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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: 9] [Impact Index Per Article: 3.0] [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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52
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de Zambotti M, Goldstone A, Forouzanfar M, Javitz H, Claudatos S, Colrain IM, Baker FC. The falling asleep process in adolescents. Sleep 2021; 43:5686157. [PMID: 31872251 DOI: 10.1093/sleep/zsz312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/03/2019] [Indexed: 01/25/2023] Open
Abstract
STUDY OBJECTIVES To investigate the pre-sleep psychophysiological state and the arousal deactivation process across the sleep onset (SO) transition in adolescents. METHODS Data were collected from a laboratory overnight recording in 102 healthy adolescents (48 girls, 12-20 years old). Measures included pre-sleep self-reported cognitive/somatic arousal, and cortical electroencephalographic (EEG) and electrocardiographic activity across the SO transition. RESULTS Adolescent girls, compared with boys, reported higher pre-sleep cognitive activation (p = 0.025) and took longer to fall asleep (p < 0.05), as defined with polysomnography. Girls also showed a less smooth progression from wake-to-sleep compared with boys (p = 0.022). In both sexes, heart rate (HR) dropped at a rate of ~0.52 beats per minute in the 5 minutes preceding SO, and continued to drop, at a slower rate, during the 5 minutes following SO (p < 0.05). Older girls had a higher HR overall in the pre-sleep period and across SO, compared to younger girls and boys (p < 0.05). The EEG showed a progressive cortical synchronization, with increases in Delta relative power and reductions in Alpha, Sigma, Beta1, and Beta2 relative powers (p < 0.05) in the approach to sleep, in both sexes. Delta relative power was lower and Theta, Alpha, and Sigma relative powers were higher in older compared to younger adolescents at bedtime and across SO (p < 0.05). CONCLUSIONS Our findings show the dynamics of the cortical-cardiac de-arousing process across the SO transition in a non-clinical sample of healthy adolescents. Findings suggest a female-specific vulnerability to inefficient sleep initiation, which may contribute to their greater risk for developing insomnia.
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Affiliation(s)
| | - Aimee Goldstone
- Center for Health Sciences, SRI International, Menlo Park, CA
| | | | - Harold Javitz
- Center for Health Sciences, SRI International, Menlo Park, CA
| | | | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA.,Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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53
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Fernandez-Mendoza J, Bourchtein E, Calhoun S, Puzino K, Snyder CK, He F, Vgontzas AN, Liao D, Bixler E. Natural history of insomnia symptoms in the transition from childhood to adolescence: population rates, health disparities, and risk factors. Sleep 2021; 44:zsaa187. [PMID: 32929504 PMCID: PMC7953218 DOI: 10.1093/sleep/zsaa187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/18/2020] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES To determine the sociodemographic, behavioral, and clinical risk factors associated with the persistence, remission, and incidence of insomnia symptoms in the transition from childhood to adolescence. METHODS The Penn State Child Cohort is a random, population-based sample of 700 children (5-12 years at baseline), of whom 421 were followed-up as adolescents (12-23 years at follow-up). Subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Insomnia symptoms were defined as a parent- or self-report of difficulty falling and/or staying asleep. RESULTS The 421 subjects with baseline (Mage = 8.8 years) and follow-up (Mage = 17 years) data were 53.9% male and 21.9% racial/ethnic minorities. The persistence of childhood insomnia symptoms (CIS) was 56% (95% CI = 46.5-65.4), with only 30.3% (95% CI = 21.5-39.0) fully remitting. The incidence of adolescent insomnia symptoms was 31.1% (95% CI = 25.9-36.3). Female sex, racial/ethnic minority, and low socioeconomic status as well as psychiatric/behavioral or neurological disorders, obesity, smoking, and evening chronotype were associated with a higher persistence or incidence of insomnia symptoms. CONCLUSIONS CIS are highly persistent, with full remission occurring in only a third of children in the transition to adolescence. Sex-, racial/ethnic-, and socioeconomic-related disparities in insomnia occur as early as childhood, while different mental/physical health and lifestyle/circadian risk factors play a key role in the chronicity of CIS versus their incidence in adolescence. CIS should not be expected to developmentally remit and should become a focus of integrated pediatric/behavioral health strategies.
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Affiliation(s)
- Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Elizaveta Bourchtein
- Sleep Research & Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Susan Calhoun
- Sleep Research & Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Kristina Puzino
- Sleep Research & Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Cynthia K Snyder
- Department of Pediatrics, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Fan He
- Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Alexandros N Vgontzas
- Sleep Research & Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Edward Bixler
- Sleep Research & Treatment Center, Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
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54
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Macedo A, Gómez C, Rebelo MÂ, Poza J, Gomes I, Martins S, Maturana-Candelas A, Pablo VGD, Durães L, Sousa P, Figueruelo M, Rodríguez M, Pita C, Arenas M, Álvarez L, Hornero R, Lopes AM, Pinto N. Risk Variants in Three Alzheimer's Disease Genes Show Association with EEG Endophenotypes. J Alzheimers Dis 2021; 80:209-223. [PMID: 33522999 PMCID: PMC8075394 DOI: 10.3233/jad-200963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Dementia due to Alzheimer’s disease (AD) is a complex neurodegenerative disorder, which much of heritability remains unexplained. At the clinical level, one of the most common physiological alterations is the slowing of oscillatory brain activity, measurable by electroencephalography (EEG). Relative power (RP) at the conventional frequency bands (i.e., delta, theta, alpha, beta-1, and beta-2) can be considered as AD endophenotypes. Objective: The aim of this work is to analyze the association between sixteen genes previously related with AD: APOE, PICALM, CLU, BCHE, CETP, CR1, SLC6A3, GRIN2
β, SORL1, TOMM40, GSK3
β, UNC5C, OPRD1, NAV2, HOMER2, and IL1RAP, and the slowing of the brain activity, assessed by means of RP at the aforementioned frequency bands. Methods: An Iberian cohort of 45 elderly controls, 45 individuals with mild cognitive impairment, and 109 AD patients in the three stages of the disease was considered. Genomic information and brain activity of each subject were analyzed. Results: The slowing of brain activity was observed in carriers of risk alleles in IL1RAP (rs10212109, rs9823517, rs4687150), UNC5C (rs17024131), and NAV2 (rs1425227, rs862785) genes, regardless of the disease status and situation towards the strongest risk factors: age, sex, and APOE ɛ4 presence. Conclusion: Endophenotypes reduce the complexity of the general phenotype and genetic variants with a major effect on those specific traits may be then identified. The found associations in this work are novel and may contribute to the comprehension of AD pathogenesis, each with a different biological role, and influencing multiple factors involved in brain physiology.
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Affiliation(s)
- Ana Macedo
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,JTA: The Data Scientists, Porto, Portugal
| | - Carlos Gómez
- Grupo de Ingeniería Biomédica, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Spain
| | - Miguel Ângelo Rebelo
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Jesús Poza
- Grupo de Ingeniería Biomédica, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Spain.,Instituto de Investigación en Matemáticas (IMUVA), Universidad de Valladolid, Valladolid, Spain
| | - Iva Gomes
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Sandra Martins
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | | | | | - Luis Durães
- Associação Portuguesa de Familiares e Amigos de Doentes de Alzheimer, Lavra, Portugal
| | - Patrícia Sousa
- Associação Portuguesa de Familiares e Amigos de Doentes de Alzheimer, Lavra, Portugal
| | - Manuel Figueruelo
- Asociación de Familiares y Amigos de Enfermos de Alzheimer y otras demencias de Zamora, Zamora, Spain
| | - María Rodríguez
- Asociación de Familiares y Amigos de Enfermos de Alzheimer y otras demencias de Zamora, Zamora, Spain
| | - Carmen Pita
- Asociación de Familiares y Amigos de Enfermos de Alzheimer y otras demencias de Zamora, Zamora, Spain
| | - Miguel Arenas
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,CINBIO (Biomedical Research Center), University of Vigo, Vigo, Spain.,Department of Biochemistry, Genetics and Immunology, University of Vigo, Vigo, Spain
| | - Luis Álvarez
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Adeneas, Valencia, Spain
| | - Roberto Hornero
- Grupo de Ingeniería Biomédica, Universidad de Valladolid, Valladolid, Spain.,Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Spain.,Instituto de Investigación en Matemáticas (IMUVA), Universidad de Valladolid, Valladolid, Spain
| | - Alexandra M Lopes
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Nádia Pinto
- IPATIMUP - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Centro de Matemática da Universidade do Porto, Porto, Portugal
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55
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The effects of non-invasive brain stimulation on sleep disturbances among different neurological and neuropsychiatric conditions: A systematic review. Sleep Med Rev 2021; 55:101381. [DOI: 10.1016/j.smrv.2020.101381] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/17/2020] [Accepted: 06/09/2020] [Indexed: 12/11/2022]
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56
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Jones S, Castelnovo A, Riedner B, Flaherty B, Prehn-Kristensen A, Benca R, Tononi G, Herringa R. Sleep and emotion processing in paediatric posttraumatic stress disorder: A pilot investigation. J Sleep Res 2021; 30:e13261. [PMID: 33442931 PMCID: PMC8365752 DOI: 10.1111/jsr.13261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
Emotion processing abnormalities and sleep pathology are central to the phenomenology of paediatric posttraumatic stress disorder, and sleep disturbance has been linked to the development, maintenance and severity of the disorder. Given emerging evidence indicating a role for sleep in emotional brain function, it has been proposed that dysfunctional processing of emotional experiences during sleep may play a significant role in affective disorders, including posttraumatic stress disorder. Here we sought to examine the relationship between sleep and emotion processing in typically developing youth, and youth with a diagnosis of posttraumatic stress disorder . We use high-density electroencephalogram to compare baseline sleep with sleep following performance on a task designed to assess both memory for and reactivity to negative and neutral imagery in 10 youths with posttraumatic stress disorder, and 10 age- and sex-matched non-traumatized typically developing youths. Subjective ratings of arousal to negative imagery (ΔArousal = post-sleep minus pre-sleep arousal ratings) remain unchanged in youth with posttraumatic stress disorder following sleep (mean increase 0.15, CI -0.28 to +0.58), but decreased in TD youth (mean decrease -1.0, 95% CI -1.44 to -0.58). ΔArousal, or affective habituation, was negatively correlated with global change in slow-wave activity power (ρ = -0.58, p = .008). When considered topographically, the correlation between Δslow-wave activity power and affective habituation was most significant in a frontal cluster of 27 electrodes (Spearman, ρ = -0.51, p = .021). Our results highlight the importance of slow-wave sleep for adaptive emotional processing in youth, and have implications for symptom persistence in paediatric posttraumatic stress disorder. Impairments in slow-wave activity may represent a modifiable risk factor in paediatric posttraumatic stress disorder.
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Affiliation(s)
- Stephanie Jones
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Anna Castelnovo
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Brady Riedner
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Bethany Flaherty
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ruth Benca
- Department of Psychiatry & Human Behavior, School of Medicine, University of California-Irvine, Irvine, CA, USA
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Ryan Herringa
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
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57
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Abstract
Insomnia is the most common sleep disorder among all ages; unfortunately, however, child and adolescent insomnia is infrequently addressed. Given the importance of adequate sleep for proper brain development, pediatric populations are particularly vulnerable to the negative effects of insomnia. Therefore, proper clinical assessment and treatment of pediatric insomnia is crucial. This article is the result of a comprehensive literature review and serves as a guide to the disorder and how it presents differently across child development.
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58
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Shao Z, Xu Y, Chen L, Wang S, Zhang M, Liu S, Wen X, Yu D, Yuan K. Dysfunction of the NAc-mPFC circuit in insomnia disorder. Neuroimage Clin 2020; 28:102474. [PMID: 33395968 PMCID: PMC7606871 DOI: 10.1016/j.nicl.2020.102474] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/13/2020] [Accepted: 10/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Insomnia disorder (ID) is a prevalent sleep disorder, which seriously affects people's daily life and was found to be associated with increased frequency of sleep stage shifts. Previous findings had revealed the critical role of the nucleus accumbens (NAc) in sleep-wake transition. However, the neuroimaging studies of the NAc in patients with ID have been rare. We hypothesized that structural and functional abnormalities of the NAc would be implicated in ID. METHODS Twenty-six ID patients and 36 matched healthy controls (HC) were included in the current study. The volumes and corresponding resting-state functional connectivity (RSFC) of the bilateral NAc were compared between the two groups. The abnormal RSFC in ID were then correlated with Pittsburgh Sleep Quality Index (PSQI). RESULTS Compared with HC, ID patients showed significantly increased volume of right NAc. Several brain regions showed increased RSFC with the NAc in ID patients, such as medial prefrontal cortex (mPFC), anterior cingulate cortex (ACC), caudate and putamen. Meanwhile, the occipital gyrus and temporal gyrus showed decreased RSFC with the NAc. Additionally, the increased RSFC strength between bilateral NAc and left mPFC was significant correlated with PSQI scores in ID patients. CONCLUSION Dysfunctions of the NAc-mPFC circuit were found in ID patients, which were associated with sleep quality measured by PSQI. The two patterns of increase and decrease of RSFC in ID patients observed in our study may reflect the state of hyperarousal and potential impairment of cognitive function in the patients, respectively. It is hoped that our study focusing on NAc-mPFC circuits could provide new insights for the neural mechanisms of ID and potential novel therapeutic targets for treatment of ID patients.
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Affiliation(s)
- Ziqiang Shao
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Yan Xu
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Longmao Chen
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Shicong Wang
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Min Zhang
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Shuang Liu
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Xinwen Wen
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China
| | - Dahua Yu
- Inner Mongolia Key Laboratory of Pattern Recognition and Intelligent Image Processing, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, People's Republic of China.
| | - Kai Yuan
- School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, People's Republic of China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, People's Republic of China; Inner Mongolia Key Laboratory of Pattern Recognition and Intelligent Image Processing, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, People's Republic of China.
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59
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Winiger EA, Huggett SB, Hatoum AS, Friedman NP, Drake CL, Wright KP, Hewitt JK. Onset of regular cannabis use and young adult insomnia: an analysis of shared genetic liability. Sleep 2020; 43:zsz293. [PMID: 31855253 PMCID: PMC7368342 DOI: 10.1093/sleep/zsz293] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/22/2019] [Indexed: 01/13/2023] Open
Abstract
STUDY OBJECTIVES Estimate the genetic and environmental influences on the relationship between onset of regular cannabis use and young adult insomnia. METHODS In a population-based twin cohort of 1882 twins (56% female, mean age = 22.99, SD = 2.97) we explored the genetic/environmental etiology of the relationship between onset of regular cannabis use and insomnia-related outcomes via multivariate twin models. RESULTS Controlling for sex, current depression symptoms, and prior diagnosis of an anxiety or depression disorder, adult twins who reported early onset for regular cannabis use (age 17 or younger) were more likely to have insomnia (β = 0.07, p = 0.024) and insomnia with short sleep on weekdays (β = 0.08, p = 0.003) as young adults. We found significant genetic contributions for the onset of regular cannabis use (a2 = 76%, p < 0.001), insomnia (a2 = 44%, p < 0.001), and insomnia with short sleep on weekdays (a2 = 37%, p < 0.001). We found significant genetic correlations between onset of regular use and both insomnia (rA = 0.20, p = 0.047) and insomnia with short sleep on weekdays (rA = 0.25, p = 0.008) but no significant environmental associations between these traits. CONCLUSIONS We found common genetic liabilities for early onset of regular cannabis use and insomnia, implying pleiotropic influences of genes on both traits.
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Affiliation(s)
- Evan A Winiger
- Institute for Behavioral Genetics, University of Colorado - Boulder, Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado - Boulder, Boulder, CO
| | - Spencer B Huggett
- Institute for Behavioral Genetics, University of Colorado - Boulder, Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado - Boulder, Boulder, CO
| | - Alexander S Hatoum
- Institute for Behavioral Genetics, University of Colorado - Boulder, Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado - Boulder, Boulder, CO
| | - Naomi P Friedman
- Institute for Behavioral Genetics, University of Colorado - Boulder, Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado - Boulder, Boulder, CO
| | | | - Kenneth P Wright
- Department of Integrative Physiology, University of Colorado - Boulder, Boulder, CO
| | - John K Hewitt
- Institute for Behavioral Genetics, University of Colorado - Boulder, Boulder, CO
- Department of Psychology and Neuroscience, University of Colorado - Boulder, Boulder, CO
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60
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Askeland KG, Sivertsen B, Hysing M. Sleep patterns and insomnia among internationally adopted adolescents. Sleep Health 2020; 6:594-600. [PMID: 32360020 DOI: 10.1016/j.sleh.2020.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/17/2020] [Accepted: 02/12/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sleep is essential for adolescent development. We aimed to investigate sleep patterns and insomnia among internationally adopted adolescents compared with their nonadopted peers. DESIGN Cross-sectional. SETTING Data stem from the population-based youth@hordaland-survey, conducted during winter/spring 2012, in Hordaland, Norway. PARTICIPANTS Of the 9846 adolescents who responded to the sleep measures in the youth@hordaland-survey, 44 were identified as international adoptees by linkage to the Central Adoption Registry. MEASURES The adolescents provided self-report information on demographic characteristics, mental health problems, and a range of sleep measures. RESULTS There were no significant differences between the adoptees and nonadopted peers regarding how much time they spent in bed, but the internationally adopted adolescents reported significantly shorter sleep duration, both on weekdays (d=0.37, P = .014) and weekends (d=0.37, P = .015). The difference was due to the adoptees spending longer time awake after sleep onset (d=0.78, P > .001). Furthermore, 32% of the adopted adolescents fulfilled the DMS-5 criteria for insomnia, compared with 18% of their nonadopted peers (odds ratio 2.06, 95% CI: 1.09-3.90). However, this association was no longer significant after adjusting for symptoms of depression. Adolescents adopted after 12 months of age reported more sleep problems than those who were adopted earlier. CONCLUSION The short sleep duration and high occurrence of insomnia among the internationally adopted adolescents suggest both a problem area that should receive more focus and a potential avenue for intervention. The results further suggest that assessing both mental health problems and sleep problems among internationally adopted adolescents who are experiencing difficulties could help target interventions.
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Affiliation(s)
- Kristin Gärtner Askeland
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research & Innovation, Helse-Fonna HF, Haugesund, Norway; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mari Hysing
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway; Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
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Baiden P, Tadeo SK, Tonui BC, Seastrunk JD, Boateng GO. Association between insufficient sleep and suicidal ideation among adolescents. Psychiatry Res 2020; 287:112579. [PMID: 31627959 DOI: 10.1016/j.psychres.2019.112579] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 12/28/2022]
Abstract
The objective of this study was to examine the association between insufficient sleep and suicidal ideation among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 13,659 adolescents aged 14-18 years (51.8% female) were analyzed using logistic regression with suicidal ideation as the outcome variable and insufficient sleep as the main explanatory variable. Of the 13,659 adolescents, 2,409 representing 17.6% experienced suicidal ideation during the past 12 months and three out of four adolescents (75.2%) had insufficient sleep on an average school night. Controlling for all other predictors, the odds of experiencing suicidal ideation were 1.35 times higher for adolescents who had insufficient sleep relative to those who had sufficient sleep on an average school night (AOR = 1.35, 95% CI = 1.16-1.58). Other factors associated with suicidal ideation include female gender, sexual minority, history of traditional bullying and cyberbullying victimization, feeling sad or hopeless, being slightly or very overweight, and substance use. Physical activity was inversely associated with suicidal ideation. School counselors, clinicians, and practitioners should consider adequate sleep as an important intervention in suicide prevention.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019, United States.
| | - Savarra K Tadeo
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019, United States
| | - Betty C Tonui
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019, United States
| | - Jaylon D Seastrunk
- The University of Texas at Arlington, Department of Psychology, 501 Nedderman Dr, Box 19528, Arlington, TX, 76019, United States
| | - Godfred O Boateng
- The University of Texas at Arlington, Public Health Program, Department of Kinesiology, 500 W. Nedderman Dr, Box 19407, Arlington, TX, 76019, United States
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Decreased sustained attention, processing speed and verbal learning memory in patients with insomnia in Chinese young and middle-aged adults: a cross-sectional study. Sleep Biol Rhythms 2020. [DOI: 10.1007/s41105-020-00262-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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63
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Howlett RDM, Lustig KA, MacDonald KJ, Cote KA. Hyperarousal Is Associated with Socioemotional Processing in Individuals with Insomnia Symptoms and Good Sleepers. Brain Sci 2020; 10:brainsci10020112. [PMID: 32093215 PMCID: PMC7071480 DOI: 10.3390/brainsci10020112] [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] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/10/2020] [Accepted: 02/18/2020] [Indexed: 12/26/2022] Open
Abstract
Despite complaints of difficulties in waking socioemotional functioning by individuals with insomnia, only a few studies have investigated emotion processing performance in this group. Additionally, the role of sleep in socioemotional processing has not been investigated extensively nor using quantitative measures of sleep. Individuals with insomnia symptoms (n = 14) and healthy good sleepers (n = 15) completed two nights of at-home polysomnography, followed by an afternoon of in-lab performance testing on tasks measuring the processing of emotional facial expressions. The insomnia group self-reported less total sleep time, but no other group differences in sleep or task performance were observed. Greater beta EEG power throughout the night was associated with higher intensity ratings of happy, fearful and sad faces for individuals with insomnia, yet blunted sensitivity and lower accuracy for good sleepers. Thus, the presence of hyperarousal differentially impacted socioemotional processing of faces in individuals with insomnia symptoms and good sleepers.
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Affiliation(s)
| | | | | | - Kimberly A. Cote
- Correspondence: ; Tel.: +1-905-688-5550 (ext. 4806); Fax: +1-905-688-6922
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64
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He JW, Tu ZH, Xiao L, Su T, Tang YX. Effect of restricting bedtime mobile phone use on sleep, arousal, mood, and working memory: A randomized pilot trial. PLoS One 2020; 15:e0228756. [PMID: 32040492 PMCID: PMC7010281 DOI: 10.1371/journal.pone.0228756] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/22/2020] [Indexed: 12/19/2022] Open
Abstract
Background This study aimed to assess the effects of restricting mobile phone use before bedtime on sleep, pre-sleep arousal, mood, and working memory. Methods Thirty-eight participants were randomized to either an intervention group (n = 19), where members were instructed to avoid using their mobile phone 30 minutes before bedtime, or a control group (n = 19), where the participants were given no such instructions. Sleep habit, sleep quality, pre-sleep arousal and mood were measured using the sleep diary, the Pittsburgh sleep quality index, the Pre-sleep Arousal Scale and the Positive and Negative Affect Schedule respectively. Working memory was tested by using the 0-,1-,2-back task (n-back task). Results Restricting mobile phone use before bedtime for four weeks was effective in reducing sleep latency, increasing sleep duration, improving sleep quality, reducing pre-sleep arousal, and improving positive affect and working memory. Conclusions Restricting mobile phone use close to bedtime reduced sleep latency and pre-sleep arousal and increased sleep duration and working memory. This simple change to moderate usage was recommended to individuals with sleep disturbances.
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Affiliation(s)
- Jing-wen He
- Department of Medical Psychology, the Second Military Medical University, Shanghai, China
| | - Zhi-hao Tu
- Department of Nautical Psychology, the Second Military Medical University, Shanghai, China
| | - Lei Xiao
- Department of Medical Psychology, the Second Military Medical University, Shanghai, China
| | - Tong Su
- Department of Medical Psychology, the Second Military Medical University, Shanghai, China
| | - Yun-xiang Tang
- Department of Medical Psychology, the Second Military Medical University, Shanghai, China
- * E-mail:
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65
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Zhao X, Wang L, Ge C, Zhen X, Chen Z, Wang J, Zhou Y. Smartphone application training program improves smartphone usage competency and quality of life among the elderly in an elder university in China: A randomized controlled trial. Int J Med Inform 2020; 133:104010. [DOI: 10.1016/j.ijmedinf.2019.104010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/21/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
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Maskevich S, Cassanet A, Allen NB, Trinder J, Bei B. Sleep and stress in adolescents: the roles of pre-sleep arousal and coping during school and vacation. Sleep Med 2019; 66:130-138. [PMID: 31877504 DOI: 10.1016/j.sleep.2019.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/14/2019] [Accepted: 10/27/2019] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVES This study explored the relationship between stress and actigraphy-measured and self-reported sleep in adolescents during periods of restricted (school) and unrestricted (vacation) sleep opportunities. We further examined whether (1) cognitive pre-sleep arousal (PSA) mediated the relationship between stress and sleep onset latency (SOL), and (2) coping moderated the effect of stress on PSA. METHODS Participants were 146 (77 females) adolescents (M = 16.2, SD = 1.0) recruited from the community. Actigraphy assessed daily sleep over the last week of a school-term and the following two-week vacation. The following self-report measures were administered during both school and vacation: the Pittsburgh Sleep Quality Index, Inventory of High-School Students Recent Life Experiences (stress), Pre-Sleep Arousal Scale, and the Brief COPE (coping). RESULTS Path analyses showed that during both school and vacation, higher cognitive PSA mediated the relationship between higher stress and longer self-report SOL (p < 0.01). During vacation, higher PSA also mediated the relationship between higher stress and longer actigraphy SOL (p < 0.05). During vacation (but not school), problem-focused coping moderated the mediating effects of PSA (p < 0.05), such that more frequent use of coping was associated with weaker association between stress and cognitive PSA, and shorter actigraphy and self-report SOL. CONCLUSIONS Cognitive PSA and coping may be two modifiable factors influencing how stress affects adolescents' sleep onset. Interventions that reduce cognitive arousal at bedtime may therefore shorten adolescents' sleep onset during both school and vacation. Further, the use of problem-focused coping strategies might be protective against the effects of stress on sleep onset, especially during vacation periods. STATEMENT OF SIGNIFICANCE This paper expands the understanding of the stress-sleep association in adolescents by examining the mediating role of cognitive pre-sleep arousal and the moderating effects of coping. By examining these associations during both school and vacation periods, findings are likely to be applicable to both restricted and relatively unconstrained sleep conditions. Practically, our findings suggest that interventions directed towards the reduction of cognitive pre-sleep arousal may improve adolescents' sleep onset latency. Additionally, fostering healthy coping, especially problem-focused coping strategies such as problem solving, may mitigate the effects of stress on adolescents' sleep.
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Affiliation(s)
- Svetlana Maskevich
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Amy Cassanet
- Krongold Clinic, Faculty of Education, Monash University, Melbourne, Australia
| | - Nicholas B Allen
- Department of Psychology, University of Oregon, Oregon, USA; Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - John Trinder
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Bei Bei
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
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McCloskey S, Jeffries B, Koprinska I, Miller CB, Grunstein RR. Data-driven cluster analysis of insomnia disorder with physiology-based qEEG variables. Knowl Based Syst 2019. [DOI: 10.1016/j.knosys.2019.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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68
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Grierson AB, Scott J, Glozier N, Hickie IB, Amminger PG, Killackey E, McGorry PD, Pantelis C, Phillips L, Scott E, Yung AR, Purcell R. Can youth at high risk of illness progression be identified by measures of rumination and sleep-wake disturbance. Early Interv Psychiatry 2019; 13:1214-1219. [PMID: 30485651 DOI: 10.1111/eip.12757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 04/09/2018] [Accepted: 10/17/2018] [Indexed: 02/05/2023]
Abstract
AIM Clinical staging models offer a useful framework for understanding illness trajectories, where individuals are located on a continuum of illness progression from stage 0 (at-risk but asymptomatic) to stage 4 (end-stage disease). Importantly, clinical staging allows investigation of risk factors for illness progression with the potential to target trans-diagnostic mechanisms at an early stage, especially in help-seeking youth who often present with sub-threshold syndromes. While depressive symptoms, rumination and sleep-wake disturbances may worsen syndrome outcomes, the role of these related phenomena has yet to be examined as risk factors for trans-diagnostic illness progression in at-risk youth. METHODS This study is a prospective follow-up of 248 individuals aged 12 to 25 years presenting to headspace services with sub-threshold syndromes (stage 1) classified under the clinical staging model to determine transition to threshold syndromes (stage 2). Factor analysis of depression, rumination and sleep-wake patterns was used to identify key dimensions and any associations between factors and transition to stage 2 at follow-up. RESULTS At 1 year, 9% of cases met criteria for stage 2 (n = 22). One of three identified factors, namely the factor reflecting the commonalities shared between rumination and sleep-wake disturbance, significantly differentiated cases that transitioned to stage 2 vs those that did not demonstrate transition. Items loading onto this factor, labelled Anergia, included depression severity and aspects of rumination and sleep-wake disturbance that were characterized as introceptive. CONCLUSIONS Common dimensions between rumination and sleep-wake disturbance present a detectable trans-diagnostic marker of illness progression in youth, and may represent a target for early intervention.
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Affiliation(s)
- Ashlee B Grierson
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Jan Scott
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia.,Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Nick Glozier
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Paul G Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christos Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Carlton South, Victoria, Australia
| | - Lisa Phillips
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Scott
- Brain and Mind Research Institute, The University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, Notre Dame University, Sydney, New South Wales, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rosemary Purcell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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69
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Fernandez-Mendoza J, Li Y, Fang J, Calhoun SL, Vgontzas AN, Liao D, Bixler EO. Childhood high-frequency EEG activity during sleep is associated with incident insomnia symptoms in adolescence. J Child Psychol Psychiatry 2019; 60:742-751. [PMID: 29989664 PMCID: PMC6328336 DOI: 10.1111/jcpp.12945] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Insomnia has been associated in cross-sectional studies with increased beta (15-35 Hz) electroencephalogram (EEG) power during nonrapid eye movement (NREM) sleep, an index of cortical hyperarousal. However, it is unknown whether this cortical hyperarousal is present before individuals with insomnia develop the disorder. To fill this gap, we examined the association of childhood sleep high-frequency EEG activity with incident insomnia symptoms (i.e., absence of insomnia symptoms in childhood but presence in adolescence). METHODS We studied a case-control subsample of 45 children (6-11 years) from the Penn State Child Cohort, a population-based random sample of 421 children, who were followed up after 8 years as adolescents (13-20 years). We examined low-beta (15-25 Hz) and high-beta (25-35 Hz) relative power at central EEG derivations during NREM sleep and, in secondary analyses, during sleep onset latency, sleep onset, and REM sleep. Incident insomnia symptoms were defined as the absence of parent-reported difficulty falling and/or staying asleep during childhood and a self-report of these insomnia symptoms during adolescence. RESULTS Childhood high-beta power during NREM sleep was significantly increased in children who developed insomnia symptoms in adolescence (n = 25) as compared to normal sleeping controls (n = 20; p = .03). Multivariable-adjusted logistic regression models showed that increased childhood high-beta EEG power during NREM sleep was associated with a threefold increased odds (95% CI = 1.12-7.98) of incident insomnia symptoms in adolescence. No other significant relationships were observed for other sleep/wake states or EEG frequency bands. CONCLUSIONS Increased childhood high-frequency EEG power during NREM sleep is associated with incident insomnia symptoms in adolescence. This study indicates that cortical hyperarousal during sleep may be a premorbid neurophysiological sign of insomnia, which may mediate the increased risk of psychiatric disorders associated with insomnia.
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Affiliation(s)
- Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University, College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Yun Li
- Sleep Medicine Center, Shantou University Medical College, Shantou, China
- Mental Health Center, Shantou University Medical College, Shantou, China
| | - Jidong Fang
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University, College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Susan L. Calhoun
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University, College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alexandros N. Vgontzas
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University, College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Edward O. Bixler
- Sleep Research & Treatment Center, Department of Psychiatry, Pennsylvania State University, College of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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70
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Kalmbach DA, Abelson JL, Arnedt JT, Zhao Z, Schubert JR, Sen S. Insomnia symptoms and short sleep predict anxiety and worry in response to stress exposure: a prospective cohort study of medical interns. Sleep Med 2019; 55:40-47. [PMID: 30763868 PMCID: PMC7045299 DOI: 10.1016/j.sleep.2018.12.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVES While anxiety rates are alarmingly high in short sleeping insomniacs, the relationship between insomnia and anxiety symptoms has not been extensively studied, especially in comparison to the relationship between insomnia and depressive symptoms. Using residency training as a naturalistic stress exposure, we prospectively assessed the role of sleep disturbance and duration on anxiety-risk in response to stress. METHODS Web-based survey data from 1336 first-year training physicians (interns) prior to and then quarterly across medical internship. Using mixed effects modeling, we examined how pre-internship sleep disturbance and internship sleep duration predicted symptoms of anxiety, using an established tool for quantifying symptom severity in generalized anxiety disorder (GAD). RESULTS Pre-internship poor sleepers are at more than twice the odds of having short sleep (≤6 h) during internship as good sleepers (OR = 2.38, 95% CI = 1.61, 3.57). Poor sleepers were also at twice the odds for screening positive for probable GAD diagnosis (OR = 2.08, 95% CI = 1.26, 3.45). Notably, sleep onset insomnia strongly predicted anxiety development under stress (OR = 3.55, 95% CI = 1.49, 8.45). During internship, short sleep associated with concurrent anxiety symptoms (b = -0.26, 95% CI = -0.38, -0.14) and predicted future anxiety symptoms even more strongly (b = -0.39, 95% CI = -0.76, -0.03). CONCLUSIONS Poor sleepers, particularly those with sleep onset insomnia symptoms, are vulnerable to short sleep and GAD anxiety and worry during chronic stress.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Novi, MI, USA
| | - James L Abelson
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - J Todd Arnedt
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Zhuo Zhao
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jessica R Schubert
- Department of Behavioral Health, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA.
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Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res 2018; 27:e12710. [PMID: 29797753 PMCID: PMC7045300 DOI: 10.1111/jsr.12710] [Citation(s) in RCA: 247] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 12/19/2022]
Abstract
Sleep reactivity is the trait-like degree to which stress exposure disrupts sleep, resulting in difficulty falling and staying asleep. Individuals with highly reactive sleep systems experience drastic deterioration of sleep when stressed, whereas those with low sleep reactivity proceed largely unperturbed during stress. Research shows that genetics, familial history of insomnia, female gender and environmental stress influence how the sleep system responds to stress. Further work has identified neurobiological underpinnings for sleep reactivity involving disrupted cortical networks and dysregulation in the autonomic nervous system and hypothalamic-pituitary-adrenal axis. Sleep reactivity is most pathologically and clinically pertinent when in excess, such that high sleep reactivity predicts risk for future insomnia disorder, with early evidence suggesting high sleep reactivity corresponds to severe insomnia phenotypes (sleep onset insomnia and short sleep insomnia). High sleep reactivity is also linked to risk of shift-work disorder, depression and anxiety. Importantly, stress-related worry and rumination may exploit sensitive sleep systems, thereby augmenting the pathogenicity of sleep reactivity. With the development of cost-effective assessment of sleep reactivity, we can now identify individuals at risk of future insomnia, shift-work disorder and mental illness, thus identifying a target population for preventive intervention. Given that insomniacs with high sleep reactivity tend to present with severe insomnia phenotypes, patient sleep reactivity may inform triaging to different levels of treatment. Future research on sleep reactivity is needed to clarify its neurobiology, characterize its long-term prospective associations with insomnia and shift-work disorder phenotypes, and establish its prognostic value for mental illness and other non-sleep disorders.
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Affiliation(s)
- David A. Kalmbach
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, Michigan
| | - Jason R. Anderson
- Department of Psychological Sciences, Kent State University, Kent, Ohio
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Insomnia in Adolescence. Med Sci (Basel) 2018; 6:medsci6030072. [PMID: 30200388 PMCID: PMC6164454 DOI: 10.3390/medsci6030072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/16/2022] Open
Abstract
Adolescent insomnia is a common condition that negatively impacts a developing young adult's mental and physical health. While the treatment of adult insomnia has been standardized, the treatment of pediatric insomnia is very practitioner-dependent and few large-scale studies are available to determine a standard recommended practice. There is great hope that as the adolescent medicine and sleep medicine fields flourish, larger cohort analyses will be performed to determine the prevalence and precipitating factors of adolescent insomnia, allowing for standardized treatment recommendations and systematic efforts to make these recommendations available to all adolescents.
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73
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Jahangard L, Solgy R, Salehi I, Taheri SK, Holsboer-Trachsler E, Haghighi M, Brand S. Cholecystokinin (CCK) level is higher among first time suicide attempters than healthy controls, but is not associated with higher depression scores. Psychiatry Res 2018; 266:40-46. [PMID: 29803785 DOI: 10.1016/j.psychres.2018.05.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/26/2018] [Accepted: 05/11/2018] [Indexed: 11/19/2022]
Abstract
Suicide and suicide attempts are dramatic events for both the individuals concerned and for their social environments. Efforts have been made to identify reliable biological predictors of suicide and suicide attempts. In the present study, we focused on one potential marker, cholecystokinin (CCK), among first time suicide attempters. A total of 25 suicide attempters (mean age: 30 years; 80% females) and 23 healthy controls were enrolled in the present cross-sectional study. Experts rated participants' symptoms of depression (Hamilton Depression Rating Scale; HDRS). Blood levels of CCK levels were assessed. Suicide attempters had CCK levels 22.67 times higher and HDRS scores 14.33 higher than healthy controls. CCK levels were only weakly associated with HDRS scores. CCK appears to be a fairly reliable biomarker for suicide attempts. However, CCK levels were not associated with depression scores, making it difficult to match biological markers to depressive behaviour.
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Affiliation(s)
- Leila Jahangard
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rahmat Solgy
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iraj Salehi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Kazem Taheri
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Edith Holsboer-Trachsler
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland
| | - Mohammad Haghighi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Serge Brand
- University of Basel, Psychiatric Clinics (UPK), Center for Affective, Stress and Sleep Disorders (ZASS), Basel, Switzerland; University of Basel, Department of Sport, Exercise, and Health, Division of Sport and Psychosocial Health, Basel, Switzerland; Kermanshah University of Medical Sciences (KUMS), Psychiatry Department, Substance Abuse Prevention Research Center and Sleep Disorders Research Center, Kermanshah, Iran.
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74
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Kalmbach DA, Cuamatzi-Castelan AS, Tonnu CV, Tran KM, Anderson JR, Roth T, Drake CL. Hyperarousal and sleep reactivity in insomnia: current insights. Nat Sci Sleep 2018; 10:193-201. [PMID: 30046255 PMCID: PMC6054324 DOI: 10.2147/nss.s138823] [Citation(s) in RCA: 173] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Hyperarousal is a key component in all modern etiological models of insomnia disorder. Overall patterns in the literature suggest that over-active neurobiological and psychological systems contribute to difficulty sleeping. Even so, mixed results regarding the specific mechanisms linking hyperarousal to sleep disturbance limit current etiological conceptualizations. Similar basal arousal profiles between individuals with high vs low risk for insomnia in the absence of stress exposure suggest that dysregulated stress "response" rather than general hyperarousal may be a more pertinent marker of risk. In this report, we discuss evidence for hyperarousal in insomnia and explore the role of sleep reactivity. A trait characteristic, sleep reactivity is the degree to which stress disrupts sleep, manifesting as difficulty falling and staying asleep. Premorbid sleep reactivity has been shown to identify individuals at risk for future insomnia disorder, such as highly reactive sleepers (whose sleep systems are sensitive to stress) who are at elevated disease risk. Research points to genetics, family history of insomnia, gender, and environmental stress as factors that influence sleep reactivity. Importantly, stress-related cognitive-emotional reactivity (e.g., rumination, worry) may exploit the vulnerability of a highly reactive sleep system. We propose that sleep reactivity and cognitive-emotional reactivity may share a bidirectional relationship, conferring an insalubrious environment for sleep in response to stress. Future research on sleep reactivity is needed to identify its neurobiology, characterize its relationship with cognitive-emotional reactivity, and explore the potential clinical utility of sleep reactivity in treatment planning.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | | | - Christine V Tonnu
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | - Kieulinh Michelle Tran
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | - Jason R Anderson
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Thomas Roth
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
| | - Christopher L Drake
- Thomas Roth Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA,
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75
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de Zambotti M, Goldstone A, Colrain IM, Baker FC. Insomnia disorder in adolescence: Diagnosis, impact, and treatment. Sleep Med Rev 2018; 39:12-24. [PMID: 28974427 PMCID: PMC5931364 DOI: 10.1016/j.smrv.2017.06.009] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/20/2017] [Accepted: 06/26/2017] [Indexed: 11/26/2022]
Abstract
Insomnia disorder is very common in adolescents; it is particularly manifest in older adolescents and girls, with a prevalence comparable to that of other major psychiatric disorders (e.g., depressive disorders). However, insomnia disorder in adolescence is poorly characterized, under-recognized, under-diagnosed, and under-treated, and the reason for the female preponderance for insomnia that emerges after puberty is largely unknown. Insomnia disorder goes beyond an individual complaint of poor sleep or a sleep state misperception, and there is emerging evidence supporting the association of insomnia symptoms in adolescents with alterations in several bio-systems including functional cortical alterations and systemic inflammation. Insomnia disorder is associated with depression and other psychiatric disorders, and is an independent risk factor for suicidality and substance use in adolescents, raising the possibility that treating insomnia symptoms in early adolescence may reduce risk for these adverse outcomes. Cognitive behavioral treatments have proven efficacy for adolescent insomnia and online methods seem to offer promising cost-effective options. Current evidence indicates that insomnia in adolescence is an independent entity that warrants attention as a public health concern in its own right.
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Affiliation(s)
| | - Aimee Goldstone
- Center for Health Sciences, SRI International, Menlo Park, CA, USA
| | - Ian M Colrain
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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76
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Blake MJ, Trinder JA, Allen NB. Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions. Clin Psychol Rev 2018; 63:25-40. [PMID: 29879564 DOI: 10.1016/j.cpr.2018.05.006] [Citation(s) in RCA: 220] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/05/2018] [Accepted: 05/26/2018] [Indexed: 11/27/2022]
Abstract
There is robust evidence of an association between insomnia, anxiety, and depression in adolescence. The aim of this review is to describe and synthesize potential mechanisms underlying this association and explore implications for the design of adolescent behavioral sleep interventions. Specifically, we examine whether insomnia symptoms are a mechanism for the development of internalizing symptoms in adolescence and whether sleep interventions are an effective treatment for both insomnia and internalizing symptoms in adolescence because they target the shared mechanisms underlying these disorders. Research using different methodologies points to the role of sequential, parallel, and interacting mechanisms. In this paper, we review a wide range of relevant biological (i.e., polymorphisms and dysregulation in serotonin, dopamine, and circadian clock genes; alterations in corticolimbic and mesolimbic brain circuits; cortisol reactivity to stress; inflammatory cytokine dysregulation; biased memory consolidation; changes in sleep architecture), psychological (i.e., cognitive inflexibility, interpretational biases, judgment biases, negative attribution styles, worry, rumination, biased attention to threat, dysfunctional beliefs and attitudes about sleep, misperception of sleep deficit), and social mechanisms (i.e., reduced and impaired social interactions, unhelpful parenting behaviors, family stress) and propose an integrative multilevel model of how these phenomena may interact to increase vulnerability to both insomnia and internalizing disorders. Several 'biopsychosocial' mechanisms hold promise as viable treatment targets for adolescent behavioral sleep interventions, which may reduce both insomnia and internalizing symptoms.
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Affiliation(s)
- Matthew J Blake
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia.
| | - John A Trinder
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia.
| | - Nicholas B Allen
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic 3010, Australia; Department of Psychology, University of Oregon, Eugene, OR 97403-1227, USA.
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77
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Markovic A, Achermann P, Rusterholz T, Tarokh L. Heritability of Sleep EEG Topography in Adolescence: Results from a Longitudinal Twin Study. Sci Rep 2018; 8:7334. [PMID: 29743546 PMCID: PMC5943340 DOI: 10.1038/s41598-018-25590-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/16/2018] [Indexed: 01/12/2023] Open
Abstract
The topographic distribution of sleep EEG power is a reflection of brain structure and function. The goal of this study was to examine the degree to which genes contribute to sleep EEG topography during adolescence, a period of brain restructuring and maturation. We recorded high-density sleep EEG in monozygotic (MZ; n = 28) and dizygotic (DZ; n = 22) adolescent twins (mean age = 13.2 ± 1.1 years) at two time points 6 months apart. The topographic distribution of normalized sleep EEG power was examined for the frequency bands delta (1-4.6 Hz) to gamma 2 (34.2-44 Hz) during NREM and REM sleep. We found highest heritability values in the beta band for NREM and REM sleep (0.44 ≤ h2 ≤ 0.57), while environmental factors shared amongst twin siblings accounted for the variance in the delta to sigma bands (0.59 ≤ c2 ≤ 0.83). Given that both genetic and environmental factors are reflected in sleep EEG topography, our results suggest that topography may provide a rich metric by which to understand brain function. Furthermore, the frequency specific parsing of the influence of genetic from environmental factors on topography suggests functionally distinct networks and reveals the mechanisms that shape these networks.
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Affiliation(s)
- Andjela Markovic
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Peter Achermann
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- Zurich Center for Interdisciplinary Sleep Research, University of Zurich, Zurich, Switzerland
| | - Thomas Rusterholz
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Leila Tarokh
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland.
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
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78
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Insomnia symptoms and sleep duration and their combined effects in relation to associations with obesity and central obesity. Sleep Med 2018; 46:81-87. [PMID: 29773216 DOI: 10.1016/j.sleep.2018.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Previous studies have shown that both sleep duration and insomnia have an impact on obesity and central obesity. However, studies of the joint effects of these sleep disorders are still sparse. METHODS The present study utilized data from the Swedish EpiHealth cohort study. Participants (45-78 y) were asked to fill out an internet-based questionnaire. Body mass index (BMI) and central obesity (calculated from waist circumference) were based on measured data. RESULTS A total of 18,823 participants (mean age = 60 ys) were included in this study. The reported prevalence of short (<6 h/night) and long (>9 h/night) sleep duration was 8% and 4% respectively, and insomnia symptoms was 19%. Of the study population, 16% were obese (BMI ≥ 30 kg/m2) and 40% had central obesity. There was a U-shaped association between sleep duration and obesity and central obesity, and significant associations between insomnia symptoms and obesity. When stratifying sleep duration by concurrent insomnia symptoms, there were associations (odds ratios, (95% confidence intervals)) between the combination of both short (1.48, (1.22-1.80)) and long sleep duration (1.77 (1.00-3.16)) with insomnia symptoms and obesity and central obesity (1.36 (1.16-1.61) and 2.44 (1.41-3.24) respectively). However, there was no significant association between insomnia symptoms and obesity or central obesity in participants with normal sleep duration. For central obesity there was an association with long sleep duration regardless of insomnia symptoms, while the association with short sleep duration was significant only if insomnia symptoms were present. CONCLUSIONS Both short and long sleep duration, as well as insomnia symptoms, are associated with obesity and central obesity. There is an important joint effect of sleep duration and insomnia symptoms and there is no association between insomnia symptoms and obesity, as long as a normal sleeping time can be attained. This indicates that sleep duration rather than insomnia symptoms per se is of importance for the relationship between sleep and obesity.
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79
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Markwald RR, Iftikhar I, Youngstedt SD. Behavioral Strategies, Including Exercise, for Addressing Insomnia. ACSM'S HEALTH & FITNESS JOURNAL 2018; 22:23-29. [PMID: 31467475 PMCID: PMC6715137 DOI: 10.1249/fit.0000000000000375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
UNLABELLED Cognitive-behavioral therapy for insomnia is superior to sleeping pills for treating insomnia, and its accessibility is rapidly improving. Exercise can also promote sleep in insomnia. A list of recommendations on good sleep practices can be applied prior to consulting with a clinician and can often resolve insomnia symptoms. SUMMARY STATEMENT Insomnia is associated with negative psychological and physiological health outcomes. Established behavioral strategies for addressing insomnia such as adoption of good sleep habits and engagement in Cognitive Behavioral Therapy for Insomnia have documented efficacy. Exercise is also efficacious with unique health benefits.
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Affiliation(s)
| | | | - Shawn D Youngstedt
- College of Health Solutions, Arizona State University
- College of Nursing and Health Innovation, Arizona State University
- Phoenix VA Health Care System
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80
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Jang KI, Shim M, Lee SM, Huh HJ, Huh S, Joo JY, Lee SH, Chae JH. Increased beta power in the bereaved families of the Sewol ferry disaster: A paradoxical compensatory phenomenon? A two-channel electroencephalography study. Psychiatry Clin Neurosci 2017. [PMID: 28632358 DOI: 10.1111/pcn.12546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM The Sewol ferry capsizing accident on South Korea's southern coast resulted in the death of 304 people, and serious bereavement problems for their families. Electroencephalography (EEG) beta frequency is associated with psychiatric symptoms, such as insomnia. The aim of this study was to investigate the relation between frontal beta power, psychological symptoms, and insomnia in the bereaved families. METHODS Eighty-four family members of the Sewol ferry victims (32 men and 52 women) were recruited and their EEG was compared with that of 25 (13 men and 12 women) healthy controls. A two-channel EEG device was used to measure cortical activity in the frontal lobe. Symptom severity of insomnia, post-traumatic stress disorder, complicated grief, and anxiety were evaluated. RESULTS The bereaved families showed a higher frontal beta power than healthy controls. Subgroup analysis showed that frontal beta power was lower in the individuals with severe insomnia than in those with normal sleep. There was a significant inverse correlation between frontal beta power and insomnia symptom in the bereaved families. CONCLUSION This study suggests that increased beta power, reflecting the psychopathology in the bereaved families of the Sewol ferry disaster, may be a compensatory mechanism that follows complex trauma. Frontal beta power could be a potential marker indicating the severity of sleep disturbances. Our results suggest that sleep disturbance is an important symptom in family members of the Sewol ferry disaster's victims, which may be screened by EEG beta power.
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Affiliation(s)
- Kuk-In Jang
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Institute of Biomedical Industry, The Catholic University of Korea, Seoul, South Korea.,Department of Psychiatry, Clinical Emotion and Cognitive Research Laboratory, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Miseon Shim
- Department of Psychiatry, Clinical Emotion and Cognitive Research Laboratory, Ilsan Paik Hospital, Inje University, Goyang, South Korea.,Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Sang Min Lee
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Institute of Biomedical Industry, The Catholic University of Korea, Seoul, South Korea
| | - Hyu Jung Huh
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seung Huh
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ji-Young Joo
- Institute of Biomedical Industry, The Catholic University of Korea, Seoul, South Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Clinical Emotion and Cognitive Research Laboratory, Ilsan Paik Hospital, Inje University, Goyang, South Korea.,Department of Psychiatry, Ilsan Paik Hospital, Inje University, Goyang, South Korea
| | - Jeong-Ho Chae
- Department of Biomedicine and Health Sciences, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Institute of Biomedical Industry, The Catholic University of Korea, Seoul, South Korea.,Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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81
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Role of Sleep Aids and Wake-Promoting Agents During Cognitive Behavior Therapy for Insomnia. CURRENT SLEEP MEDICINE REPORTS 2017. [DOI: 10.1007/s40675-017-0095-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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82
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Maski K, Owens JA. Insomnia, parasomnias, and narcolepsy in children: clinical features, diagnosis, and management. Lancet Neurol 2017; 15:1170-81. [PMID: 27647645 DOI: 10.1016/s1474-4422(16)30204-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/03/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022]
Abstract
Sleep problems are frequently encountered as presenting complaints in child neurology clinical practice. They can affect the functioning and quality of life of children, particularly those with primary neurological and neurodevelopmental disorders, since coexisting sleep problems can add substantially to neurocognitive and behavioural comorbidities. Additionally, symptoms of some sleep disorders such as parasomnias and narcolepsy can be confused with those of other neurological disorders (eg, epilepsy), posing diagnostic challenges for paediatric neurologists. The understanding of the neurophysiology of sleep disorders such as insomnia, parasomnias, and narcolepsy is still evolving. There is a complex relation between the sleeping brain and its waking function. The interplay among genetic factors, alterations in neurotransmitters, electrophysiological changes, and environmental factors potentially contribute to the genesis of these sleep disorders.
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Affiliation(s)
- Kiran Maski
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Judith A Owens
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
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83
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Ponomareva NV, Andreeva TV, Protasova MS, Shagam LI, Malina DD, Goltsov AY, Fokin VF, Illarioshkin SN, Rogaev EI. Quantitative EEG during normal aging: association with the Alzheimer's disease genetic risk variant in PICALM gene. Neurobiol Aging 2017; 51:177.e1-177.e8. [DOI: 10.1016/j.neurobiolaging.2016.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 11/14/2016] [Accepted: 12/11/2016] [Indexed: 10/20/2022]
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84
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Fernandez-Mendoza J, Baker JH, Vgontzas AN, Gaines J, Liao D, Bixler EO. Insomnia symptoms with objective short sleep duration are associated with systemic inflammation in adolescents. Brain Behav Immun 2017; 61:110-116. [PMID: 28041986 PMCID: PMC5316336 DOI: 10.1016/j.bbi.2016.12.026] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/28/2016] [Accepted: 12/28/2016] [Indexed: 01/14/2023] Open
Abstract
Inflammation has been suggested as a potential pathway by which insomnia and short sleep can affect risk of morbidity in adults. However, few studies have examined the association of insomnia with inflammation in adolescents, despite accumulating evidence that pathophysiologic changes may already occur during this critical developmental period. The present study sought to examine the association of insomnia symptoms with systemic inflammation and the role of objective sleep duration in this association. Participants were 378 adolescents (16.9±2.3y, 45.8% female) from the Penn State Child Cohort, a population-based sample who underwent 9-h polysomnography (PSG) followed by a single fasting blood draw to assess plasma levels of C-reactive protein (CRP) and other inflammatory markers. Insomnia symptoms were defined by a self-report of difficulties falling and/or staying asleep, while objective sleep duration groups were defined as a PSG total sleep time ⩾8, 8-7, and ⩽7h. We assessed the association of insomnia symptoms, objective sleep duration, and their interaction with inflammatory markers, while adjusting for multiple potential confounders. Adolescents reporting insomnia symptoms had significantly higher levels of CRP compared to controls and a significant interaction (p<0.01) showed that objective sleep duration modified this association. Elevated CRP was present in adolescents with insomnia symptoms and ⩽7h of sleep (1.79mg/L) as compared to controls or adolescents with insomnia symptoms and ⩾8h of sleep (0.90mg/L and 0.98mg/L, respectively) or controls with ⩽7h of sleep (0.74mg/L; all p-values <0.01). In sum, insomnia symptoms with objective short sleep duration are associated with systemic inflammation as early as adolescence. This study suggests that chronic low-grade inflammation may be a common final pathway towards morbidity in adulthood in this insomnia phenotype.
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Affiliation(s)
- Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Joshua H. Baker
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA
| | - Alexandros N. Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA
| | - Jordan Gaines
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA
| | - Edward O. Bixler
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA
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85
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The insomnia with short sleep duration phenotype: an update on it's importance for health and prevention. Curr Opin Psychiatry 2017; 30:56-63. [PMID: 27764017 DOI: 10.1097/yco.0000000000000292] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW It was first proposed in the late 1990s that objective markers of sleep disturbance could serve as an index of the biological severity of insomnia. In 2013, a heuristic model of two insomnia phenotypes based on objective sleep duration was proposed. Herein, we review the studies conducted in the past 3 years on the insomnia with short sleep duration phenotype and its implications for a clinical research agenda. RECENT FINDINGS Studies have shown that insomnia with objective short sleep duration is associated with physiologic hyperarousal and cardiometabolic and neurocognitive morbidity, whereas insomnia with normal sleep duration is not. Both insomnia phenotypes are associated with psychiatric morbidity albeit through different psychobiological mechanisms. Novel recent studies have included occupational outcomes, developmental approaches, at-home objective sleep testing, diagnostic accuracy measures, and response to cognitive-behavioral treatment. SUMMARY Accumulating evidence in the past years has continued to support that insomnia with short sleep duration is a more severe phenotype of the disorder associated with physiologic changes, significant morbidity and mortality and, potentially, a differential response to treatment.
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86
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Insomnia Phenotypes Based on Objective Sleep Duration in Adolescents: Depression Risk and Differential Behavioral Profiles. Brain Sci 2016; 6:brainsci6040059. [PMID: 27983580 PMCID: PMC5187573 DOI: 10.3390/brainsci6040059] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 11/26/2016] [Accepted: 12/08/2016] [Indexed: 01/20/2023] Open
Abstract
Based on previous studies on the role of objective sleep duration in predicting morbidity in individuals with insomnia, we examined the role of objective sleep duration in differentiating behavioral profiles in adolescents with insomnia symptoms. Adolescents from the Penn State Child Cohort (n = 397, ages 12–23, 54.7% male) underwent a nine-hour polysomnography (PSG), clinical history, physical examination and psychometric testing, including the Child or Adult Behavior Checklist and Pediatric Behavior Scale. Insomnia symptoms were defined as a self-report of difficulty falling and/or staying asleep and objective “short” sleep duration as a PSG total sleep time ≤7 h. A significant interaction showed that objective short sleep duration modified the association of insomnia symptoms with internalizing problems. Consistently, adolescents with insomnia symptoms and short sleep duration were characterized by depression, rumination, mood dysregulation and social isolation, while adolescents with insomnia symptoms and normal sleep duration were characterized by rule-breaking and aggressive behaviors and, to a lesser extent, rumination. These findings indicate that objective sleep duration is useful in differentiating behavioral profiles among adolescents with insomnia symptoms. The insomnia with objective short sleep duration phenotype is associated with an increased risk of depression earlier in the lifespan than previously believed.
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87
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Kalmbach DA, Pillai V, Arnedt JT, Drake CL. DSM-5 Insomnia and Short Sleep: Comorbidity Landscape and Racial Disparities. Sleep 2016; 39:2101-2111. [PMID: 27634805 DOI: 10.5665/sleep.6306] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/30/2016] [Indexed: 01/22/2023] Open
Abstract
STUDY OBJECTIVES We estimated rates of cardiometabolic disease, pain conditions, and psychiatric illness associated with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) insomnia disorder (current and in remission) and habitual short sleep (fewer than 6 h), and examined the roles of insomnia and short sleep in racial disparities in disease burden between black and non-Hispanic white Americans. METHODS This epidemiological survey study was cross-sectional. The community-based sample consisted of 3,911 subjects (46.0 y ± 13.3; 65.4% female; 25.0% black) across six sleep groups based on DSM-5 insomnia classification (never vs. remitted vs. current) and self-reported habitual sleep duration (normal vs. short). Vascular events, cardiometabolic disease, pain conditions, and psychiatric symptoms were self-reported. RESULTS Short sleeping insomniacs were at elevated risk for myocardial infarction, stroke, treated hypertension, diabetes, chronic pain, back pain, depression, and anxiety, independent of sex, age, and obesity. Morbidity profiles for insomniacs with normal sleep duration and former insomniacs, irrespective of sleep duration, were similar with elevations in treated hypertension, chronic pain, depression, and anxiety. Regarding racial disparities, cardiometabolic and psychiatric illness burden was greater for blacks, who were more likely to have short sleep and the short sleep insomnia phenotype. Evidence suggested that health disparities may be attributable in part to race-related differences in sleep. CONCLUSIONS Insomnia disorder with short sleep is the most severe phenotype of insomnia and comorbid with many cardiometabolic and psychiatric illnesses, whereas morbidity profiles are highly similar between insomniacs with normal sleep duration and former insomniacs. Short sleep endemic to black Americans increases risk for the short sleep insomnia phenotype and likely contributes to racial disparities in cardiometabolic disease and psychiatric illness.
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Affiliation(s)
- David A Kalmbach
- Departments of Psychiatry and Neurology, University of Michigan Medical School, Ann Arbor, MI
| | - Vivek Pillai
- Sleep Disorders and Research Center, Henry Ford Hospital, Detroit, MI
| | - J Todd Arnedt
- Departments of Psychiatry and Neurology, University of Michigan Medical School, Ann Arbor, MI
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88
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Miller CB, Bartlett DJ, Mullins AE, Dodds KL, Gordon CJ, Kyle SD, Kim JW, D'Rozario AL, Lee RSC, Comas M, Marshall NS, Yee BJ, Espie CA, Grunstein RR. Clusters of Insomnia Disorder: An Exploratory Cluster Analysis of Objective Sleep Parameters Reveals Differences in Neurocognitive Functioning, Quantitative EEG, and Heart Rate Variability. Sleep 2016; 39:1993-2004. [PMID: 27568796 DOI: 10.5665/sleep.6230] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/23/2016] [Indexed: 02/01/2023] Open
Abstract
STUDY OBJECTIVES To empirically derive and evaluate potential clusters of Insomnia Disorder through cluster analysis from polysomnography (PSG). We hypothesized that clusters would differ on neurocognitive performance, sleep-onset measures of quantitative (q)-EEG and heart rate variability (HRV). METHODS Research volunteers with Insomnia Disorder (DSM-5) completed a neurocognitive assessment and overnight PSG measures of total sleep time (TST), wake time after sleep onset (WASO), and sleep onset latency (SOL) were used to determine clusters. RESULTS From 96 volunteers with Insomnia Disorder, cluster analysis derived at least two clusters from objective sleep parameters: Insomnia with normal objective sleep duration (I-NSD: n = 53) and Insomnia with short sleep duration (I-SSD: n = 43). At sleep onset, differences in HRV between I-NSD and I-SSD clusters suggest attenuated parasympathetic activity in I-SSD (P < 0.05). Preliminary work suggested three clusters by retaining the I-NSD and splitting the I-SSD cluster into two: I-SSD A (n = 29): defined by high WASO and I-SSD B (n = 14): a second I-SSD cluster with high SOL and medium WASO. The I-SSD B cluster performed worse than I-SSD A and I-NSD for sustained attention (P ≤ 0.05). In an exploratory analysis, q-EEG revealed reduced spectral power also in I-SSD B before (Delta, Alpha, Beta-1) and after sleep-onset (Beta-2) compared to I-SSD A and I-NSD (P ≤ 0.05). CONCLUSIONS Two insomnia clusters derived from cluster analysis differ in sleep onset HRV. Preliminary data suggest evidence for three clusters in insomnia with differences for sustained attention and sleep-onset q-EEG. CLINICAL TRIAL REGISTRATION Insomnia 100 sleep study: Australia New Zealand Clinical Trials Registry (ANZCTR) identification number 12612000049875. URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347742.
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Affiliation(s)
- Christopher B Miller
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Medical School, University of Sydney, Australia
| | - Delwyn J Bartlett
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Medical School, University of Sydney, Australia
| | - Anna E Mullins
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Nursing School, University of Sydney, Australia
| | - Kirsty L Dodds
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Nursing School, University of Sydney, Australia
| | - Christopher J Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Nursing School, University of Sydney, Australia
| | - Simon D Kyle
- Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience Institute, University of Oxford, UK
| | - Jong Won Kim
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia
| | - Angela L D'Rozario
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Medical School, University of Sydney, Australia.,Department of Respiratory and Sleep Medicine, RPAH, Sydney Local Health District, Sydney, NSW, Australia
| | - Rico S C Lee
- Clinical Research Unit, Brain & Mind Centre, University of Sydney, Australia
| | - Maria Comas
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia
| | - Nathaniel S Marshall
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Nursing School, University of Sydney, Australia
| | - Brendon J Yee
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Medical School, University of Sydney, Australia.,Department of Respiratory and Sleep Medicine, RPAH, Sydney Local Health District, Sydney, NSW, Australia
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences and Sleep & Circadian Neuroscience Institute, University of Oxford, UK
| | - Ronald R Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Medical School, University of Sydney, Australia.,Department of Respiratory and Sleep Medicine, RPAH, Sydney Local Health District, Sydney, NSW, Australia
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