subjects with greater pre-sleep arousal exhibited poorer sleep quality. Also, sleep quality was strongly associated with somatic and cognitive pre-sleep arousal. Regarding the predictors of sleep and sleep-related measures, depressive and event-related stress symptoms were the main factors associated with both poor sleep quality and pre-sleep arousal components. Moreover, specific sociodemographic and environmental variables were uniquely related to sleep quality, cognitive or somatic pre-sleep arousal. Conclusions These findings suggest that the assessment of specific sleep-related factors (ie, pre-sleep arousal), together with more global measures of sleep quality, may be crucial to depict the complex impact of the pandemic on sleep, and to help prevent and counteract the spread of insomnia symptoms.
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Affiliation(s)
- Maurizio Gorgoni
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Serena Scarpelli
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Anastasia Mangiaruga
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | | | - Francesco Fanfulla
- Sleep Medicine Unit, Clinical and Scientific Maugeri Institutes, Scientific Institute of Pavia IRCCS Pavia, Italy
| | | | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Medical and Surgical Neuroscience and Rehabilitation (DINOGMI), University of Genoa, Genoa, Italy
| | - Giuseppe Plazzi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luigi De Gennaro
- Department of Psychology, Sapienza University of Rome, Rome, Italy; IRCCS Fondazione Santa Lucia, Rome, Italy.
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66
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Gardani M, Bradford DRR, Russell K, Allan S, Beattie L, Ellis JG, Akram U. A systematic review and meta-analysis of poor sleep, insomnia symptoms and stress in undergraduate students. Sleep Med Rev 2021; 61:101565. [PMID: 34922108 DOI: 10.1016/j.smrv.2021.101565] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 12/14/2022]
Abstract
University students experience high prevalence of mental health problems and exacerbation of mental health difficulties, including sleep disturbances and stress during their studies. Stress and poor sleep quality and/or insomnia are interlinked outcomes for this population. The aim was to conduct a systematic review, and meta-analyses, of the relationships between sleep quality and/or insomnia with stress in students. Full-text articles of studies exploring the associations of stress with poor sleep quality and/or insomnia in undergraduate students using validated tools and published in peer-reviewed journals were eligible for inclusion. Thirty-four studies, resulting in 37 effect sizes, included and all were suitable for meta-analysis. The weighted pooled effect size between sleep quality and stress was for 0.39 (25 studies, n = 10,065), whereas a slightly higher pooled association of 0.41 was demonstrated for insomnia and stress (12 studies, n = 5564.5). Pooled associations show moderate effects for associations between sleep quality, insomnia and stress in undergraduate students. High heterogeneity in meta-analyses was found, suggesting the findings should be considered cautiously. Future research should focus on longitudinal studies exploring sleep difficulties across the academic year, whilst university services should consider psychoeducation for stress and sleep in university students, especially during transition to university.
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Affiliation(s)
- Maria Gardani
- School of Health in Social Science, University of Edinburgh, UK.
| | | | - Kirsten Russell
- School of Psychological Sciences and Health, University of Strathclyde, UK
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Louise Beattie
- Institute of Health and Wellbeing, University of Glasgow, UK
| | - Jason G Ellis
- Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, UK
| | - Umair Akram
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, UK
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67
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Galbiati A, Sforza M, Scarpellino A, Salibba A, Leitner C, D'Este G, Mombelli S, Ferini-Strambi L, Castronovo V. "Thinking About Thinking" in Insomnia Disorder: The Effect of Cognitive-Behavioral Therapy for Insomnia on Sleep-Related Metacognition. Front Psychol 2021; 12:705112. [PMID: 34566784 PMCID: PMC8458623 DOI: 10.3389/fpsyg.2021.705112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Metacognition is defined as the ability to reflect on one’s mental state and to govern thoughts and beliefs. Metacognitive dysfunctions are typical of several psychopathologic conditions, and also a feature of insomnia disorder, possibly playing a crucial role in its genesis and maintenance. In the context of insomnia, metacognition describes how individuals react to their own sleep-related thoughts and beliefs, boosting the hyperarousal state experienced by these patients. Up to now, no studies evaluated the effect of cognitive behavioral therapy for insomnia (CBT-I) on metacognitive functioning. Therefore, the aim of our study was to evaluate the effect of CBT-I administered in group format in patients with insomnia disorder. As expected, all patients showed significant improvements in both insomnia and sleep diary parameters after treatment. Furthermore, an improvement was observed also in dysfunctional metacognitive levels, assessed by means of the Metacognitions Questionnaire-Insomnia (MCQ-I). However, 63% of patients still showed a MCQ-I score above the clinical cutoff after treatment. Dividing the sample on the basis of MCQ-I questionnaire scores after CBT-I, we found that patients, who still presented metacognitive impairment, received significant beneficial effects from CBT-I both on insomnia symptoms and on dysfunctional beliefs, but not on dysfunctional metacognitive functioning. These findings suggest that metacognition should be carefully evaluated in insomnia patients and further studies are needed to evaluate long-term implications of this remaining dysfunction.
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Affiliation(s)
- Andrea Galbiati
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Sforza
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Scarpellino
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Salibba
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Leitner
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giada D'Este
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Samantha Mombelli
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini-Strambi
- Vita-Salute San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenza Castronovo
- Department of Clinical Neurosciences, Neurology - Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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68
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Jansson-Fröjmark M, Alfonsson S, Bohman B, Rozental A, Norell-Clarke A. Paradoxical intention for insomnia: A systematic review and meta-analysis. J Sleep Res 2021; 31:e13464. [PMID: 34405469 DOI: 10.1111/jsr.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/04/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
Paradoxical intention (PI) has been considered an evidence-based treatment for insomnia since the 1990s, but it has not been evaluated with modern review techniques such as meta-analysis. The present study aimed to conduct the first systematic review and meta-analysis of studies that explore the effectiveness of PI for insomnia on insomnia symptomatology and theory-derived processes. A systematic review and meta-analysis was conducted by searching for eligible articles or dissertations in six online bibliographic databases. Randomised controlled trials and experimental studies comparing PI for insomnia to active and passive comparators and assessing insomnia symptoms as outcomes were included. A random effects model was estimated to determine the standardised mean difference Hedge's g at post-treatment. Test for heterogeneity was performed, fail-safe N was calculated, and study quality was assessed. The study was pre-registered at International Prospective Register of Systematic Reviews (PROSPERO, CRD42019137357). A total of 10 trials were identified. Compared to passive comparators, PI led to large improvements in key insomnia symptoms. Relative to active comparators, the improvements were smaller, but still moderate for several central outcomes. Compared to passive comparators, PI resulted in great reductions in sleep-related performance anxiety, one of several proposed mechanisms of change for PI. PI for insomnia resulted in marked clinical improvements, large relative to passive comparators and moderate compared to active comparators. However, methodologically stronger studies are needed before more firm conclusions can be drawn.
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Affiliation(s)
- Markus Jansson-Fröjmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sven Alfonsson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Benjamin Bohman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Alexander Rozental
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Great Ormond Street Hospital Institute of Child Health, UCL, London, UK
| | - Annika Norell-Clarke
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.,Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
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70
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Staines AC, Broomfield N, Pass L, Orchard F, Bridges J. Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis. J Sleep Res 2021; 31:e13451. [PMID: 34331373 DOI: 10.1111/jsr.13451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/09/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
Research indicates a bidirectional relationship between sleep and anxiety, with findings suggesting anxiety can precede poor sleep and vice versa. Evidence suggests sleep-related thought processes associated with anxiety are involved in the maintenance of insomnia. Previous meta-analyses provide some evidence to suggest cognitive behavioural therapy for insomnia moderately improves anxiety, yet little research has investigated the effect of other sleep interventions on anxiety symptoms. The aim of this meta-analysis was to review whether non-pharmacological sleep interventions have an impact on anxiety symptoms immediately post-intervention. A systematic search of electronic databases was conducted to identify all randomized control trials (RCTs) investigating non-pharmacological sleep interventions that included anxiety symptoms as an outcome. Forty-three RCTs (n = 5945) met full inclusion criteria and were included in a random-effects meta-analysis model. The combined effect size of non-pharmacological sleep interventions on anxiety symptoms was moderate (Hedges' g = -0.38), indicating a reduction in symptoms. Subgroup analyses found a moderate effect for those with additional physical health difficulties (g = -0.46), a moderate effect for those with additional mental health difficulties (g = -0.47) and a moderate effect for those with elevated levels of anxiety at baseline (g = -0.43). A secondary meta-analysis found a large effect of non-pharmacological sleep interventions on sleep-related thought processes (g = -0.92). These findings indicate non-pharmacological sleep interventions are effective in reducing anxiety and sleep-related thought processes, and these effects may be larger in patients with anxiety. This has clinical implications for considering sleep interventions in the treatment of anxiety.
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Affiliation(s)
- Alex Catherine Staines
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Niall Broomfield
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Laura Pass
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Faith Orchard
- School of Psychology, University of Sussex, Brighton, UK
| | - Jessica Bridges
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
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Norell-Clarke A, Hagström M, Jansson-Fröjmark M. Sleep-Related Cognitive Processes and the Incidence of Insomnia Over Time: Does Anxiety and Depression Impact the Relationship? Front Psychol 2021; 12:677538. [PMID: 34234716 PMCID: PMC8255681 DOI: 10.3389/fpsyg.2021.677538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: According to the Cognitive Model of Insomnia, engaging in sleep-related cognitive processes may lead to sleep problems over time. The aim was to examine associations between five sleep-related cognitive processes and the incidence of insomnia, and to investigate if baseline anxiety and depression influence the associations. Methods: Two thousand three hundred and thirty-three participants completed surveys on nighttime and daytime symptoms, depression, anxiety, and cognitive processes at baseline and 6 months after the first assessment. Only those without insomnia at baseline were studied. Participants were categorized as having or not having incident insomnia at the next time point. Baseline anxiety and depression were tested as moderators. Results: Three cognitive processes predicted incident insomnia later on. Specifically, more safety behaviors and somatic arousal at Time 1 increased the risk of developing insomnia. When investigating changes in the cognitive processes over time, reporting an increase of worry and safety behaviors also predicted incident insomnia. Depressive symptoms moderated the association between changes in worry and incident insomnia. Conclusion: These findings provide partial support for the hypothesis that cognitive processes are associated with incident insomnia. In particular, safety behaviors, somatic arousal, and worry increase the risk for incident insomnia. Preventative interventions and future research are discussed.
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Affiliation(s)
- Annika Norell-Clarke
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
- Department of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | | | - Markus Jansson-Fröjmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, The Centre for Psychotherapy, Education & Research, Region Stockholm, Stockholm, Sweden
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Pfaff A, Jud A, Schlarb A. Systematic review on the association between sleep-related hyperarousal and child maltreatment. Sleep Med 2021; 84:219-226. [PMID: 34171796 DOI: 10.1016/j.sleep.2021.05.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/25/2021] [Accepted: 05/31/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Various outcomes like sleep deficiencies can endure into adulthood as consequences from child maltreatment (CM). Hyperarousal as an explanation for the development of insomnia can be applied on this association. However, research on this link is lacking. METHOD A PRISMA-guided systematic literature review was conducted by searching academic literature databases. Empirical studies with no restriction of publishing year were eligible. Search terms were predefined and related to CM. RESULTS Of 602 records, 13 studies met the inclusion criteria. Sample sizes ranged from 39 to 304, with a total of 1469 participants. The studies were heterogenous, therefore comparability was diminished. Yet tendencies for sleep-related hyperarousal in maltreated individuals were found especially for somatic hyperarousal. Cortical and cognitive hyperarousal was rarely examined. CONCLUSION Hyperarousal (heightened nighttime acticity and heart rate, diminished heart rate variability) was found in individuals with CM experiences in several studies. The insights into mechanisms of how CM and sleep problems are interrelated, can help to sensitize therapists to not oversee CM experiences when a patient reports sleep difficulties. Yet, more studies with more rigorous methods are needed to illuminate this topic. This gap in research regarding the consequences of CM is not acceptable.
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Abstract
Sleep quality in elderly individuals is affected by increased mental and physical health issues associated with aging, but also a decrease in sleep drive and an advance of the circadian phase. These issues may, in part, be due to lifestyle changes in older adults, such as retirement and/or reduced social and physical activity, which can lead to spending more time in bed, resulting in chronic insomnia. Cognitive behavioral therapy for insomnia has been shown to be an effective treatment method for difficulty sleeping in elderly individuals and should be the first-line treatment due to its efficacy and safety profile.
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Yang S, Tian Y, He Q, Qiu J, Feng T, Chen H, Lei X. Enhanced Anti-correlation Between the Dorsal Attention and Default-mode Networks: A Resting-state fMRI Study of Acute Insomnia. Neuroscience 2021; 467:47-55. [PMID: 34022324 DOI: 10.1016/j.neuroscience.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/25/2022]
Abstract
With a greatly changed environment, sleep problem becomes a common phenomenon among college freshmen. However, this type of acute insomnia usually recovers after adapting to the circumstances, which can be defined as adaptive sleep problem (ASP). Few studies deal with this type of sleep problems. In this study, 991 first-year college freshmen were recruited on different days of the first semester to investigate their sleep status. We found that the sleep problem of college freshmen at the beginning of the semester was the most severe, compared with the other two-thirds of semester. Next, behavioral and resting-state functional magnetic imaging (rs-fMRI) data from 30 freshmen with ASP and 28 matched healthy controls (HC) were used to explore the neural basis of acute insomnia. Results showed that ASP group performed worse on many behavioral indices, such as fatigue, depression, and trait anxiety. Interestingly, students with ASP also showed significantly more negative functional connectivity between the anterior default mode network (aDMN) and the dorsal attentional network (DAN). Furthermore, a significant negative correlation was observed between Insomnia Severity Index (ISI) score and aDMN-DAN functional connectivity in the HC group, which was not observed in the case of ASP. In conclusion, the study explored the neural biomarker of adaptive sleep problem (ASP) in freshmen, and found its potentiating antagonism within the DMN-DAN. This enhanced anticorrelation may corroborate that students with ASP are in a hyperarousal state. Our current study may deepen our understanding of sleep disorders, and the enhanced anticorrelation may corroborate that ASP in due to a hyperarousal state.
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Affiliation(s)
- Shuyi Yang
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality (Ministry of Education), Chongqing 400715, China
| | - Yun Tian
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality (Ministry of Education), Chongqing 400715, China
| | - Qinghua He
- Key Laboratory of Cognition and Personality (Ministry of Education), Chongqing 400715, China
| | - Jiang Qiu
- Key Laboratory of Cognition and Personality (Ministry of Education), Chongqing 400715, China
| | - Tingyong Feng
- Key Laboratory of Cognition and Personality (Ministry of Education), Chongqing 400715, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality (Ministry of Education), Chongqing 400715, China
| | - Xu Lei
- Sleep and NeuroImaging Center, Faculty of Psychology, Southwest University, Chongqing 400715, China; Key Laboratory of Cognition and Personality (Ministry of Education), Chongqing 400715, China.
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75
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Lee MH, Kim N, Yoo J, Kim HK, Son YD, Kim YB, Oh SM, Kim S, Lee H, Jeon JE, Lee YJ. Multitask fMRI and machine learning approach improve prediction of differential brain activity pattern in patients with insomnia disorder. Sci Rep 2021; 11:9402. [PMID: 33931676 PMCID: PMC8087661 DOI: 10.1038/s41598-021-88845-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/19/2021] [Indexed: 11/26/2022] Open
Abstract
We investigated the differential spatial covariance pattern of blood oxygen level-dependent (BOLD) responses to single-task and multitask functional magnetic resonance imaging (fMRI) between patients with psychophysiological insomnia (PI) and healthy controls (HCs), and evaluated features generated by principal component analysis (PCA) for discrimination of PI from HC, compared to features generated from BOLD responses to single-task fMRI using machine learning methods. In 19 patients with PI and 21 HCs, the mean beta value for each region of interest (ROIbval) was calculated with three contrast images (i.e., sleep-related picture, sleep-related sound, and Stroop stimuli). We performed discrimination analysis and compared with features generated from BOLD responses to single-task fMRI. We applied support vector machine analysis with a least absolute shrinkage and selection operator to evaluate five performance metrics: accuracy, recall, precision, specificity, and F2. Principal component features showed the best classification performance in all aspects of metrics compared to BOLD response to single-task fMRI. Bilateral inferior frontal gyrus (orbital), right calcarine cortex, right lingual gyrus, left inferior occipital gyrus, and left inferior temporal gyrus were identified as the most salient areas by feature selection. Our approach showed better performance in discriminating patients with PI from HCs, compared to single-task fMRI.
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Affiliation(s)
- Mi Hyun Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nambeom Kim
- Department of Biomedical Engineering Research Center, Gachon University, Inchon, Republic of Korea
| | - Jaeeun Yoo
- Department of Biomedical Engineering, Gachon University, Inchon, Republic of Korea
| | - Hang-Keun Kim
- Department of Biomedical Engineering, Gachon University, Inchon, Republic of Korea
| | - Young-Don Son
- Department of Biomedical Engineering, Gachon University, Inchon, Republic of Korea
| | - Young-Bo Kim
- Department of Neurosurgery, Gachon University Gil Hospital, Inchon, Republic of Korea
| | - Seong Min Oh
- Department of Psychiatry, Dongguk University Hospital, Ilsan, Republic of Korea
| | - Soohyun Kim
- Department of Neurology, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Hayoung Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Eun Jeon
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu Jin Lee
- Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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76
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Decreased modulation of segregated SEEKING and selective attention systems in chronic insomnia. Brain Imaging Behav 2021; 15:430-443. [PMID: 32367486 DOI: 10.1007/s11682-020-00271-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sleep-related attentional bias and instinctual craving-sleep status may be associated with value-driven selective attention network and SEEKING system. We hypothesized that the two networks might be important components and underlie etiology of inability to initiate or/and maintain sleep in patients with chronic insomnia (PIs). Our aim is to investigate whether frequency-frequency couplings(temporal and spatial coupling, and differences of a set of imaging parameters) could elevate the sensibility to characterize the two insomnia-related networks in studying their relationships with sleep parameters and post-insomnia emotions. Forty-eight PIs and 48 status-matched good sleepers were requested to complete sleep and emotion-related questionnaires. Receiver operating characteristic curve was used to calculate the discriminatory power of a set of parameters. Granger causality and mediating causality analysis were used to address the causal relationships between the two networks and sleep/emotion-related parameters. Frequency-frequency couplings could characterize the two networks with high discriminatory power (AUC, 0.951; sensitivity, 87.5%; specificity, 95.8%), which suggested that the frequency-frequency couplings could be served as a useful biomarker to address the insomnia-related brain networks. Functional deficits of the SEEKING system played decreased mediator acting in post-insomnia negative emotions (decreased frequency-frequency coupling). Functional hyperarousal of the value-driven attention network played decreased mediator acting in sleep regulation (increased frequency-frequency coupling). Granger causality analysis showed decreased causal effect connectivity between and within the two networks. The between-network causal effect connectivity segregation played decreased mediator acting in sleep regulation (decreased connectivity). These findings suggest that the functional deficits and segregation of the two systems may underlie etiology of PIs.
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77
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Azza Y, Grueschow M, Karlen W, Seifritz E, Kleim B. How stress affects sleep and mental health: nocturnal heart rate increases during prolonged stress and interacts with childhood trauma exposure to predict anxiety. Sleep 2021; 43:5682806. [PMID: 31863098 DOI: 10.1093/sleep/zsz310] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/17/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Stress can adversely impact sleep health by eliciting arousal increase and a cascade of endocrine reactions that may impair sleep. To date, little is known regarding continuous effects of real-world stress on physiological sleep characteristics and potential effects on stress-related psychopathology. We examined effects of stress on heart rate (HR) during sleep and total sleep time (TST) during prolonged real-world stress exposure in medical interns. Moreover, we investigated the influence of previous stress and childhood trauma exposure on HR during sleep, TST, and its interaction in predicting anxiety. METHODS We examined a sample of 50 medical students prior to and during their first internship, a well described real-world stressor. HR and TST were continuously collected over 12 weeks non-invasively by a wrist-worn activity monitor. Prior to starting the internship, at baseline, participants reported on their sleep, anxiety, and childhood trauma exposure. They also tracked stress exposure during internship and reported on their anxiety symptoms 3 months after this professional stress. RESULTS Mean HR during sleep increased over time, while TST remained unchanged. This effect was more pronounced in interns exposed to childhood trauma exposure. In multilevel models, childhood trauma exposure also moderated the relation between individual HR increase and development of anxiety. CONCLUSIONS Prolonged stress may lead to increased HR during sleep, whereas individuals with childhood trauma exposure are more vulnerable. Childhood trauma exposure also moderated the relation between individual HR increase and development of anxiety. These findings may inform prevention and intervention measures.
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Affiliation(s)
- Yasmine Azza
- Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Sleep & Health Zürich, University of Zurich, Zurich, Switzerland
| | - Marcus Grueschow
- Zurich Center for Neuroeconomics, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Walter Karlen
- Mobile Health Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Sleep & Health Zürich, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Sleep & Health Zürich, University of Zurich, Zurich, Switzerland
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78
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Akram U, Bickle E, Howell C, Ozhan V, Williamson J, Du Rocher A. Sleep-related monitoring on awakening mediates the relationship between insomnia-related interpretive bias and insomnia symptoms using the insomnia ambiguity paradigm. J Sleep Res 2021; 30:e13343. [PMID: 33768602 DOI: 10.1111/jsr.13343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/07/2021] [Accepted: 03/07/2021] [Indexed: 12/01/2022]
Abstract
A number of studies have examined and confirmed the presence of a sleep-related interpretive bias amongst poor sleepers and individuals with insomnia using an insomnia ambiguity task. This study explored possible mechanisms underlying the relationship between interpretive bias and insomnia using the insomnia ambiguity task. More importantly, the possible mediating role of sleep-associated monitoring, sleep preoccupation, sleep anticipatory anxiety and generalized anxiety was also examined. A total of N = 176 participants were stratified into normal sleepers and those displaying insomnia symptoms. Participants completed an online version of the insomnia ambiguity task and questionnaire measures pertaining to sleep and anxiety. Data concerning task response time and time of testing were also collected. Individuals in the insomnia symptom group presented significantly higher sleep-related interpretive bias scores compared to normal sleepers. When sleepiness, sleep-associated monitoring, sleep preoccupation, sleep anticipatory anxiety and generalized anxiety were controlled for, only monitoring on awakening predicted sleep-related interpretive bias. Multiple mediation modelling demonstrated that sleep-associated monitoring on awakening mediated the relationship between interpretive bias and insomnia symptoms. The current outcomes are consistent with previous research, supporting the notion that insomnia is characterized by a disorder-consistent interpretive bias. Furthermore, monitoring for insomnia-consistent cues on awakening appears to mediate group differences in interpretive bias.
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Affiliation(s)
- Umair Akram
- Department of Psychology, Sheffield Hallam University, Sheffield, UK
| | - Eleanor Bickle
- Department of Psychology, Sheffield Hallam University, Sheffield, UK
| | - Carley Howell
- Department of Psychology, Sheffield Hallam University, Sheffield, UK
| | - Vildan Ozhan
- Department of Psychology, Sheffield Hallam University, Sheffield, UK
| | | | - Andrew Du Rocher
- Department of Psychology, Sheffield Hallam University, Sheffield, UK
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79
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Ballesio A, Vacca M, Bacaro V, Benazzi A, De Bartolo P, Alivernini F, Lucidi F, Lombardo C, Baglioni C. Psychological correlates of insomnia in professional soccer players: An exploratory study. Eur J Sport Sci 2021; 22:897-905. [PMID: 33599195 DOI: 10.1080/17461391.2021.1892197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sleep promotes health, well-being, recovery and athletic performance. As a consequence, sleep problems in athletes may have detrimental effects. Previous investigations showed that professional athletes often reported to suffer of poor sleep quality and insomnia (e.g. difficulties falling asleep and/or maintaining sleep). However, psychological variables exacerbating and maintaining insomnia in professional athletes as well as its mechanistic pathways are still largely unknown. Available literature mostly focused on effects of sport-related variables, such as evening training and stimulant consumption on athletes' sleep. Instead, the contribution of cognitive and emotional variables globally associated with insomnia in athletes in clinical models has been largely neglected. To address these limitations, this study explored the associations between emotional experience, pre-sleep arousal, pre-sleep worry and rumination and insomnia severity in a sample of 210 (25.93 ± 6.68 years) male professional soccer players. Bivariate correlations, multiple regression, and structural equation modelling with manifest variables (path analysis) were computed. Results showed that insomnia severity was associated with stimulants consumption, pre-sleep arousal, negative emotions, positive emotions, and pre-sleep worry/rumination (all p < .05). Path analysis showed that relationship between stimulant consumption, emotional experience, worry/rumination and insomnia was mediated by pre-sleep arousal (p < .05). Our results suggest that preventive and interventional studies in professional soccer players would benefit from considering global cognitive-emotional variables as targets of interventions.HighlightsInsomnia was associated with greater stimulants consumption, pre-sleep arousal, negative emotions, pre-sleep worry/rumination, and lower positive emotions.Path analysis showed that pre-sleep arousal mediated the relationship between stimulant consumption, emotional experience, worry/rumination and insomnia severity.Cognitive-emotional and behavioural factors as well as sport-related variables were important predictors of insomnia in professional soccer players.
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Affiliation(s)
- Andrea Ballesio
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy.,Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy
| | | | - Valeria Bacaro
- Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy
| | - Adriano Benazzi
- Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy.,Associazione Italiana Calciatori, AIC, Vicenza, Italy
| | - Paola De Bartolo
- Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy.,Laboratory of Experimental Neurophysiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Fabio Alivernini
- INVALSI - Italian National Institute for the Educational Evaluation of Instruction and Training, Rome, Italy
| | - Fabio Lucidi
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Chiara Baglioni
- Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy.,Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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80
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Lee S, Park JB, Lee KJ, Ham S, Jeong I. Effects of work organization on the occurrence and resolution of sleep disturbances among night shift workers: a longitudinal observational study. Sci Rep 2021; 11:5499. [PMID: 33750873 PMCID: PMC7970909 DOI: 10.1038/s41598-021-85017-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/23/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to investigate the association between work organization and the trajectories of insomnia patterns among night shift workers in a hospital. The health examination data of hospital workers, recorded from January 2014 to December 2018, were collected; 6765 records of 2615 night shift workers were included. Insomnia was defined as a score of ≥ 15 on the Insomnia Severity Index (ISI). Participants were categorized into five groups according to insomnia patterns derived from the analysis of their ISI scores. Work organization and socio-demographic characteristics were also investigated. Generalized estimating equation models and linear mixed models were constructed to analyze the longitudinal data. Of the total participants, 53.0% reported insomnia at least once during the follow-up period. The lack of nap opportunities and work-time control was associated with the occurrence of insomnia, whereas more than 5 years of shift work experience was related to the resolution of insomnia. All work-related factors were significantly related to insomnia risk; however, the effects were not significant in the sustained insomnia group. Although sleep problems are inevitable in night shift workers, well-designed work schedules and better work organization can help reduce the occurrence of insomnia among them.
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Affiliation(s)
- Seungho Lee
- Department of Occupational and Environmental Medicine, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Jae Bum Park
- Department of Occupational and Environmental Medicine, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Kyung-Jong Lee
- Department of Occupational and Environmental Medicine, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Seunghon Ham
- Department of Occupational and Environmental Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, 21565, South Korea
| | - Inchul Jeong
- Department of Occupational and Environmental Medicine, Ajou University School of Medicine, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
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81
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Bjorvatn B, Jernelöv S, Pallesen S. Insomnia - A Heterogenic Disorder Often Comorbid With Psychological and Somatic Disorders and Diseases: A Narrative Review With Focus on Diagnostic and Treatment Challenges. Front Psychol 2021; 12:639198. [PMID: 33643170 PMCID: PMC7904898 DOI: 10.3389/fpsyg.2021.639198] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/21/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with insomnia complain of problems with sleep onset or sleep maintenance or early morning awakenings, or a combination of these, despite adequate opportunity and circumstances for sleep. In addition, to fulfill the diagnostic criteria for insomnia the complaints need to be associated with negative daytime consequences. For chronic insomnia, the symptoms are required to be present at least 3 days per week for a duration of at least 3 months. Lastly, for insomnia to be defined as a disorder, the sleep complaints and daytime symptoms should not be better explained by another sleep disorder. This criterion represents a diagnostic challenge, since patients suffering from other sleep disorders often complain of insomnia symptoms. For instance, insomnia symptoms are common in e.g., obstructive sleep apnea and circadian rhythm sleep-wake disorders. It may sometimes be difficult to disentangle whether the patient suffers from insomnia disorder or whether the insomnia symptoms are purely due to another sleep disorder. Furthermore, insomnia disorder may be comorbid with other sleep disorders in some patients, e.g., comorbid insomnia and sleep apnea (COMISA). In addition, insomnia disorder is often comorbid with psychological or somatic disorders and diseases. Thus, a thorough assessment is necessary for correct diagnostics. For chronic insomnia disorder, treatment-of-choice is cognitive behavioral therapy, and such treatment is also effective when the insomnia disorder appears comorbid with other diagnoses. Furthermore, studies suggest that insomnia is a heterogenic disorder with many different phenotypes or subtypes. Different insomnia subtypes may respond differently to treatment, but more research on this issue is warranted. Also, the role of comorbidity on treatment outcome is understudied. This review is part of a Research Topic on insomnia launched by Frontiers and focuses on diagnostic and treatment challenges of the disorder. The review aims to stimulate to more research into the bidirectional associations and interactions between insomnia disorder and other sleep, psychological, and somatic disorders/diseases.
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Affiliation(s)
- Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Susanna Jernelöv
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
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82
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Motomura Y, Katsunuma R, Ayabe N, Oba K, Terasawa Y, Kitamura S, Moriguchi Y, Hida A, Kamei Y, Mishima K. Decreased activity in the reward network of chronic insomnia patients. Sci Rep 2021; 11:3600. [PMID: 33574355 PMCID: PMC7878866 DOI: 10.1038/s41598-020-79989-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 12/04/2020] [Indexed: 12/03/2022] Open
Abstract
In modern society, many people have insomnia. Chronic insomnia has been noted as a risk factor for depression. However, there are few functional imaging studies of the brain on affective functions in chronic insomnia. This study aimed to investigate brain activities induced by emotional stimuli in chronic insomnia patients. Fifteen patients with primary insomnia and 30 age and gender matched healthy controls participated in this study. Both groups were presented images of fearful, happy, and neutral expressions consciously and non-consciously while undergoing MRI to compare the activity in regions of the brain responsible for emotions. Conscious presentation of the Happy-Neutral contrast showed significantly lower activation in the right orbitofrontal cortex of patients compared to healthy controls. The Happy-Neutral contrast presented in a non-conscious manner resulted in significantly lower activation of the ventral striatum, right insula, putamen, orbitofrontal cortex and ventral tegmental area in patients compared to healthy controls. Our findings revealed that responsiveness to positive emotional stimuli were decreased in insomniac patients. Specifically, brain networks associated with rewards and processing positive emotions showed decreased responsiveness to happy emotions especially for non-conscious image. The magnitude of activity in these areas also correlated with severity of insomnia, even after controlling for depression scale scores. These findings suggest that insomnia induces an affective functional disorder through an underlying mechanism of decreased sensitivity in the regions of the brain responsible for emotions and rewards to positive emotional stimuli.
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Affiliation(s)
- Yuki Motomura
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan. .,Faculty of Design, Kyushu University, 4-9-1 Shiobaru, Minami-ku, Fukuoka, 815-8540, Japan. .,Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
| | - Ruri Katsunuma
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Naoko Ayabe
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.,Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, 1-1, Tegata-Gakuenmachi, Akita, 010-8502, Japan
| | - Kentaro Oba
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.,Department of Human Brain Science, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Yuri Terasawa
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.,Department of Psychology, Keio University, 4-1-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, 223-8521, Japan
| | - Shingo Kitamura
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Yoshiya Moriguchi
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.,Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Akiko Hida
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Yuichi Kamei
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.,Kamisuwa Hospital, 1-17-7 Ote, Suwa, Nagano, Japan
| | - Kazuo Mishima
- Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan. .,Faculty of Medicine, Akita University, 1-1-1 Hondo, Akita, 010-8543, Japan. .,International Institute for Integrative Sleep Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan.
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83
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Chan NY, Chan JWY, Li SX, Wing YK. Non-pharmacological Approaches for Management of Insomnia. Neurotherapeutics 2021; 18:32-43. [PMID: 33821446 PMCID: PMC8116473 DOI: 10.1007/s13311-021-01029-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
Insomnia is a prevalent sleep problem associated with a constellation of negative health-related outcomes and significant socioeconomic burden. It commonly co-occurs with psychiatric and medical conditions, which may further exacerbate these comorbid conditions and hinder treatment response. There is much empirical evidence to support the clinical efficacy of non-pharmacological treatment for insomnia, especially cognitive behavioral therapy for insomnia (CBT-I), in managing insomnia in a wide range of populations. This article reviews the research on the efficacy of CBT-I for primary insomnia and insomnia comorbid with other psychiatric and medical conditions, the empirical evidence regarding different CBT-I treatment modalities, the implementation of CBT-I across different age groups, and some initial evidence on the sequential combination of insomnia treatments. A brief overview of other non-pharmacological treatment with regard to complementary alternative medicine is also provided.
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Affiliation(s)
- Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Departments of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Joey Wing Yan Chan
- Li Chiu Kong Family Sleep Assessment Unit, Departments of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Departments of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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84
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Xiao S, Liu S, Zhang P, Yu J, A H, Wu H, Zhang F, Xiao Y, Ma N, Zhang X, Ma X, Li J, Wang X, Shao X, Liu W, Zhang X, Wu W, Wang L, Wu R, He Y, Xu Z, Chi L, Du S, Zhang B. The Association Between Depressive Symptoms and Insomnia in College Students in Qinghai Province: The Mediating Effect of Rumination. Front Psychiatry 2021; 12:751411. [PMID: 34744840 PMCID: PMC8563788 DOI: 10.3389/fpsyt.2021.751411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study investigates the mediating effect of rumination on the associations between depressive symptoms and insomnia. Methods: This is a cross-sectional study. Insomnia Severity Index (ISI), Ruminant Response Scale (RRS) and Beck Depression Inventory (BDI) were determined in 12,178 college students in Qinghai province by a questionnaire network platform. Results: The prevalence of insomnia was 38.6% in the participants. Insomnia symptoms [interquartile range: 6 (3, 9)], depressive symptoms [interquartile range: 5 (1, 9)], and rumination [interquartile range: 22 (20, 26)] were positively correlated (r = 0.25-0.46, p < 0.01). Mediation effect analysis showed that the depressive symptoms affected insomnia directly and indirectly. The direct effect and the indirect effect through rumination account for 92.4 and 7.6% of the total effect, respectively. Conclusion: The study shows that insomnia, depressive symptoms, and rumination are related constructs in college students in Qinghai province. It demonstrates the direct effects and the rumination-mediated indirect effects between depressive symptoms and insomnia; the direct effects seem to be dominant.
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Affiliation(s)
- Shuheng Xiao
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuai Liu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China.,The Third People's Hospital of Qinghai Province, Xining, China
| | - Puxiao Zhang
- First Clinical Medical College, Xinjiang Medical University, Urumqi, China
| | - Jia Yu
- The Third People's Hospital of Panzhihua, Panzhihua, China
| | - Huaihong A
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Hui Wu
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Fabin Zhang
- Department of Student Affairs, Qinghai University, Xining, China
| | - Yulan Xiao
- Office of the President, Qinghai Nationalities University, Xining, China
| | - Naiben Ma
- Department of Student Affairs, Qinghai Nationalities University, Xining, China
| | - Xiuqin Zhang
- Department of Student Affairs, Qinghai Nationalities University, Xining, China.,Mental Health Education Center, Qinghai Nationalities University, Xining, China
| | - Xiaoxia Ma
- Mental Health Education Center, Qinghai Nationalities University, Xining, China
| | - Junfeng Li
- School of Economics and Trade, Hebei GEO University, Shijiazhuang, China.,School of Economics and Management, Qinghai Nationalities University, Xining, China
| | - Xiaodun Wang
- School of Civil Engineering, Tianjin University, Tianjin, China.,School of Civil and Traffic Engineering, Qinghai Nationalities University, Xining, China
| | - Xin Shao
- School of Physics Science and Information Technology, Liaocheng University, Liaocheng, China.,School of Physics and Electronic Information Engineering, Qinghai Normal University, Xining, China
| | - Wenjing Liu
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Xiaolin Zhang
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Wei Wu
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Lihua Wang
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Rihan Wu
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Yinglian He
- The Third People's Hospital of Qinghai Province, Xining, China
| | - Zeyu Xu
- Institute of Health Management, Southern Medical University, Guangzhou, China
| | - Luhao Chi
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shixu Du
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
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85
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Gökce F, Ehring T, Werner GG, Takano K. Misperception of sleep is associated with intrinsic motivation toward thinking about sleep. J Behav Ther Exp Psychiatry 2020; 69:101591. [PMID: 32553998 DOI: 10.1016/j.jbtep.2020.101591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/31/2020] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Misperception of sleep, the underestimation of total sleep time and overestimation of sleep onset latency (SOL) relative to objective measures, is often found in people with sleep disturbances. Theories of insomnia have proposed that perceived sleeplessness triggers excessive intention and effort to sleep, ironically disturbing the normal initiation of sleep. The current study tested this specific association between (mis)perception of sleep and intrinsic motivation to think about sleep. METHODS The sample (n = 74) covered students and community living in Munich and surrounds with ages between 18 and 30 years. We assessed the subjective and objective sleep of participants using a sleep diary and actigraphy. Participants also completed a decision-making task (the pay-per-view task), where they had to decide between thinking about sleep vs. eating. As these options were associated with a variable monetary reward, participants typically experienced a conflict between their preferred topic and the reward for their choice. RESULTS Multilevel logistic regression analyses showed that participants with greater SOL misperception (i.e., longer subjective relative to objective SOL) forgo a greater reward for the opportunity to think about sleep. LIMITATIONS The non-clinical nature of our sample may limit the implication of the findings for clinical levels of insomnia. CONCLUSIONS Results support the cognitive model of insomnia, suggesting that perception of sleeplessness is associated with higher intrinsic motivation to engage in sleep-related thinking.
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Affiliation(s)
- Feyza Gökce
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, LMU Munich, Leopoldstrasse 13, 80802, Munich, Germany
| | - Thomas Ehring
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, LMU Munich, Leopoldstrasse 13, 80802, Munich, Germany
| | - Gabriela G Werner
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, LMU Munich, Leopoldstrasse 13, 80802, Munich, Germany
| | - Keisuke Takano
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, LMU Munich, Leopoldstrasse 13, 80802, Munich, Germany.
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86
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Jeon MS, Agar MR, Koh ES, Nowak AK, Hovey EJ, Dhillon HM. Understanding sleep disturbance in the context of malignant brain tumors: a qualitative analysis. Neurooncol Pract 2020; 8:179-189. [PMID: 33898051 DOI: 10.1093/nop/npaa081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background Sleep is an important element in health-related quality of life of cancer patients and caregivers. This study aimed to explore the experience of sleep disturbance in people with malignant brain tumors (BT) and their family caregivers. Methods Participants were recruited from ambulatory neuro-oncology clinics. Semi-structured interviews were conducted with 24 patients (67% with high-grade gliomas) and 14 caregivers. Data were analyzed thematically using a framework synthesis. Results We identified six themes relating to perceptions of the nature, impact, causal factors, and interventions for sleep disturbance, beliefs about sleep and impact, and personal coping strategies. Participants described their sleep disturbance in terms of insomnia symptoms; most commonly difficulties initiating and maintaining sleep. Participants had varied views on causal factors including the BT diagnosis and treatment and caregiver burden. However, excessive thinking and BT-related anxiety were evident in both patients and caregivers. The described impact on daytime functioning due to non-restful sleep and fatigue appeared to be significant and many participants needed daytime naps, although they understated the impact on individual functioning. Some participants were reluctant to seek help from clinicians for sleep disturbance due to previous experiences where sleep disturbance was overlooked, or because they held negative views toward pharmacological interventions. Participants reported various coping strategies, ranging from relaxation-promoting techniques to behaviors to distract thinking at night that may instead disturb sleep. Conclusions Psychological factors contribute to sleep disturbance in patients with BT and caregivers. This population may benefit from information about sleep disturbance and interventions targeting anxiety.
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Affiliation(s)
- Megan S Jeon
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Meera R Agar
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Department of Radiation Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Anna K Nowak
- Medical School, QEII Medical Centre Unit, University of Western Australia, Crawley, WA, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Elizabeth J Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, NSW, Australia
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87
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Maurer LF, Espie CA, Omlin X, Reid MJ, Sharman R, Gavriloff D, Emsley R, Kyle SD. Isolating the role of time in bed restriction in the treatment of insomnia: a randomized, controlled, dismantling trial comparing sleep restriction therapy with time in bed regularization. Sleep 2020; 43. [DOI: 10.1093/sleep/zsaa096] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Abstract
Study Objectives
Sleep restriction therapy (SRT) is one of the most effective treatments for insomnia. Restriction of time in bed (TIB) is assumed to be the central mechanism through which SRT improves sleep consolidation and reduces insomnia symptoms. This hypothesis has never been directly tested. We designed a randomized, controlled, dismantling trial in order to isolate the role of TIB restriction in driving both clinical and polysomnographic sleep outcomes.
Methods
Participants aged 25–55 who met diagnostic criteria for insomnia disorder were block-randomized (1:1) to 4 weeks of SRT or time in bed regularization (TBR), a treatment that involves the prescription of a regular but not reduced TIB. The primary outcome was assessed with the insomnia severity index (ISI) at baseline, 4-, and 12-weeks post-randomization. Secondary outcomes included sleep continuity (assessed via polysomnography, actigraphy, and diary) and quality of life. We performed intention-to-treat analyses using linear mixed models.
Results
Fifty-six participants (39 females, mean age = 40.78 ± 9.08) were assigned to SRT (n = 27) or TBR (n = 29). Daily monitoring of sleep via diaries and actigraphy confirmed large group differences in TIB (d range = 1.63–1.98). At 4-weeks post-randomization, the adjusted mean difference for the ISI was −4.49 (d = −1.40) and −4.35 at 12 weeks (d = −1.36), indicating that the SRT group reported reduced insomnia severity relative to TBR. Robust treatment effects in favor of SRT were also found for objective and self-reported sleep continuity variables (d range = 0.40–0.92) and sleep-related quality of life (d = 1.29).
Conclusions
For the first time, we demonstrate that TIB restriction is superior to the regularization of TIB on its own. Our results underscore the centrality of the restriction component in reducing insomnia symptoms and consolidating sleep.
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Affiliation(s)
- Leonie Franziska Maurer
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Colin Alexander Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ximena Omlin
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Matthew James Reid
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Rachel Sharman
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Dimitri Gavriloff
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Simon David Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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88
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Puzino K, Amatrudo G, Sullivan A, Vgontzas AN, Fernandez-Mendoza J. Clinical Significance and Cut-Off Scores for the Pre-Sleep Arousal Scale in Chronic Insomnia Disorder: A Replication in a Clinical Sample. Behav Sleep Med 2020; 18:705-718. [PMID: 31545084 DOI: 10.1080/15402002.2019.1669604] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: In contrast to pre-sleep cognitive arousal, self-reported pre-sleep somatic arousal is a rather elusive construct for which little validity has been provided. Thus, the clinical significance of somatic symptoms during the pre-sleep period remains unknown. Participants: 248 patients (45.0 ± 16.7 years old, 65.3% female) with a diagnosis of chronic insomnia disorder, out of 388 consecutive patients evaluated at the Behavioral Sleep Medicine (BSM) program of Penn State Hershey Sleep Research & Treatment Center. Methods: Participants completed the Pre-sleep Arousal Scale assessing cognitive (PSAS-C) and somatic (PSAS-S) arousal as well as the Insomnia Severity Index (ISI), Ford Insomnia Response to Stress Test (FIRST), Arousal Predisposition Scale (APS), and Depression Anxiety Stress Scale (DASS). Multivariable stepwise regression assessed which clinical factors were independently associated with greater PSAS-C and PSAS-S scores. Receiver operating characteristic analysis determined the predictive value for identifying sleep reactivity (FIRST≥18) and clinical anxiety (DASS-A ≥ 10) and clinically useful cutoff scores. Results: The strongest correlates of PSAS-S were DASS-A (β = 0.64) and chronic pain (β = 0.11), while those of PSAS-C were FIRST (β = 0.29) and a history of stroke (β = 0.10). A PSAS-S score of 14.8 (AUC = 0.87, 95%CI = 0.83-0.91) and a PSAS-C score of 24.5 (AUC = 0.82, 95%CI = 0.76-0.88) showed the best balance in specificity and sensitivity to identify clinical anxiety and sleep reactivity, respectively. Conclusions: Self-reported pre-sleep somatic symptoms are a marker of comorbid anxiety and, potentially chronic pain, impacting nighttime sleep. The optimal cutoff scores of 14 and 20 proposed herein can help clinicians with case formulation, with tailoring BSM treatments and their targets.
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Affiliation(s)
- Kristina Puzino
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University , Hershey, PA
| | - Gregory Amatrudo
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University , Hershey, PA
| | - Alanna Sullivan
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University , Hershey, PA
| | - Alexandros N Vgontzas
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University , Hershey, PA
| | - Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Penn State Health Milton S. Hershey Medical Center, College of Medicine, Pennsylvania State University , Hershey, PA
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89
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Rasskazova EI, Leonov SV. [Behavioral factors of sleep-related complaints and subjective poor well-being in general population]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:34-39. [PMID: 33076643 DOI: 10.17116/jnevro202012009234] [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: 11/17/2022]
Abstract
OBJECTIVE To validate the Scale of Behavioral Factors of Sleep Disturbances is people without diagnosed sleep disorders, as well as to reveal direct and indirect effects of sleep behavior on subjective sleep quality and well-being. MATERIAL AND METHODS Sample 1 included 66 people, aged 19-55 years, without diagnosed sleep disturbances who completed the Scale of Behavioral Factors of Sleep Disturbances (subscales for Taking Medications and Non-Medications, Alcohol, Tonic Drinks and Using Gadgets in the evening, Delaying Bedtime, Self-Limitations, Sleep Ritual, Adherence to the Regimen, Postponement of the Morning Rise), Insomnia Severity Index, Hospital Scale of Anxiety and Depression. Sample 2 included 174 people, aged 17-57 years, without diagnosed sleep disorders, who completed Beck's Anxiety and Depression Inventories in addition to the scales administered to sample 1. Forty-four people completed the Scale of Behavioral Factors again after two weeks. RESULTS The moderate reliability-consistency (α=0.62-0.93) and retest reliability of the subscales (r=0.33-0.79, p<0.01) as well as the relationship between poor sleep, especially in the evening, self-limitating behavior and sleep-related complaints of sleep, anxiety and, to a lesser extent, complaints of depressive symptoms (r=0.15-0.58, p<0.05) were revealed. All behavioral strategies, except for the sleep ritual, are characterized by an indirect effect on anxiety, depressiveness, poor well-being (|β|=0.03-0.24): the more often a person uses them, the more likely he/she has sleep-related complaints, which, in turn, is a risk factor for poorer well-being. Self-limiting behavior and delaying the morning rise are associated with a lower level of well-being, even in the absence of sleep-related complaints (β=0.23-0.34, p<0.01). CONCLUSIONS The Scale of Behavioral Factors of Sleep Disturbances can be used for research purposes. The results of the study suggest that the dysfunctional role of behavior on well-being is predominantly indirect (through the perpetuation of complaints), but it can also be direct (regardless of complaints of sleep disorders).
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Affiliation(s)
- E I Rasskazova
- Lomonosov Moscow State University, Moscow, Russia.,Mental Health Research Center, Moscow, Russia
| | - S V Leonov
- Lomonosov Moscow State University, Moscow, Russia
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90
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91
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Hartescu I, Morgan K, Stevinson CD. Psychomotor Performance Decrements following a Successful Physical Activity Intervention for Insomnia. Behav Sleep Med 2020; 18:298-308. [PMID: 30773058 DOI: 10.1080/15402002.2019.1578774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: Evidence supports the view that reductions in cognitive hyperarousal contribute substantially to improved sleep outcomes following cognitive and behavioral interventions for insomnia disorder. Assuming an inverted-u relationship between arousal and performance, a theoretical possibility, supported by limited empirical data, is that the same mediating processes could negatively impact aspects of psychomotor performance, reducing speed on tests of reaction time. Participants: Sedentary participants (mean age = 59.8; SD = 9.46) meeting research diagnostic criteria for insomnia were randomized to either an exercise intervention of ≥150 min of moderate-intensity activity per week (n = 20), or a wait-list control group (n = 21). Of these, n = 17 intervention and n = 18 control participants completed 6-month follow-up assessments. Methods: Digit span, and simple and complex vigilance task performance was assessed using a computerized protocol at baseline and 6-month follow-up. Dependent variables included digit span, simple reaction time (SRT), complex reaction time (CRT), false positive responses, number of lapses, and SRT/CRT ratio (indicative of the magnitude of difference between simple and complex RT performance). The primary clinical outcome was Insomnia Severity Index (ISI) score. Results: In comparisons of baseline to follow-up change, ISI scores showed clinically significant improvement in the intervention group at 6-month follow-up (F (8,26) = 5.16; P = 0.03). Baseline vigilance performance was equivalent in both groups. At 6-month follow-up, however, the intervention group showed significantly slower simple reaction time F(4,30) = 10.25, p < 0.01, and a significantly decreased SRT/CRT ratio (F(4,30) = 13.22, p < 0.01). Conclusions: Among people meeting diagnostic criteria for insomnia, beneficial sleep outcomes following successful behavioral interventions may, under some circumstances, come at the cost of slower psychomotor performance.
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Affiliation(s)
- Iuliana Hartescu
- Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Kevin Morgan
- Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Clare D Stevinson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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92
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Lemyre A, Belzile F, Landry M, Bastien CH, Beaudoin LP. Pre-sleep cognitive activity in adults: A systematic review. Sleep Med Rev 2020; 50:101253. [DOI: 10.1016/j.smrv.2019.101253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 11/09/2019] [Accepted: 12/08/2019] [Indexed: 12/20/2022]
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93
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Gupta L, Morgan K, North C, Gilchrist S. Napping in high-performance athletes: Sleepiness or sleepability? Eur J Sport Sci 2020; 21:321-330. [PMID: 32174283 DOI: 10.1080/17461391.2020.1743765] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Daytime napping is a common practice in high-performance athletes, and is widely assumed to reflect sleepiness arising from sports-related sleep debt. The possibility that athlete naps may also be indicative of 'sleepability', a capacity to nap on demand that is only weakly related to homeostatic sleep pressure, has not previously been tested. The present study compared daytime sleep latencies in high-performance athletes and non-athlete controls using a single nap opportunity model. Elite (n = 10), and sub-elite (n = 10) athletes, and non-athlete controls (n = 10) attended the laboratory for a first adaption trial, and a subsequent experimental trial. Subjective sleepiness was assessed using the Karolinska Sleepiness Scale (KSS) at 14:00, 14:30 and immediately prior to a 20-minute nap opportunity at 15:00. Sleep latencies were measured using polysomnography, and defined as the time from lights out to the first epoch of any stage of sleep (N1, N2, N3, REM). In unadjusted comparisons with non-athlete controls, elite athletes showed significantly shorter sleep latencies in both the adaptation (p < 0.05) and experimental trials (p < 0.05). These significant differences were maintained in models controlling for pre-trial KSS scores and pre-trial total sleep time (all p < 0.05). Sleep latency scores for sub-elite athletes showed similar trends, but were more labile. These results are consistent with a conclusion that, among elite athletes, napping behaviour can reflect sleepability and may not necessarily result from nocturnal sleep disruption and daytime sleepiness.
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Affiliation(s)
- Luke Gupta
- English Institute of Sport, The High Performance Centre, Bisham Abbey National Sports Centre, Buckinghamshire, UK.,Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE113TU, UK
| | - Kevin Morgan
- Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE113TU, UK
| | - Courtney North
- Clinical Sleep Research Unit, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE113TU, UK
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94
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Cheng MY, Wang MJ, Chang MY, Zhang RX, Gu CF, Zhao YH. Relationship between resilience and insomnia among the middle-aged and elderly: mediating role of maladaptive emotion regulation strategies. PSYCHOL HEALTH MED 2020; 25:1266-1277. [PMID: 32098490 DOI: 10.1080/13548506.2020.1734637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study aimed to investigate the relationships between cognitive emotion regulation (CER) strategies, resilience, and insomnia and the underlying mechanism that explains the relationships. Six hundred and fifty-three middle-aged and old people recruited from community service centers in Henan province completed questionnaires related to CER strategies, resilience, and insomnia. Results showed refocus on planning and positive reappraisal negatively predicted insomnia, and catastrophising, rumination and self-blame positively predicted insomnia. Moreover, maladaptive emotion regulation strategies (especially catastrophising) mediated the relationship between resilience and insomnia. The findings suggest the middle-aged and elderly with insomnia tended to employ maladaptive emotion regulation strategies and had lower resilience. Maladaptive emotion regulation strategies buffered the positive effect of resilience on sleep.
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Affiliation(s)
- Meng-Yin Cheng
- School of Nursing and Health, Zhengzhou University , Zhengzhou, China
| | - Meng-Jia Wang
- School of Nursing and Health, Zhengzhou University , Zhengzhou, China
| | - Ming-Yu Chang
- School of Nursing and Health, Zhengzhou University , Zhengzhou, China
| | - Rui-Xing Zhang
- School of Nursing and Health, Zhengzhou University , Zhengzhou, China
| | - Chao-Fan Gu
- School of Nursing and Health, Zhengzhou University , Zhengzhou, China
| | - Yu-Hua Zhao
- School of Nursing and Health, Zhengzhou University , Zhengzhou, China
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95
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Thakral M, Von Korff M, McCurry SM, Morin CM, Vitiello MV. Changes in dysfunctional beliefs about sleep after cognitive behavioral therapy for insomnia: A systematic literature review and meta-analysis. Sleep Med Rev 2020; 49:101230. [PMID: 31816582 PMCID: PMC7012685 DOI: 10.1016/j.smrv.2019.101230] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/30/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for chronic insomnia and sleep-related cognitions are one target of treatment. There has been little systematic investigation of how sleep-related cognitions are being assessed in CBT-I trials and no meta-analysis of the impact of CBT-I on dysfunctional beliefs about sleep, a core cognitive component of treatment. Academic Search Complete, Medline, CINAHL and PsychInfo from 1990 to 2018 were searched to identify randomized controlled trials of CBT-I in adults (≥18 years) reporting some measure of sleep-related cognitions. Sixteen randomized controlled trials were identified comparing 1134 CBT-I and 830 control subjects. The Dysfunctional Beliefs and Attitudes about Sleep Scale was utilized almost exclusively to assess sleep-related cognitions in these trials. Hedge's g at 95% confidence interval (CI) was calculated to assess CBT-I effect size at post-treatment compared to controls. CBT-I significantly reduced dysfunctional beliefs about sleep (g = -0.90, 95% CI -1.19, -0.62) at post-treatment. Three trials contributed data to estimate effect size for long-term effects (g = -1.04, 95% CI -2.07, -0.02) with follow up time ranging from 3 to 18 mo. We concluded that cognitive behavioral therapy for insomnia has moderate to large effects on dysfunctional beliefs about sleep.
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Affiliation(s)
- Manu Thakral
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; University of Washington School of Nursing, Seattle, WA, USA.
| | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Susan M McCurry
- University of Washington School of Nursing, Seattle, WA, USA
| | - Charles M Morin
- School of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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96
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Riemann D, Krone LB, Wulff K, Nissen C. Sleep, insomnia, and depression. Neuropsychopharmacology 2020; 45:74-89. [PMID: 31071719 PMCID: PMC6879516 DOI: 10.1038/s41386-019-0411-y] [Citation(s) in RCA: 330] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 12/23/2022]
Abstract
Since ancient times it is known that melancholia and sleep disturbances co-occur. The introduction of polysomnography into psychiatric research confirmed a disturbance of sleep continuity in patients with depression, revealing not only a decrease in Slow Wave Sleep, but also a disinhibition of REM (rapid eye movement) sleep, demonstrated as a shortening of REM latency, an increase of REM density, as well as total REM sleep time. Initial hopes that these abnormalities of REM sleep may serve as differential-diagnostic markers for subtypes of depression were not fulfilled. Almost all antidepressant agents suppress REM sleep and a time-and-dose-response relationship between total REM sleep suppression and therapeutic response to treatment seemed apparent. The so-called Cholinergic REM Induction Test revealed that REM sleep abnormalities can be mimicked by administration of cholinomimetic agents. Another important research avenue is the study of chrono-medical timing of sleep deprivation and light exposure for their positive effects on mood in depression. Present day research takes the view on insomnia, i.e., prolonged sleep latency, problems to maintain sleep, and early morning awakening, as a transdiagnostic symptom for many mental disorders, being most closely related to depression. Studying insomnia from different angles as a transdiagnostic phenotype has opened many new perspectives for research into mechanisms but also for clinical practice. Thus, the question is: can the early and adequate treatment of insomnia prevent depression? This article will link current understanding about sleep regulatory mechanisms with knowledge about changes in physiology due to depression. The review aims to draw the attention to current and future strategies in research and clinical practice to the benefits of sleep and depression therapeutics.
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Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Lukas B Krone
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Katharina Wulff
- Departments of Radiation Sciences & Molecular Biology, Umea University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine (WCMM), Umea University, Umeå, Sweden
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
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97
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Doos Ali Vand H, Ahmadian Vargahan F, Charkhabi M, Sadeghniiat Haghighi K, Dutheil F, Habibi M. Glasgow Sleep Effort Scale: Translation, Test, and Evaluation of Psychometric Properties of the Persian Version. Nat Sci Sleep 2020; 12:843-854. [PMID: 33162761 PMCID: PMC7643769 DOI: 10.2147/nss.s258471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of the current study is to translate, test and evaluate the psychometric properties of the Glasgow Sleep Effort Scale (GSES) in Persian language. METHODS Participants consisted of two samples: a clinical sample of 120 patients (58%) with insomnia disorder meeting DSM-5 criteria for insomnia and a non-clinical sample of 110 participants (42%) with normal sleep. Both samples completed the following measures: GSES, Pittsburg Sleep Quality Index, Insomnia Severity Index, Dysfunctional Beliefs and Attitudes about Sleep Scale-10, Pre Sleep Arousal Scale-cognitive subscale, Depression-Anxiety-Stress Scale-21 and sleep diary. RESULTS Significant correlations were found between GSES and related measures in both groups. Principal component analysis indicated a single component accounted for 64.77% of total variance in the clinical group. Results of the fit estimates for the one-factor model were consistent with the previously specified fit criteria and adequately fitted the data in the non-clinical group. Statistical analyses showed that the GSES has acceptable internal consistency in terms of Cronbach's Alpha in the clinical (0.75) and non-clinical (0.77) samples. Test-retest reliability for a 4-week interval was significant (r = 0.70). The cut-off point, sensitivity, and specificity of the scale were 6, 85% and 94.5%, respectively. CONCLUSION The Persian translated and validated version of the GSES obtained adequate values in psychometric properties in both clinical and non-clinical samples and it can be used for research and clinical purposes in Iran.
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Affiliation(s)
- Hoda Doos Ali Vand
- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ahmadian Vargahan
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Charkhabi
- National Research University, Higher School of Economics, Moscow, Russia.,Department of Psychology, University of Clermont Auvergne, Clermont-Ferrand, France
| | | | - Frederic Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Mojtaba Habibi
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
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98
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Lebrun C, Gély-Nargeot MC, Maudarbocus KH, Bayard S. Assessing Sleep-Related Safety Behaviors: Adaptation and Validation of a French Version of the Sleep-Related Behaviors Questionnaire in a Nonclinical Sample. Behav Sleep Med 2020; 18:107-119. [PMID: 30462561 DOI: 10.1080/15402002.2018.1546178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective/Background: Safety behaviors play a prominent role in the development and maintenance of insomnia. The Sleep-Related Behaviors Questionnaire (SRBQ) is a self-report questionnaire designed to assess safety behaviors employed to cope with fatigue or to improve sleep. Despite its frequent use in insomnia, no systematic psychometric validation of the SRBQ has been conducted; its factor structure has never been explored. Furthermore, there is no French version of this scale. The goal of this study was to empirically validate a French version of the SRBQ. Participants/Methods: A total of 539 French-speaking community-dwelling participants from the general population completed a face-to-face clinical interview to determine insomnia disorder against DSM-5 criteria and several questionnaires including the French SRBQ. Results: SRBQ items with poor psychometric properties were removed, thus leading to a 20-item version (SRBQ-20). Exploratory factor analysis and parallel analysis revealed three distinct factors with good internal consistency. The results supported the internal temporal stability of the SRBQ-20. The construct validity of that instrument was underpinned by correlations obtained with various measures of insomnia and related constructs. Adequate discriminative validity was established by comparing individuals with insomnia and individuals without insomnia. Conclusions: This study demonstrated that the French version of the SRBQ-20 has good psychometric properties.
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Affiliation(s)
- Cindy Lebrun
- Department of Psychology, Univ Paul Valéry Montpellier 3, Univ Montpellier, Montpellier, France
| | | | | | - Sophie Bayard
- Department of Psychology, Univ Paul Valéry Montpellier 3, Univ Montpellier, Montpellier, France
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99
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Gerlach F, Ehring T, Werner GG, Takano K. Insomnia‐related interpretational bias is associated with pre‐sleep worry. J Sleep Res 2019; 29:e12938. [DOI: 10.1111/jsr.12938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/27/2019] [Accepted: 10/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Finja Gerlach
- Department of Psychology Division of Clinical Psychology and Psychotherapy LMU Munich Munich Germany
| | - Thomas Ehring
- Department of Psychology Division of Clinical Psychology and Psychotherapy LMU Munich Munich Germany
| | - Gabriela G. Werner
- Department of Psychology Division of Clinical Psychology and Psychotherapy LMU Munich Munich Germany
| | - Keisuke Takano
- Department of Psychology Division of Clinical Psychology and Psychotherapy LMU Munich Munich Germany
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100
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Lebrun C, Gély-Nargeot MC, Maudarbocus KH, Rossignol A, Geny C, Bayard S. Presleep Cognitive Arousal and Insomnia Comorbid to Parkinson Disease: Evidence for a Serial Mediation Model of Sleep-Related Safety Behaviors and Dysfunctional Beliefs About Sleep. J Clin Sleep Med 2019; 15:1217-1224. [PMID: 31538592 PMCID: PMC6760400 DOI: 10.5664/jcsm.7906] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Insomnia disorder (ID) is highly associated with Parkinson disease (PD) with great negative effect on health-related quality of life. Nonetheless, the relevance of psychological processes involved in the maintenance of insomnia is yet to be established in the context of this neurological condition. Our aim was to examine a serial meditation model of sleep-related safety behaviors and dysfunctional beliefs about sleep in association with presleep cognitive arousal and ID in patients with PD. METHODS A total of 68 patients with PD completed self-report measures including the Sleep-Related Behaviors Questionnaire (SRBQ-20), Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16), and the cognitive subscale of the Presleep Arousal Scale (PSAS-C). ID was assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Bootstrapped serial mediation analyses were conducted to test indirect effects. RESULTS Overall, 55.6% of patients with PD met diagnostic criteria for ID. The association between presleep cognitive arousal (PSAS-C) and ID was serially mediated by sleep-related safety behaviors (SRBQ-20) and strong endorsement of dysfunctional beliefs about sleep (DBAS-16) (bias-corrected 95% confidence interval for the indirect effect = 0.013, 0.093). An alternate serial mediation model in which dysfunctional beliefs about sleep precede sleep-related safety behaviors was not statistically significant (bias-corrected 95% confidence interval for the indirect effect = -0.001, 0.046). CONCLUSIONS ID comorbid to PD is associated with the classic psychological factors perpetuating ID in neurological disease-free individuals with insomnia. Target-oriented interventions for instance cognitive behavioral therapy for chronic insomnia should be considered as a treatment approach for ID comorbid to PD. CITATION Lebrun C, Gély-Nargeot M-C, Maudarbocus KH, Rossignol A, Geny C, Bayard S. Presleep cognitive arousal and insomnia comorbid to parkinson disease: evidence for a serial mediation model of sleep-related safety behaviors and dysfunctional beliefs about sleep. J Clin Sleep Med. 2019;15(9):1217-1224.
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Affiliation(s)
- Cindy Lebrun
- Univ Paul Valéry Montpellier 3, Univ Montpellier, Montpellier, France
| | | | | | - Alexia Rossignol
- Centre Expert Maladie de Parkinson, Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France
| | - Christian Geny
- Centre Expert Maladie de Parkinson, Service de Neurologie, Hôpital Gui de Chauliac, Montpellier, France
| | - Sophie Bayard
- Univ Paul Valéry Montpellier 3, Univ Montpellier, Montpellier, France
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