Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment

Insomnia with objective short sleep duration in community-living older persons: A multifactorial geriatric health condition

BACKGROUND

Insomnia or poor sleep quality with objective short sleep duration (hereafter referred to as ISSD) has been identified as a high-risk phenotype among middle-aged persons. We evaluated the prevalence and clinical correlates of ISSD among community-living older persons.

METHODS

In 3053 men from the Osteoporotic Fractures in Men Sleep Study (MrOS; average age 76.4 ± 5.5 years) and 3044 women from the Study of Osteoporotic Fractures (SOF; average age 83.6 ± 3.8 years), we evaluated the prevalence of ISSD (trouble getting to sleep within 30 minutes, waking up in the middle of the night or early morning, and/or taking a medication to help with sleep ≥3 times per week and actigraphy-estimated sleep duration <6 h). Using separate logistic regression models in men and women, we evaluated the cross-sectional associations between predisposing, precipitating, and perpetuating factors for ISSD, as compared with normal sleep (no insomnia and actigraphy-estimated sleep duration of 6-9 h).

RESULTS

Overall, 20.6% of older men and 12.8% of older women had insomnia with short sleep duration. Multiple predisposing, precipitating, and perpetuating factors were cross-sectionally associated with ISSD in both men and women. In multivariable models that adjusted for predisposing factors (demographics, multimorbidity, obesity), precipitating (depression, anxiety, central nervous system-active medication use, restless legs syndrome) and perpetuating (napping, falls) factors were significantly associated with ISSD in men and women (adjusted odds ratios ranging 1.63-4.57).

CONCLUSIONS

In this cross-sectional study of community-living older men and women, ISSD was common and associated with multiple predisposing, precipitating, and perpetuating factors, akin to a multifactorial geriatric health condition. Future work should examine causal pathways and determine whether the identified correlates represent modifiable risk factors.

The Relationship between Working Night Shifts and Depression among Nurses: A Systematic Review and Meta-Analysis

BACKGROUND

For many years, occupational physicians have debated whether there is a link between working the night shift and depression and other co-occurring mental health issues, with an emphasis on work-related, biological, individual, and environmental factors. We performed this systematic review and meta-analysis to estimate the overall association between sleep deprivation and depression among nurses working night shifts.

METHODS

A systematic search was carried out across the electronic databases PubMed, Scopus, and Web of Science from inception to 30 September 2022, for studies that reported a relationship between estimated night shift work and depression in nurses. The outcomes were measured using the odds ratio (OR) and matching 95% confidence interval (CI). The I² statistic was used to assess heterogeneity. The Grading of Recommendations Assessment, Development and Evaluation technique was used to evaluate the quality of the evidence, and the Newcastle-Ottawa Scale was utilized to assess the methodological quality of each of the included studies. We determined the overall relationship between working nights and the onset of depression.

RESULTS

A total of 20 studies were included in the systematic review. Furthermore, 8 studies were included in the meta-analysis due to their common use of the OR as an effect measure. The 8 studies gave an overall estimate indicating a statistically significant association between night shift work and depression among nurses (OR = 1.49 95% CI: 1.26, 1.76). The prediction interval for the overall estimate was (0.995, 2.231). This implies that the true OR in a future study would most likely fall within this range, with a 95% certainty.

CONCLUSIONS

The outcome of this systematic review and meta-analysis showed a significant association between night shift work, the circadian and sleep disruption it causes, and the risk of depression in nurses. This demonstrates that nurses who work night shifts are at risk of developing depression.

A novel method to increase specificity of sleep-wake classifiers based on wrist-worn actigraphy

The knowledge of the distribution of sleep and wake over a 24-h day is essential for a comprehensive image of sleep-wake rhythms. Current sleep-wake scoring algorithms for wrist-worn actigraphy suffer from low specificities, which leads to an underestimation of the time staying awake. The goal of this study (ClinicalTrials.gov Identifier: NCT03356938) was to develop a sleep-wake classifier with increased specificity. By artificially balancing the training dataset to contain as much wake as sleep epochs from day- and nighttime measurements from 12 subjects, we optimized the classification parameters to an optimal trade-off between sensitivity and specificity. The resulting sleep-wake classifier achieved high specificity of 80.4% and sensitivity of 88.6% on the balanced dataset containing 3079.9 h of actimeter data. In the validation on night sleep of separate adaptation recordings from 19 healthy subjects, the sleep-wake classifier achieved 89.4% sensitivity and 64.6% specificity and estimated accurately total sleep time and sleep efficiency with a mean difference of 12.16 min and 2.83%, respectively. This new, device-independent method allows to rid sleep-wake classifiers from their bias towards sleep detection and lay a foundation for more accurate assessments in everyday life, which could be applied to monitor patients with fragmented sleep-wake rhythms.

Systemic Lupus Erythematous and Obstructive Sleep Apnea: A Possible Association

Marked fatigue is common in patients with systemic lupus erythematosus (SLE). This study aimed to assess the association of sleep disorders, including obstructive sleep apnea (OSA), with SLE. Forty-two consecutive patients with SLE and 20 healthy controls were recruited and underwent a one-night ambulatory sleep examination. They completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and Functional Assessment of Chronic Illness Therapy (FACIT). SLE disease activity and damage were assessed by the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI). A significantly increased apnea/hypopnea index was noted in the SLE group compared to healthy controls (p = 0.004). SLE patients had higher rates of moderate-to-severe OSA (p = 0.04), PSQI (p = 0.001), and FACIT scores (p = 0.0008). Multivariate analysis revealed that the SDI was associated with OSA (p = 0.03). There was a positive association between SLEDAI-2K and moderate-to-severe OSA (p = 0.03). Patients with SLE had an increased prevalence of OSA and poorer quality of sleep compared to healthy controls. Our findings suggest that active disease and accumulated damage may be associated with OSA. These findings highlight the importance of identifying the presence of OSA in patients with SLE.

Actigraphy evaluation before and after intravenous ferric carboxymaltose in 3 children with restless sleep disorder

Restless sleep disorder has been described in the literature as a disorder affecting children and presenting with large muscle movements during sleep with an index of 5 events/h or more, leading to daytime impairment including sleepiness or behavioral problems. Children with restless sleep disorder have been found to have low ferritin levels. Studies with iron supplementation both oral or intravenous have been shown effective in clinically improving both nighttime and daytime symptoms. However objective data of the improvement is lacking. Repeating polysomnography is expensive, and alternative methods of assessing large muscle movements are needed. In this small case series we present actigraphy results in 3 children with restless sleep disorder collected for 1 week, a week before and 8 weeks after intravenous iron supplementation. Although actigraphy parameters were not highly consistent between our 3 patients, improvement in symptoms tend to parallel sleep parameters in actigraphy.

CITATION

Chu ZYB, DelRosso LM, Mogavero MP, Ferri R. Actigraphy evaluation before and after intravenous ferric carboxymaltose in 3 children with restless sleep disorder. J Clin Sleep Med. 2023;19(3):633-637.

Impact of COVID-19 lockdown on physical activity, insomnia, and loneliness among Spanish women and men

During COVID-19 pandemic, quality of living was impacted by social isolation, loneliness, and altered sleep habits. The aims of this study were (1) to examine the relationship between physical activity (PA) levels with insomnia and loneliness among adults during Spain's first COVID-19 wave of lockdown and its impact on women and (2) to examine the digital technologic resources used to support both PA and other recreational activities in women. A cross-sectional design was used. An anonymous 15-min online survey was conducted in Spain to adults (≥ 18 years old) during the first COVID-19 lockdown, a 40-day period. A snowball distribution method was employed using personal email and social networks (Facebook, Whatsapp, Linkedin, Twitter). Variables studied included: socio-demographic items, insomnia, loneliness, PA, and digital technologic resources. A total of 996 adults (females = 663, 66.6%) completed the survey. Higher education levels were associated with greater PA levels (p-value < 0.001). Women presented with higher insomnia risk than men with low PA levels (OR = 1.9, CI = 1.25; 2.95). Living with family members or other individuals was related to lower insomnia risk. A strong correlation between medium-high PA levels was found with greater digital technology resources (DTS) than individuals with low PA levels. Females used significantly more DTS than males (p-value < 0.001). No significant associations between DTS were found with age or academic education level. PA levels, sex, and loneliness were related to insomnia risk. A strong correlation between PA and DTS use was observed. Participants with medium-high PA levels and females use them more than those with low PA levels and males. We recommend promoting the PA through digital technologies for women. This recommendation would also improve sleep disorders in women who present higher insomnia risks than men.

Shorter sleep among adolescents is associated with lower fruit and vegetable consumption the following day

BACKGROUND

Insufficient sleep has been associated with weight gain and metabolic dysregulation, with one suggested mechanism being through reduction in diet quality. Experimental evidence supports a causal effect of sleep timings on diet but this may not be applicable to a free-living adolescent population. In this analysis we use daily measures of sleep timings and diet quality, to examine the effect of sleep duration and timing on diet quality the following day among free-living adolescents.

METHODS

The ROOTS study is a prospective cohort recruited from secondary schools in Cambridgeshire and Suffolk (UK). Participants (n = 815) at mean age 15.0y (SD 0.3y) completed a diet diary and wore a combined heart rate and accelerometer device over 4 consecutive days. Sleep duration and timing (midpoint) were derived from acceleration and heart rate traces, while daily energy density and fruit and vegetable intake were calculated from dietary data. Analyses were performed at day-level (1815 person-days). Multilevel random effects models were used to test associations between sleep each night and subsequent day diet, with daily sleep and diet measures nested within individuals and schools, and adjusted for day-level and individual-level confounding variables.

RESULTS

Adolescents slept a mean of 7.88 hrs (SD 1.10) per night, reporting a mean energy density of 2.12 kcal/g (SD 0.48) and median energy-adjusted daily fruit and vegetable intake of 137.3 g (IQR 130.4). One hour shorter sleep duration was associated with lower intake of fruit and vegetables (-6.42 g, 95%CI -1.84, -10.99) the following day. An association with higher dietary energy density (0.016 kcal/g, 95%CI 0.034, -0.002) the following day was observed but did not reach statistical significance. Sleep timing was not associated with either fruit and vegetable intake (-2.52 g/d, 95%CI -7.66, 2.62) or dietary energy density (-0.001 kcal/g, 95%CI -0.022, 0.020).

CONCLUSIONS

Our observational findings from a free-living adolescent population support the experimental evidence for a causal role of sleep on diet, with shorter sleep duration at night leading to a small decrease in diet quality the following day. These findings support experimental evidence to suggest inclusion of sleep duration as one component of interventions designed to improve diet quality and weight status in adolescents.

Effect of sleep on development of early childhood caries: a systematic review

PURPOSE

To investigate the impact of sleep on the development of early childhood caries (ECC).

METHODS

Seven electronic databases and grey literature were searched with various keyword combinations. Two reviewers independently selected studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale. The studies were included if they evaluated the impact of sleep parameters on the caries experience or severity of ECC in children under 6 years of age.

RESULTS

Four cross-sectional studies and two longitudinal studies were included. Children who had irregular bedtimes had a 66-71% higher chance of developing ECC. Children who slept after 11 pm might have a 74-85% higher chance of developing ECC. Children who slept less than 8 h during the night had a 30% increased risk of caries than children who slept more than 11 h.

CONCLUSION

Irregular or late bedtime and fewer sleeping hours could be an independent risk factor for ECC. The risk of ECC might be related inversely in a dose-response manner to the number of sleep hours.

Actigraphy Enables Home Screening of Rapid Eye Movement Behavior Disorder in Parkinson's Disease

OBJECTIVES

Rapid eye movement sleep behavior disorder (RBD) is a potentially harmful, often overlooked sleep disorder affecting up to 70% of Parkinson's disease patients. Current diagnosis relies on nocturnal video-polysomnography, which is an expensive and cumbersome examination requiring specific clinical expertise. Here, we explored the use of wrist actigraphy to enable automatic RBD diagnoses in home settings.

METHODS

A total of 26 Parkinson's disease patients underwent 2-week home wrist actigraphy, followed by two in-laboratory evaluations. Patients were classified as RBD versus non-RBD based on dream enactment history and video-polysomnography. We comprehensively characterized patients' movement patterns during sleep using actigraphic signals. We then trained machine learning classification algorithms to discriminate patients with or without RBD using the most relevant features. Classification performance was quantified with respect to clinical diagnosis, separately for in-laboratory and at-home recordings. Performance was further validated in a control group of non-Parkinson's disease patients with other sleep conditions.

RESULTS

To characterize RBD, actigraphic features extracted from both (1) individual movement episodes and (2) global nocturnal activity were critical. RBD patients were more active overall, and showed movements that were shorter, of higher magnitude, and more scattered in time. Using these features, our classification algorithms reached an accuracy of 92.9 ± 8.16% during in-clinic tests. When validated on home recordings in Parkinson's disease patients, accuracy reached 100% over a 2-week window, and was 94.4% in non-Parkinson's disease control patients. Features showed robustness across tests and conditions.

INTERPRETATION

These results open new perspectives for faster, cheaper, and more regular screening of sleep disorders, both for routine clinical practice and clinical trials. ANN NEUROL 2023;93:317-329.

Impact of ground-level ozone exposure on sleep quality and electroencephalogram patterns at different time scales

Ozone exposure is associated with various adverse health outcomes, but its impact on sleep quality is uncertain. Here we assessed the causal effect of long-term (yearly and monthly) exposure to ozone on nocturnal workday sleep time in a national representative sample from the China Family Panel Study, using a difference-in-differences approach. We further followed ninety healthy Chinese young adults four times in four seasons from September 2020 to June 2021, measured their daily sleep architecture using accelerometers, ascertained daily ozone exposure, recorded 5-min eye-closed resting-state electroencephalogram (EEG) signals at the last day of each one-week-long measurement session, and explored the effect of ozone exposure on objectively-measured sleep architecture. In the national sample, we found that every 1 interquartile range (IQR) μg/m³ increase in yearly and monthly ozone exposure was causally associated with 7.31 (p = 0.0039) and 4.19 (p = 0.040) minutes decline in nocturnal workday sleep time; the dose-response curve represented a quasi-linear pattern with no safety threshold, and plateaued at higher concentrations. In the small-scale study with objectively-measured sleep architecture, we found that every 1 IQR μg/m³ increase in the weekly ozone exposure was associated with 5.33 min decrease in night-time total sleep time (p = 0.031), 1.63 percentage points decrease in sleep efficiency (p < 0.001), 1.99 min increase in sleep latency (p = 0.0070), and 5.34 min increase in wake after sleep onset time (p = 0.0016) in a quasi-linear pattern. Notably, we found the accumulating trend of ozone exposure on sleep quality during both the short-term and long-term periods. We also found that short-term ozone exposure was associated with altered EEG patterns, mediated by sleep quality. This study indicates that long-term and short-term ozone exposures have negative and accumulating impacts on sleep quality and might impair brain functioning. More hidden health burdens of ozone are worth exploring.

Home Sleep Apnea Testing for the Diagnosis of Obstructive Sleep Apnea

A 50-year-old patient with epilepsy, hypertension, loud snoring, recent 50-lb weight gain, and abrupt awakenings with a feeling of breathlessness but no headaches or excessive daytime sleepiness presented with concerns. What would you do next?

Measuring Sleep Stages and Screening for Obstructive Sleep Apnea with a Wearable Multi-Sensor System in Comparison to Polysomnography

Objective

To assess the performance of a wearable multi-sensor system (SensEcho) in comparison to polysomnography (PSG) in measuring sleep stages and searching for obstructive sleep apnea (OSA).

Methods

Participants underwent overnight simultaneous monitoring using SensEcho and PSG in a sleep laboratory. SensEcho analyzed the recordings spontaneously, and PSG was assessed as per standard guidelines. The degree of snoring was evaluated according to the guidelines for the diagnosis and treatment of OSA hypopnea syndrome (2011 revision). The Epworth Sleepiness Scale (ESS) was used to assess general daytime sleepiness.

Results

This study included 103 Han Chinese, 91 of whom (age 39.02 ± 13.84 years, body mass index 27.28 ± 5.12 kg/m2, 61.54% male) completed the assessments. The measures of total sleep time (P = 0.198); total wake time (P = 0.182); shallow sleep (P = 0.297), deep sleep (P = 0.422), rapid eye movement sleep (P = 0.570), and awake (P = 0.336) proportions were similar between SensEcho and PSG. Using an apnea-hypopnea index (AHI) cutoff of ≥ 5 events/h, the SensEcho had 82.69% sensitivity and 89.74% specificity. Almost the same results were obtained at an AHI threshold of ≥ 15 events/h. Although the specificity increased to 94.67%, it decreased to 43.75% at an AHI cutoff of ≥ 30 events/h.

Conclusion

This study demonstrated that SensEcho can be used to evaluate sleep status and screen for OSA. Nevertheless, improving the accuracy of its assessment of severe OSA and further testing its effectiveness in community and home environments is necessary.

Feasibility of wearable devices and machine learning for sleep classification in children with Rett syndrome: A pilot study

Sleep is vital to many processes involved in the well-being and health of children; however, it is estimated that 80% of children with Rett syndrome suffer from sleep disorders. Caregiver reports and questionnaires, which are the current method of studying sleep, are prone to observer bias and missed information. Polysomnography is considered the gold standard for sleep analysis but is labor and cost-intensive and limits the frequency of data collection for sleep disorder studies. Wearable digital health technologies, such as actigraphy devices, have shown potential and feasibility as a method for sleep analysis in Rett syndrome, but have not been validated against polysomnography. Furthermore, the collected accelerometer data has limitations due to the rigidity, periodic limb movement, and involuntary muscle contractions prevalent in Rett syndrome. Heart rate and electrodermal activity, along with other physiological signals, have been linked to sleep stages and can be utilized with machine learning to provide better resistance to noise and false positives than actigraphy. This research aims to address the gap in Rett syndrome sleep analysis by comparing the performance of a machine learning model utilizing both accelerometer data and physiological data features to the gold-standard polysomnography for sleep analysis in Rett syndrome. Our analytical validation pilot study (n = 7) found that using physiological and accelerometer features, our machine learning models can differentiate between awake, non-rapid eye movement sleep, and rapid eye movement sleep in Rett syndrome children with an accuracy of 85.1% when using an individual model. Additionally, this work demonstrates that it is feasible to use digital health technologies in Rett syndrome, even at a young age, without data loss or interference from repetitive movements that are characteristic of Rett syndrome.

Contact-free radar recordings of body movement can reflect ultradian dynamics of sleep

This work aimed to evaluate if a contact-free radar sensor can be used to observe ultradian patterns in sleep physiology, by way of a data processing tool known as Locomotor Inactivity During Sleep (LIDS). LIDS was designed as a simple transformation of actigraphy recordings of wrist movement, meant to emphasise and enhance the contrast between movement and non-movement and to reveal patterns of low residual activity during sleep that correlate with ultradian REM/NREM cycles. We adapted the LIDS transformation for a radar that detects body movements without direct contact with the subject and applied it to a dataset of simultaneous recordings with polysomnography, actigraphy, and radar from healthy young adults (n = 12, four nights of polysomnography per participant). Radar and actigraphy-derived LIDS signals were highly correlated with each other (r > 0.84), and the LIDS signals were highly correlated with reduced-resolution polysomnographic hypnograms (r_radars  >0.80, r_actigraph  >0.76). Single-harmonic cosine models were fitted to LIDS signals and hypnograms; significant differences were not found between their amplitude, period, and phase parameters. Mixed model analysis revealed similar slopes of decline per cycle for radar-LIDS, actigraphy-LIDS, and hypnograms. Our results indicate that the LIDS technique can be adapted to work with contact-free radar measurements of body movement; it may also be generalisable to data from other body movement sensors. This novel metric could aid in improving sleep monitoring in clinical and real-life settings, by providing a simple and transparent way to study ultradian dynamics of sleep using nothing more than easily obtainable movement data.

Sleep and Circadian Disturbance in Cardiovascular Risk

PURPOSE OF REVIEW

We discuss the relationship between sleep and circadian factors with cardiovascular disease (CVD) risk, including physiologic, behavioral, and psychological mechanisms along this pathway.

RECENT FINDINGS

The relationship between short and long sleep duration, as well as insomnia, with CVD risk is well-established. Recent work has highlighted how other sleep factors, such as sleep regularity (i.e., consistency of sleep timing), multidimensional sleep health, and circadian factors like chronotype and social jetlag, relate to CVD risk. Sleep-focused interventions (e.g., cognitive behavioral therapy for insomnia and sleep extension) may be effective to reduce CVD risk and disease burden. Sleep is increasingly recognized as an integral component of cardiovascular health. This was underscored by the recent inclusion of sleep duration as a health behavior in the American Heart Association's Life's Essential 8 for defining optimal cardiovascular health.

Changes in parental sleep from pregnancy to postpartum: A meta-analytic review of actigraphy studies

Sleep changes in new parents are widely observed but there is no extant meta-analysis of changes to sleep parameters in this group. We completed a meta-analysis of changes in actigraphy-measured parent sleep between pregnancy and the end of the first year of a child's life. A search of six databases was completed. Following review using predetermined inclusion and exclusion criteria, 16 papers were left for review. Data were extracted, analysed and each paper was reviewed for methodological quality. Where possible, subgroup analysis was completed based on time since birth and location of the study, and meta-regression of parent age. Parents' total sleep time and sleep efficiency were shown to decrease following the birth of a child, with wake after sleep onset increasing. This change was most notably observed in the first four weeks after birth. Up to 16 weeks post-birth, differences were still apparent, but sleep parameters were beginning to return to pre-birth levels. New parents experience a significant change in multiple sleep parameters following the birth of a child. Future data collection, using best practice actigraphy measurement, reporting a broader range of variables and including fathers, as well as mothers, is warranted.

An unsupervised machine learning approach using passive movement data to understand depression and schizophrenia

INTRODUCTION

Schizophrenia and Major Depressive Disorder (MDD) are highly burdensome mental disorders, with significant cost to both individuals and society. Despite these disorders representing distinct clinical categories, they are each heterogenous in their symptom profiles, with considerable transdiagnostic features. Although movement and sleep abnormalities exist in both disorders, little is known of the precise nature of these changes longitudinally. Passively-collected longitudinal data from wearable sensors is well suited to characterize naturalistic features which may cross traditional diagnostic categories (e.g., highlighting behavioral markers not captured by self-report information).

METHODS

The present analyses utilized raw minute-level actigraphy data from three diagnostic groups: individuals with schizophrenia (N = 23), individuals with depression (N = 22), and controls (N = 32), respectively, to interrogate naturalistic behavioral differences between groups. Subjects' week-long actigraphy data was processed without diagnostic labels via unsupervised machine learning clustering methods, in order to investigate the natural bounds of psychopathology. Further, actigraphic data was analyzed across time to determine timepoints influential in model outcomes.

RESULTS

We find distinct actigraphic phenotypes, which differ between diagnostic groups, suggesting that unsupervised clustering of naturalistic data aligns with existing diagnostic constructs. Further, we found statistically significant inter-group differences, with depressed persons showing the highest behavioral variability.

LIMITATIONS

However, diagnostic group differences only consider biobehavioral trends captured by raw actigraphy information.

CONCLUSIONS

Passively-collected movement information combined with unsupervised deep learning algorithms shows promise in identifying naturalistic phenotypes in individuals with mental health disorders, specifically in discriminating between MDD and schizophrenia.

Validation of an automated sleep detection algorithm using data from multiple accelerometer brands

To evaluate the criterion validity of an automated sleep detection algorithm applied to data from three research-grade accelerometers worn on each wrist with concurrent laboratory-based polysomnography (PSG). A total of 30 healthy volunteers (mean [SD] age 31.5 [7.2] years, body mass index 25.5 [3.7] kg/m² ) wore an Axivity, GENEActiv and ActiGraph accelerometer on each wrist during a 1-night PSG assessment. Sleep estimates (sleep period time window [SPT-window], sleep duration, sleep onset and waking time, sleep efficiency, and wake after sleep onset [WASO]) were generated using the automated sleep detection algorithm within the open-source GGIR package. Agreement of sleep estimates from accelerometer data with PSG was determined using pairwise 95% equivalence tests (±10% equivalence zone), intraclass correlation coefficients (ICCs) with 95% confidence intervals and limits of agreement (LoA). Accelerometer-derived sleep estimates except for WASO were within the 10% equivalence zone of the PSG. Reliability between data from the accelerometers worn on either wrist and PSG was moderate for SPT-window duration (ICCs ≥ 0.65), sleep duration (ICCs ≥ 0.54), and sleep onset (ICCs ≥ 0.61), mostly good for waking time (ICCs ≥ 0.80), but poor for sleep efficiency (ICCs ≥ 0.08) and WASO (ICCs ≥ 0.08). The mean bias between all accelerometer-derived sleep estimates worn on either wrist and PSG were low; however, wide 95% LoA were observed for all sleep estimates, apart from waking time. The automated sleep detection algorithm applied to data from Axivity, GENEActiv and ActiGraph accelerometers, worn on either wrist, provides comparable measures to PSG for SPT-window and sleep duration, sleep onset and waking time, but a poor measure of wake during the sleep period.

Changes in the rest-activity rhythm in migraine patients are associated with anxiety symptoms

OBJECTIVE

To characterize rest-activity rhythm in chronic migraine (CM) and to investigate the relationship between this rhythm and depressive and anxiety symptoms in patients with CM.

METHODS

This was a study of adults aged 20 to 40 years. The rest-activity rhythm of patients with CM (n=23) and non-headache controls (NH, n=23) was assessed by actigraphy for 15 days, and they completed the following assessments: Visual Analogue Scale for pain intensity; Headache Diary; Headache Impact Test-6; Morningness-Eveningness Questionnaire; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Beck Depression Inventory; and State-Trait Anxiety Inventory.

RESULTS

Patients with CM showed less activity over 24 hours and more fragmented sleep. Reduced interdaily stability of the rest-activity rhythm was observed, with less robustness of this rhythm in the CM group. Multiple linear regressions revealed a significant association between the rest-activity rhythm and trait anxiety variables in patients with CM, specifically regarding the relative amplitude of the cycle, activity throughout 24 hours and during sleep, and robustness of the rest-activity rhythm.

CONCLUSIONS

Our findings provide evidence that the robustness of the rest-activity rhythm, activity throughout 24 hours, and sleep fragmentation are associated with trait anxiety in patients with CM.

Actigraphy-Based Sleep Detection: Validation with Polysomnography and Comparison of Performance for Nighttime and Daytime Sleep During Simulated Shift Work

Purpose

Actigraphy-based sleep detection algorithms were mostly validated using nighttime sleep, and their performance in detecting daytime sleep is unclear. We evaluated and compared the performance of Actiware and the Cole-Kripke algorithm (C-K) - two commonly used actigraphy-based algorithms - in detecting daytime and nighttime sleep.

Participants and Methods

Twenty-five healthy young adults were monitored by polysomnography and actigraphy during two in-lab protocols with scheduled nighttime and/or daytime sleep (within-subject design). Mixed-effect models were conducted to compare the sensitivity, specificity, and F1 score (a less-biased measure of accuracy) of Actiware (with low/medium/high threshold setting, separately) and C-K in detecting sleep epochs from actigraphy recordings during nighttime/daytime. t-tests and intraclass correlation coefficients were used to assess the agreement between actigraphy-based algorithms and polysomnography in scoring total sleep time (TST).

Results

Sensitivity was similar between nighttime (Actiware: 0.93-0.99 across threshold settings; C-K: 0.61) and daytime sleep (Actiware: 0.93-0.99; C-K: 0.66) for both the C-K and Actiware (daytime/nighttime×algorithm interaction: p > 0.1). Specificity for daytime sleep was lower (Actiware: 0.35-0.54; C-K: 0.91) than that for nighttime sleep (Actiware: 0.37-0.62; C-K: 0.93; p = 0.001). Specificity was also higher for C-K than Actiware (p < 0.001), with no daytime/nighttime×algorithm interaction (p > 0.1). C-K had lower F1 (nighttime = 0.74; daytime = 0.77) than Actiware (nighttime = 0.95-0.98; daytime = 0.90-0.91) for both nighttime and daytime sleep (all p < 0.05). The daytime-nighttime difference in F1 was opposite for Actiware (daytime: 0.90-0.91; nighttime: 0.95-0.98) and C-K (daytime: 0.77; nighttime: 0.74; interaction p = 0.003). Bias in TST was lowest in Actiware (with medium-threshold) for nighttime sleep (underestimation of 5.99 min/8h) and in Actiware (with low-threshold) for daytime sleep (overestimation of 17.75 min/8h).

Conclusion

Daytime/nighttime sleep affected specificity and F1 but not sensitivity of actigraphy-based sleep scoring. Overall, Actiware performed better than the C-K algorithm. Actiware with medium-threshold was the least biased in estimating nighttime TST, and Actiware with low-threshold was the least biased in estimating daytime TST.

Psychometric properties of the Last-7-Day Sedentary Time Questionnaire (SIT-Q-7d): Testing the validity and reliability among general population

BACKGROUNDS

Sedentary behavior (SB) is an independent risk factor causing chronic diseases. Previous studies compared sitting time mostly with physical activity. The present study aimed to evaluate the validity and reliability of the Last-7-Day Sedentary Time Questionnaire (SIT-Q-7d) in Iran. Moreover, SB was assessed among the study participants.

METHODS

The current validity study was conducted among 290 subjects (51.7% males vs. 48.3% females) with a mean age of 34.81 ± 9.63 years in Poldasht, Iran. Sampling was done using simple random sampling and the data were collected using the SIT-Q-7d. To confirm the validity of the questionnaire, forward-backward translation method, content validity, and construct validity were used. Furthermore, temporal stability was calculated by the test-retest method and internal consistency coefficient (ICC).

RESULTS

Our results confirmed the content validity of the questionnaire (content validity score: 0.90 and content validity index: 0.80). Using exploratory factor analysis (EFA), seven factors of SB were identified as follows: eating while sitting down, doing domestic affairs, screen time, leisure time, studying books, watching TV, and attending family gatherings. The reliability of the questionnaire was confirmed using Cronbach's alpha (α = 0.7). In addition, temporal stability was confirmed by test-retest method and ICC was 0.9 (95% CI: 83-97).

CONCLUSION

Our results confirmed that the Persian version of SIT-Q-7d is a reliable and valid tool for assessing SB.

Insomnia – Is it a Symptom or a Disorder?

Insomnia disorder is a common public health problem with a prevalence of approximately 2-5% of the population. It is of major importance to differentiate the insomnia disorder from the isolated symptoms and normal variants, and to define the secondary or associated conditions. Insomnia was mainly classified as acute and chronic insomnia disorder based on the 3rd edition of the International Classification of Sleep Disorders. Many models have been developed to explain the underlying mechanisms of insomnia, such as the Drosophila model, the cognitive model, the psychobiological inhibition model, the neurocognitive model, stimulus control model, hyperarousal model and the “3P model” (Spielman model). Optimizing the environmental conditions, lifestyle changes and elaborating the triggering factors are the first step in the management of insomnia disorders.

The impact of social rhythm and sleep disruptions on waist circumference after job loss: A prospective 18-month study

OBJECTIVE

This study prospectively examined change in waist circumference (WC) as a function of daily social rhythms and sleep in the aftermath of involuntary job loss. It was hypothesized that disrupted social rhythms and fragmented/short sleep after job loss would independently predict gains in WC over 18 months and that resiliency to WC gain would be conferred by the converse.

METHODS

Eligible participants (n = 191) completed six visits that included standardized measurements of WC. At the baseline visit, participants completed the social rhythm metric and daily sleep diary and wore an actigraph on their nondominant wrist each day for a period of 2 weeks.

RESULTS

When controlling for obesity and other covariates, WC trajectories decreased for individuals with more consistent social rhythms, more activities in their sdiocial rhythms, and higher sleep quality after job loss. WC trajectories did not change for individuals with lower scores on these indicators.

CONCLUSIONS

The frequency and consistency of social rhythms after job loss play a key role in WC loss. These findings support the implementation of social rhythm interventions after job loss, a potentially sensitive time for the establishment of new daily routines that have an impact on metabolic health.

Considerations for Analyzing and Interpreting Data from Biometric Monitoring Technologies in Clinical Trials

BACKGROUND

The proliferation and increasing maturity of biometric monitoring technologies allow clinical investigators to measure the health status of trial participants in a more holistic manner, especially outside of traditional clinical settings. This includes capturing meaningful aspects of health in daily living and a more granular and objective manner compared to traditional tools in clinical settings.

SUMMARY

Within multidisciplinary teams, statisticians and data scientists are increasingly involved in clinical trials that incorporate digital clinical measures. They are called upon to provide input into trial planning, generation of evidence on the clinical validity of novel clinical measures, and evaluation of the adequacy of existing evidence. Analysis objectives related to demonstrating clinical validity of novel clinical measures differ from typical objectives related to demonstrating safety and efficacy of therapeutic interventions using established measures which statisticians are most familiar with.

KEY MESSAGES

This paper discusses key considerations for generating evidence for clinical validity through the lens of the type and intended use of a clinical measure. This paper also briefly discusses the regulatory pathways through which clinical validity evidence may be reviewed and highlights challenges that investigators may encounter while dealing with data from biometric monitoring technologies.

Sleep patterns of patients receiving home parenteral nutrition: A home-based observational study

BACKGROUND

Patients supported with home parenteral nutrition (HPN) often report poor sleep; however, limited research has been conducted to objectively measure sleep patterns of HPN-dependent patients.

METHODS

We aimed to characterize the sleep patterns of patients receiving HPN through 7-day actigraphy in a home-based observational study. Sleep measures of clinical importance were derived from actigraphy, including sleep duration, sleep efficiency, sleep onset latency, and wake after sleep onset. Participants also completed validated sleep surveys.

RESULTS

Twenty participants completed all study procedures (mean [SD]: age = 51.6 [13.9] years, body mass index = 21.4  [4.6], and 80% female). The population median (IQR) for sleep duration, sleep efficiency, sleep onset latency, and wake after sleep onset was 6.9 (1.1) h, 83.3% (7.8%), 11.8 (7.1) min, and 57.2 (39.9) min, respectively, and 55%, 60%, 35%, and 100% of participants did not meet the recommendations for these measures from the National Sleep Foundation. Sixty-five percent of participants reported napping at least once during the 7-day period. Based on the Insomnia Severity Index, 70% of participants were classified as having subthreshold or more severe insomnia. Based on the Pittsburgh Sleep Quality Index, 85% were classified as having significant sleep disturbance.

CONCLUSION

Most HPN-dependent patients likely have disrupted sleep largely driven by difficulty maintaining sleep. The extent to which HPN contributed to poor sleep cannot be elucidated from this observational study. Addressing known factors that contribute to sleep disruption and considering sleep interventions may improve the overall quality of life of patients receiving HPN.

The Associations between Daytime Physical Activity, While-in-Bed Smartphone Use, Sleep Delay, and Sleep Quality: A 24-h Investigation among Chinese College Students

Bedtime smartphone use is an emerging issue that threatens the sleep health of children and young adults. Physical activity can have numerous health benefits, including reducing problematic or addictive behavior. However, the role of daily physical activity in reducing bedtime smartphone use is understudied. Hence, we conducted a one-day cross-sectional on the weekend (21-22 May 2021) to investigate the associations between daytime physical activity, bedtime smartphone use, and sleep quality. A total of 828 college students were recruited in two colleges. Their daytime physical activity indices were captured, including self-reported physical activity duration, intensity, volume, and smartphone-monitored walking steps. The participants reported whether they used smartphone while lying in bed (before sleep) and whether they delayed sleep due to smartphone use. Their while-in-bed screen time (duration) and subsequent sleep quality were also measured with self-report and a numeric rating scale, respectively. The results suggested that daytime physical activity duration was associated with lower chances of while-in-bed smartphone use (OR = 0.907, p = 0.019) and smartphone-related sleep delay (OR = 0.932, p = 0.014). However, no significant association was found between physical activity indices and while-in-bed screen time or sleep quality. These findings may contribute to understanding the reciprocal relationship between physical activity and smartphone use and highlighting the potential of controlling problematic bedtime smartphone use through daily physical activity. Future research is warranted to examine the associations with extra objective measures.

Objective sleep outcomes in randomized-controlled trials in persons with substance use disorders: A systematic review

BACKGROUND

Improving sleep health is an important target for substance use disorder (SUD) research. However, there is little guidance for SUD researchers regarding the use of technologies to objectively assess sleep outcomes in randomized-controlled trials (RCTs). This systematic review aimed to describe the use of technologies to objectively measure sleep outcomes in RCTs conducted in persons with SUDs, in order to inform future sleep intervention studies in SUD populations.

METHODS

This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on May 7th, 2020 (CRD42020182004). RCTs were reviewed here if they were peer-reviewed manuscripts that included objective measures of sleep in RCTs that sought to improve sleep in persons with SUDs.

RESULTS

The initial search yielded 13,403 potential articles, with 27 meeting a priori criteria to be included in this review. The most common SUD was alcohol use disorder (59%). The most common technology used to assess sleep was polysomnography (41%), followed by actigraphy (37%), ambulatory polysomnography or components of polysomnography (e.g., electroencephalography; 19%), and at-home sleep apnea testing (7%). The most common sleep outcome reported was total sleep time (96%).

CONCLUSIONS

There are a range of options to assess objective sleep outcomes. Polysomnography or ambulatory devices that directly measure brain activity are critical to advance medications through the regulatory process for the indication of improving sleep duration, continuity, and/or sleep onset latency outcomes. Actigraphy is also useful in preliminary investigations and in detecting the relationship between diurnal and SUD-related behaviors.

Italian Validation of the Pittsburgh Sleep Quality Index (PSQI) in a Population of Healthy Children: A Cross Sectional Study

Background: Sleep disorders are one of the most discussed topics in scientific literature every year. Although they are one of the most studied topics, in both adults and children, knowledge of sleep disorders and their treatment is still not completely clear, and there is a need to deepen and analyze these disorders on a country-by-country basis. However, research in the Italian literature reveals a scarce quantity of tools to evaluate sleep quality in children. The Pittsburgh Sleep Quality Index (PSQI) is probably the most commonly used retrospective self-assessment questionnaire in the adult population. Purpose: We aimed to validate and analyze the psychometric characteristics of this tool in order to detect and explore the presence of sleep disorders in a healthy Italian population of children throughout the country. Methods: Individuals aged between 3 and 16 years without symptoms of insomnia were included in this study. The reliability and construct validity of the PSQI were assessed according to Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. Results: We enrolled 222 individuals in this study (mean age 11 years). The PSQI demonstrated good internal consistency (Cronbach’s α = 0.719). Test–retest reliability was assessed on a randomized subgroup of the sample (n = 35). The PSQI showed good test–retest reliability with an intraclass correlation coefficient of 0.829 for the total score (95% confidence interval: 0.662–0.914). The Pearson correlation coefficient, used for construct validity, showed a statistically significant positive correlation with the Sleep Disturbance Scale for Children (SDSC). Conclusion: The PSQI proved to be a very reliable and valid tool to investigate sleep experiences in children.

Sleep patterns and psychosocial health of parents of preterm and full-born infants: a prospective, comparative, longitudinal feasibility study

Background

The early birth and hospitalization of a preterm infant in neonatal intensive care unit can produce several emotional and behavioural responses including sleep problems for parents. Few studies have explored sleep and its associations with health and HRQoL over time in this vulnerable parent population. This purpose of this study was to evaluate the feasibility of a prospective, comparative, longitudinal study of the sleep patterns and psychosocial health of preterm and full-born infants’ parents during the first postpartum year.

Methods

A prospective, comparative, longitudinal feasibility study was conducted. Parents of preterm infants were compared to parents of full-born infants to identify if there were differences in outcomes between the groups. The parents were instructed to wear actigraphs and complete sleep diaries for two consecutive weeks, and responded to a digital questionnaire covering stress, insomnia, fatigue, depression, social support, self-efficacy, and health-related quality of life. Survey data were collected at infant ages of 2, 6, and 12 months, actigraphy and sleep diary data were collected at infant age of 2 months only. Descriptive analysis was used to describe recruitment and attrition rates. Differences between completers and dropouts were analysed with a chi-square test (categorical data) and Mann–Whitney–Wilcoxon test for two independent samples (continuous variables).

Results

Between June 2019 and March 2020, 25 parents of a preterm infant and 78 parents of a full-born infant were recruited from four neonatal intensive care units and two maternity wards, respectively, in four Norwegian hospitals. Feasibility was predefined as recruiting ≥ 75 parents each of preterm and full-born infants. The target for the full-born group was reached. However, the preterm group recruitment was challenging. Actigraphs, sleep diaries, and questionnaires were evaluated as feasible for use in a future study. Attrition rates were high in both groups at 6 and 12 months. No parent-related characteristics were associated with participation at 6 months. At 12 months, dropouts had a statistically significantly lower age in the full-born group (both parents) and higher age and body mass index in the preterm group (fathers).

Conclusions

A longitudinal study is feasible; however, procedural changes, including using active methods and contacting participants, are necessary to increase the recruitment of preterm infants’ parents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04862-1.

Longitudinal associations of DNA methylation and sleep in children: a meta-analysis

BACKGROUND

Sleep is important for healthy functioning in children. Numerous genetic and environmental factors, from conception onwards, may influence this phenotype. Epigenetic mechanisms such as DNA methylation have been proposed to underlie variation in sleep or may be an early-life marker of sleep disturbances. We examined if DNA methylation at birth or in school age is associated with parent-reported and actigraphy-estimated sleep outcomes in children.

METHODS

We meta-analysed epigenome-wide association study results. DNA methylation was measured from cord blood at birth in 11 cohorts and from peripheral blood in children (4-13 years) in 8 cohorts. Outcomes included parent-reported sleep duration, sleep initiation and fragmentation problems, and actigraphy-estimated sleep duration, sleep onset latency and wake-after-sleep-onset duration.

RESULTS

We found no associations between DNA methylation at birth and parent-reported sleep duration (n = 3658), initiation problems (n = 2504), or fragmentation (n = 1681) (p values above cut-off 4.0 × 10^-8). Lower methylation at cg24815001 and cg02753354 at birth was associated with longer actigraphy-estimated sleep duration (p = 3.31 × 10^-8, n = 577) and sleep onset latency (p = 8.8 × 10^-9, n = 580), respectively. DNA methylation in childhood was not cross-sectionally associated with any sleep outcomes (n = 716-2539).

CONCLUSION

DNA methylation, at birth or in childhood, was not associated with parent-reported sleep. Associations observed with objectively measured sleep outcomes could be studied further if additional data sets become available.

TeaSpam: A Novel Method of TEmporal And SPAtial Movement Encoding during Sleep

Movements during sleep characterize sleep disorders, which can disturb sleep or its onset, impacting sleep quantity and quality. Video-polysomnography is the current gold standard to assess movements during sleep, but its availability is limited. Using data recorded with a 3D time of flight sensor, we developed a novel method of encoding temporal and spatial information of automatically identified movements during sleep. In a cohort of 20 insomnia patients and 18 controls, we showed that this novel method holds important information able to discriminate the groups. Future studies will explore the methodology in the context of other sleep disorders.

Factors that Impact Day-to-Day Esophageal Acid Reflux Variability and Its Diagnostic Significance for Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a common disease affecting a significant number of adults both globally and in the USA. GERD is clinically diagnosed based on patient-reported symptoms, and the gold standard for diagnosis is ambulatory reflux monitoring, a tool particularly utilized in the common scenario of non-response to therapy or atypical features. Over the past 20 years, there has been a shift toward extending the duration of reflux monitoring, initially from 24 to 48 h and more recently to 96 h, primarily based on a demonstrated increase in diagnostic yield. Further, multiple studies demonstrate clinically relevant variability in day-to-day acid exposure levels in nearly 30% of ambulatory reflux monitoring studies. For these reasons, an ongoing clinical dilemma relates to the optimal activities patients should engage in during prolonged reflux monitoring. Thus, the aims of this review are to detail what is known about variability in daily acid exposure, discuss factors that are known to influence this day-to-day variability (i.e., sleep patterns, dietary/eating habits, stress, exercise, and medications), and finally provide suggestions for patient education and general GERD management to reduce variation in esophageal acid exposure levels.

Isolated REM sleep behaviour disorder: current diagnostic procedures and emerging new technologies

Isolated REM sleep behaviour disorder (iRBD) is characterised by dream enactment behaviours, such as kicking and punching while asleep, and vivid/violent dreams. It is now acknowledged as a prodromal phase of neurodegenerative disease-approximately 80% of people with iRBD will develop dementia with Lewy Bodies, Parkinson's disease or another degenerative brain disease within 10 years. It is important that neurologists and other clinicians understand how to make an early accurate diagnosis of iRBD so that affected people can have the opportunity to take part in clinical trials. However, making a diagnosis can be clinically challenging due to a variety of reasons, including delayed referral, symptom overlap with other disorders, and uncertainty about how to confirm a diagnosis. Several methods of assessment are available, such as clinical interview, screening questionnaires and video polysomnography or 'sleep study'. This review aims to support clinical neurologists in assessing people who present with symptoms suggestive of iRBD. We describe the usefulness and limitations of each diagnostic method currently available in clinical practice, and present recent research on the utility of new wearable technologies to assist with iRBD diagnosis, which may offer a more practical assessment method for clinicians. This review highlights the importance of thorough clinical investigation when patients present with suspected iRBD and emphasises the need for easier access to diagnostic procedures for accurate and early diagnosis.

Feasibility of a new homebased ballistocardiographic tool for sleep-assessment in a real-life context among workers

BACKGROUND: There is a need for simple and suitable tools for assessing sleep in a natural home environment. OBJECTIVES: This study explores the feasibility in terms of implementation and acceptability of a new homebased ballistocardiographic (BCG) tool for objective sleep-assessment in a real-life context. METHODS: The participants included thirty-nine workers, taking part in two seven nights’ sleep-assessment periods. Objective data regarding sleep was collected with BCG. Subjective data regarding sleep was collected with a sleep diary. Implementation was analysed by determining the number of nights with usable signal quality and comparing with the total number of potential nights and by exploring associations between objective and subjective sleep data. Acceptability was analysed by categorizing the participants’ experiences of how the BCG tool impacted the sleep. RESULTS: In terms of implementation, usable BCG data increased from 40% at assessment phase 1 to 70% during assessment phase 2. Moreover, in assessment phase 2, there was a significant moderate correlation between the ‘time in bed’ assessed by the BCG and in sleep diary by participants in the first five nights. In terms of acceptability, almost one third of the participants did not experience any impact of the BCG on the sleep. Two participants experienced a major negative impact on the sleep. CONCLUSIONS: This study indicates that the novel BCG tool could be feasible for objective assessing of sleep in workers natural home-environment in the future, but there is still a need for development of the BCG both regarding technology and implementation process.

Discrepancy between subjective and objective sleep duration among dementia caregivers and non-caregivers

STUDY OBJECTIVES

Poor sleep, including short sleep duration, is common among caregivers of persons with dementia. However, it is unclear whether poor sleep is consistent across both self-reported and objective measures of sleep in caregivers. This study aimed to test the role of caregiving status (caregivers vs. non-caregivers) on the discrepancy between self-reported and objective sleep duration.

METHODS

This was a cross-sectional study. Study participants were community-dwelling caregivers of spouses with dementia (n=122) and non-caregivers (n=53). A sleep duration discrepancy index was created by subtracting objective sleep duration measured with three consecutive 24-hour periods of actigraphy from self-reported sleep duration measured with the Pittsburgh Sleep Quality Index. Covariates included participants' demographic characteristics, depressive symptoms, positive and negative affect, personal mastery, and caregiving-role overload.

RESULTS

Caregivers showed a greater discrepancy in sleep duration than did non-caregivers (-0.46 hour vs. 0.22 hour, respectively; p=0.003). In a regression model, however, caregiving status was no longer associated with this sleep duration discrepancy, when accounting for covariates. Higher positive affect was significantly associated with less sleep duration discrepancy (R²=11.3%, p=0.014). Sobel's test of mediation showed that 26% of the effect of caregiving on this sleep discrepancy was attributable to caregivers with low positive affect.

CONCLUSIONS

The findings suggest a potential mediating role of positive affect on the relationship between caregiving status and sleep duration discrepancy. As an aid for understanding the role of lower positive affect, use of actigraphy may be useful to address sleep discrepancy in caregivers.

Evaluating Patterns and Factors Related to Sleep Disturbances in Prostate Cancer Patients

Prostate cancer patients may experience disturbed sleep as a result of their diagnosis or treatment. This study sought to evaluate disturbed sleep and excessive daytime sleepiness in newly diagnosed patients and those receiving androgen deprivation therapy (ADT). This study was conducted with 74 patients. Subjective data using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) and actigraphy data on ADT/ADT-naïve patients were collected. The prevalence of poor sleep quality, determined from PSQI and ESS scores, was 50% and 16.7% respectively. Those on ADT (n = 20) had poorer sleep quality as determined by significantly higher PSQI scores (70 vs. 40% scoring > 5) and were more likely to have poor sleep quality, sleep latency, and sleep efficiency than ADT-naïve patients (n = 40). Actigraphy data showed that ADT patients slept significantly longer (7.7 vs. 6.8 h), experienced a higher Fragmentation Index (48.3 vs. 37.4%), and had longer daytime nap duration (64.1 vs. 45.2 min) than ADT-naïve patients. The use of objective measures such as actigraphy in the clinical arena is recommended and may be used as a valuable tool for research into sleep assessment in prostate cancer patients.

Bidirectional longitudinal dynamics of self-reported total sleep time and perceived stress: Establishing potential causal relationships

OBJECTIVE

Most studies in developing countries suggest that less total sleep time (TST) increases subsequent perceived stress (PS) more consistently than the inverse, but have used statistical models that are not optimal when ratings are measured in close proximity.

METHODS

We used multilevel dynamic structural equation modeling with Bayesian estimation, ideal for assessing longitudinal daily dynamic interplay between self-reported TST and PS (minimum of 30 days) in 92 Brazilian pre-university students.

RESULTS

TST showed lower inertia than PS (autoregressive effect: TST perturbations influenced subsequent TST ratings less so than corresponding PS measures) and exerted negative prospective effects on PS (cross-lagged effect).

CONCLUSION

In our developing nation sample, PS deviations from mean ratings took longer to return to baseline values than TST and PS was more sensitive to changes in prior TST than vice-versa, confirming previous findings. Future studies should confirm these findings with objective TST and stress measures.

The effect of robot interventions on sleep in adults: a systematic review and network meta-analysis

STUDY OBJECTIVES

Robotic pets or companion robots have demonstrated positive effects on several emotional and physiological factors in humans. Robots could constitute a complementary or alternative method to treat sleep problems, but individual studies on robots' effectiveness regarding sleep show mixed results. The aim of the current study was to compare the effects of robots, plush toys, and treatment as usual on sleep in adults.

METHODS

The current study is a systematic review and frequentist network meta-analysis of all randomized and cluster randomized controlled trials comparing the effects of robots, plush toys, and treatment as usual on total sleep time in adults.

RESULTS

Four studies were included in the analysis. Three studies were considered to have a high risk of bias, whereas one was rated with some concerns. The studies comprised 381 participants. These subjects were older adults, with or without dementia, living in nursing homes. The total sleep time was the only common sleep measure included in all four studies. The network meta-analysis showed no statistically significant differences between the three experimental groups.

CONCLUSIONS

The robot interventions were not found to have positive effects on total sleep time in older adults compared with plush toys or treatment as usual. Future studies should use robots especially made to target sleep, include a thorough screening of the participants, and exclude people with adequate sleep, select appropriate sleep measures, and report the results appropriately for future meta-analyses.

Multimodal prediction of pain and functional outcomes 6 months following total knee replacement: a prospective cohort study

BACKGROUND

Knee osteoarthritis (OA) is among the most common and disabling persistent pain conditions, with increasing prevalence and impact around the globe. In the U.S., the rising prevalence of knee OA has been paralleled by an increase in annual rates of total knee arthroplasty (TKA), a surgical treatment option for late-stage knee OA. While TKA outcomes are generally good, post-operative trajectories of pain and functional status vary substantially; a significant minority of patients report ongoing pain and impaired function following TKA. A number of studies have identified sets of biopsychosocial risk factors for poor post-TKA outcomes (e.g., comorbidities, negative affect, sensory sensitivity), but few prospective studies have systematically evaluated the unique and combined influence of a broad array of factors.

METHODS

This multi-site longitudinal cohort study investigated predictors of 6-month pain and functional outcomes following TKA. A wide spectrum of relevant biopsychosocial predictors was assessed preoperatively by medical history, patient-reported questionnaire, functional testing, and quantitative sensory testing in 248 patients undergoing TKA, and subsequently examined for their predictive capacity.

RESULTS

The majority of patients had mild or no pain at 6 months, and minimal pain-related impairment, but approximately 30% reported pain intensity ratings of 3/10 or higher. Reporting greater pain severity and dysfunction at 6 months post-TKA was predicted by higher preoperative levels of negative affect, prior pain history, opioid use, and disrupted sleep. Interestingly, lower levels of resilience-related "positive" psychosocial characteristics (i.e., lower agreeableness, lower social support) were among the strongest, most consistent predictors of poor outcomes in multivariable linear regression models. Maladaptive profiles of pain modulation (e.g., elevated temporal summation of pain), while not robust unique predictors, interacted with psychosocial risk factors such that the TKA patients with the most pain and dysfunction exhibited lower resilience and enhanced temporal summation of pain.

CONCLUSIONS

This study underscores the importance of considering psychosocial (particularly positively-oriented resilience variables) and sensory profiles, as well as their interaction, in understanding post-surgical pain trajectories.

Napping behavior in adults with episodic migraine: a six-week prospective cohort study

STUDY OBJECTIVES

Patients with migraine commonly endorse napping as a strategy for headache pain relief, but also experience high rates of sleep disturbance. To elucidate the relationship between napping behavior and migraine, we evaluated the association between napping and headache frequency, severity, and intensity among adults with episodic migraine. We also examined the association between daily napping and that night's sleep.

METHODS

In this six-week prospective cohort study, 97 adults with episodic migraine completed twice-daily headache and sleep electronic diaries and wore a wrist actigraph. We modeled the associations between napping (yes/no) and headaches with conditional logistic regression and daily napping and nighttime sleep with linear regression.

RESULTS

Over 4,353 study days, participants reported 1,059 headache days and 389 days with naps. More than 80% of participants napped during the study, with mean nap duration of 76.7 ± 62.4 min. Naps were more likely to occur on day 2 of headache 35/242 (14.5%) than on nonheadache days 279/3294 (8.5%, OR 2.2 [95% CI 1.4, 3.4]). Mean nap onset time (14:40 ± 3.3 h) was later than headache onset (12:48 ± 5.3 h). In adjusted models, napping was associated with an additional 1.1 (95% CI -1.4, 3.6) headache days/month. Naps were not associated with worse self-reported or objective sleep that night.

CONCLUSIONS

Our findings suggest that naps may be an uncommonly used behavioral strategy for prolonged migraine attacks and do not contribute to nightly sleep disturbance. Future studies are needed to examine the acute analgesic effects of daytime napping in patients with migraine.

The diagnostic value of sleep and vigilance tests in central disorders of hypersomnolence

Study Objectives

This retrospective cross-sectional observational study explored the diagnostic value of selected sleep and vigilance tests (SVT) beyond the multiple sleep latency test to differentiate between various central disorders of hypersomnolence (CDH) and fatigue syndromes.

Methods

Data from patients who underwent the multiple sleep latency test and at least one additional SVT were extracted from the Bern sleep database (1997–2018). One thousand three hundred fifty-two patients with a CDH (106 narcolepsy type 1, 90 narcolepsy type 2, 119 idiopathic hypersomnia, 192 nonorganic hypersomnia, 205 insufficient sleep syndrome), fatigue syndromes (n = 183), and a subgroup of patients with sleep apnea (n = 457) were analyzed. Classification based on SVT parameters was compared with the final clinical diagnosis serving as a reference.

Results

An overall model predicted the final diagnosis in 49.5% of patients. However, for the pairwise differentiation of two clinically suspected diagnoses, many SVT parameters showed a sensitivity and specificity above 70%. While the overall discrimination power of the multiple sleep latency test was slightly better than the one of the maintenance of wakefulness test, the latter differentiated best between narcolepsy and idiopathic hypersomnia with prolonged sleep need. Disproportionally poor results in reaction tests (e.g. steer clear test), despite comparable or lower sleepiness levels (SLAT, WLAT), were valuable for differentiating nonorganic hypersomnia from idiopathic hypersomnia/sleep insufficiency syndrome.

Conclusion

This study demonstrates how the combination of a careful clinical assessment and a selection of SVTs can improve the differentiation of CDH, whereas it was not possible to establish an overall prediction model based on SVTs alone.

Validation of a nonwearable device in healthy adults with normal and short sleep durations

STUDY OBJECTIVES

To determine the accuracy of early and newer versions of a nonwearable sleep tracking device relative to polysomnography and actigraphy, under conditions of normal and restricted sleep duration.

METHODS

Participants were 35 healthy adults (mean age = 18.97; standard deviation = 0.95 years; 77.14% female; 42.86% White). In a controlled sleep laboratory environment, we randomly assigned participants to go to bed at 10:30 pm (normal sleep) or 1:30 am (restricted sleep), setting lights-on at 7:00 am. Sleep was measured using polysomnography, wristband actigraphy (the Philips Respironics Actiwatch Spectrum Plus), self-report, and an early or newer version of a nonwearable device that uses a sensor strip to measure movement, heart rate, and breathing (the Apple, Inc. Beddit). We tested accuracy against polysomnography for total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset.

RESULTS

The early version of the nonwearable device (Beddit 3.0) displayed poor reliability (intraclass correlation coefficient [ICC] < 0.30). However, the newer nonwearable device (Beddit 3.5) yielded excellent reliability with polysomnography for total sleep time (ICC = 0.998) and sleep efficiency (ICC = 0.98) across normal and restricted sleep conditions. Agreement was also excellent for the notoriously difficult metrics of sleep onset latency (ICC = 0.92) and wake after sleep onset (ICC = 0.92). This nonwearable device significantly outperformed clinical-grade actigraphy (ICC between 0.44 and 0.96) and self-reported sleep measures (ICC < 0.75).

CONCLUSIONS

A nonwearable device showed better agreement than actigraphy with polysomnography outcome measures. Future work is needed to test the validity of this device in clinical populations.

CITATION

Hsiou DA, Gao C, Matlock RC, Scullin MK. Validation of a nonwearable device in healthy adults with normal and short sleep durations. J Clin Sleep Med. 2022;18(3):751-757.

Relationship between sleep quality, mood state, and performance of elite air-rifle shooters

Background

To evaluate the impact of pre-competition sleep quality on the mood and performance of elite air-rifle shooters.

Methods

Elite shooters who participated in an air-rifle shooting-competition from April 2019 to October 2019 were evaluated using actigraphy, including Total Sleep Time (TST), Sleep Efficiency (SE), Sleep Latency (SL), Wake-time after Sleep Onset (WASO). Sleep quality was assessed by Pittsburgh sleep quality index (PSQI) and Profile of Mood State (POMS). Mood state was assessed by Competitive State Anxiety Inventory-2.

Results

Study included 23 shooters, of them 13 male and 10 female with the mean age 23.11 ± 4.82 years. The average time to fall asleep was 20.6 ± 14.9 min, TST was 7.0 ± 0.8 h and SE was 85.9 ± 5.3%. Average sleep quality was 5.2 ± 2.2 and tended to decrease as the competition progressed. Pre-competition sleep time in female athletes was significantly higher compared to the competition day (P = 0.05). Pre-competition SL was significantly longer in women than in men (P = 0.021). During training and pre-competition, the tension, fatigue, depression, and emotional disturbance were significantly lower in athletes with good sleep quality. Athletes with good sleep quality had significantly more energy. The PSQI total score positively correlated with cognitive anxiety (r = 0.471, P < 0.01), and somatic anxiety (r = 0.585, P < 0.01), and negatively correlated with energy (− 0.504, P < 0.01) and self-confidence scores (r = − 0.523, P < 0.01).

Conclusion

Poor sleep quality negatively impacted the mood of athletes; however, sleep indices and competition performance of athletes during competitions were not significantly correlated.

Sleep Disorders in Patients With Craniopharyngioma: A Physiopathological and Practical Update

Sleep disorders (SDs) represent an important issue in patients with craniopharyngioma (CP). Nearly 70% of these patients complain of sleep-wake cycle alterations and/or excessive diurnal somnolence due to sleep-related breathing disorders, such as obstructive sleep apnea (OSA) and/or central hypersomnia, including secondary narcolepsy. SDs may severely reduce quality of life, increase disease-related cardiorespiratory and cardiovascular morbidity, and finally play a major role in increased long-term mortality reported on patients with CP. A major risk factor for SDs is represented by the hypothalamic syndrome, which may develop because of direct hypothalamic damage by the tumor itself and/or complications of the treatments, neurosurgery and/or radiotherapy, and typically includes permanent neuroendocrine dysfunctions, morbid obesity, and secondary metabolic disorders. Despite increasing attention to SDs in the general population, and in particular to OSA as a risk factor for cardio-metabolic diseases and excessive daytime somnolence, sleep evaluation is still not routinely proposed to patients with CP. Hence, SDs are often underdiagnosed and undertreated. The aim of this paper is to update current knowledge of the pathogenesis and prevalence of SDs in patients with CP and propose practical algorithms for their evaluation and management in clinical practice. Particular attention is paid to screening and diagnostic tools for appropriate characterization of SDs, identification of risk factors, and potential role of hypothalamic sparing surgery in the prevention of morbid obesity and SDs. Available tools in sleep medicine, including lifestyle interventions, drugs, and respiratory devices, are discussed, as well as the importance of optimal hormone replacement and metabolic interventions. Current limits in the diagnosis and treatment of SDs in patients with CP and possible future avenues for research agenda are also considered.

Self-reported and actigraphic short sleep duration in older adults

STUDY OBJECTIVES

Persons > 65 years with short sleep duration (≤ 6 hours) are at risk for adverse outcomes, but the accuracy of self-reported sleep duration may be affected by reduced symptom awareness. We evaluated the performance characteristics of self-reported vs objectively measured sleep duration in this age group.

METHODS

In 2,980 men from the Osteoporotic Fractures in Men Sleep Study and 2,855 women from the Study of Osteoporotic Fractures we examined the agreement and accuracy of self-reported vs actigraphy-measured short and normal (> 6 but < 9 hours) sleep duration. We evaluated associations of select factors (demographics; medical, physical, and neuropsychiatric conditions; medication and substance use; and sleep-related measures) with risk of false-negative (normal sleep duration by self-report but short sleep duration by actigraphy) and false-positive (short sleep duration by self-report and normal sleep duration by actigraphy) designations, respectively, using logistic regression.

RESULTS

Average ages were 76.3 ± 5.5 and 83.5 ± 3.7 years in men and women, respectively. There was poor agreement between self-reported and actigraphic sleep duration (kappa ≤ 0.24). False negatives occurred in nearly half and false positives in over a quarter of older persons. In multivariable models in men and women, false negatives were independently associated with obesity, daytime sleepiness, and napping, while false positives were significantly lower with obesity.

CONCLUSIONS

Under- and overreporting of short sleep is common among older persons. Reliance on self-report may lead to missed opportunities to prevent adverse outcomes or unnecessary interventions. Self-reported sleep duration should be objectively confirmed when evaluating the effect of sleep duration on health outcomes.

CITATION

Miner B, Stone KL, Zeitzer JM, et al. Self-reported and actigraphic short sleep duration in older adults. J Clin Sleep Med. 2022;18(2):403-413.

Digging for data: How sleep is losing out to roster design, sleep disorders, and lifestyle factors

Shift workers employed at a remote mining operation may experience sleep loss, impaired alertness, and consequently negative health and safety outcomes. This study determined the sleep behaviors and prevalence of risk for sleep disorders among shift workers; and quantified alertness for a roster cycle. Sleep duration was significantly less following; night shift by 77 ± 7 min and day shift by 30 ± 7 min. The wake after sleep onset was less by 23 ± 3 min for night shifts and 22 ± 3 min for day shifts (p < 0.05 for all). The prevalence of risk for sleep apnea was 31%, insomnia was 8%, and shiftwork disorder was 44%. Average alertness for all working hours was 75%. Shiftwork in remote mining operations is a significant factor that leads to sleep loss and reduced alertness, which is exacerbated by the high prevalence of risk for sleep disorders.