101
|
Hsiou DA, Gao C, Matlock RC, Scullin MK. Validation of a nonwearable device in healthy adults with normal and short sleep durations. J Clin Sleep Med 2022; 18:751-757. [PMID: 34608858 PMCID: PMC8883102 DOI: 10.5664/jcsm.9700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To determine the accuracy of early and newer versions of a nonwearable sleep tracking device relative to polysomnography and actigraphy, under conditions of normal and restricted sleep duration. METHODS Participants were 35 healthy adults (mean age = 18.97; standard deviation = 0.95 years; 77.14% female; 42.86% White). In a controlled sleep laboratory environment, we randomly assigned participants to go to bed at 10:30 pm (normal sleep) or 1:30 am (restricted sleep), setting lights-on at 7:00 am. Sleep was measured using polysomnography, wristband actigraphy (the Philips Respironics Actiwatch Spectrum Plus), self-report, and an early or newer version of a nonwearable device that uses a sensor strip to measure movement, heart rate, and breathing (the Apple, Inc. Beddit). We tested accuracy against polysomnography for total sleep time, sleep efficiency, sleep onset latency, and wake after sleep onset. RESULTS The early version of the nonwearable device (Beddit 3.0) displayed poor reliability (intraclass correlation coefficient [ICC] < 0.30). However, the newer nonwearable device (Beddit 3.5) yielded excellent reliability with polysomnography for total sleep time (ICC = 0.998) and sleep efficiency (ICC = 0.98) across normal and restricted sleep conditions. Agreement was also excellent for the notoriously difficult metrics of sleep onset latency (ICC = 0.92) and wake after sleep onset (ICC = 0.92). This nonwearable device significantly outperformed clinical-grade actigraphy (ICC between 0.44 and 0.96) and self-reported sleep measures (ICC < 0.75). CONCLUSIONS A nonwearable device showed better agreement than actigraphy with polysomnography outcome measures. Future work is needed to test the validity of this device in clinical populations. CITATION Hsiou DA, Gao C, Matlock RC, Scullin MK. Validation of a nonwearable device in healthy adults with normal and short sleep durations. J Clin Sleep Med. 2022;18(3):751-757.
Collapse
Affiliation(s)
- David A. Hsiou
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas,School of Medicine, Baylor College of Medicine, Houston, Texas
| | - Chenlu Gao
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts,Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Robert C. Matlock
- Ascension Medical Group Providence, Department of Sleep Medicine, Waco, Texas
| | - Michael K. Scullin
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas,Address correspondence to: Michael K. Scullin, PhD, Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX 76798; Tel: (254) 710-2241;
| |
Collapse
|
102
|
Lu J, An Y, Qiu J. Relationship between sleep quality, mood state, and performance of elite air-rifle shooters. BMC Sports Sci Med Rehabil 2022; 14:32. [PMID: 35216616 PMCID: PMC8881879 DOI: 10.1186/s13102-022-00424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/18/2022] [Indexed: 11/17/2022]
Abstract
Background To evaluate the impact of pre-competition sleep quality on the mood and performance of elite air-rifle shooters.
Methods Elite shooters who participated in an air-rifle shooting-competition from April 2019 to October 2019 were evaluated using actigraphy, including Total Sleep Time (TST), Sleep Efficiency (SE), Sleep Latency (SL), Wake-time after Sleep Onset (WASO). Sleep quality was assessed by Pittsburgh sleep quality index (PSQI) and Profile of Mood State (POMS). Mood state was assessed by Competitive State Anxiety Inventory-2. Results Study included 23 shooters, of them 13 male and 10 female with the mean age 23.11 ± 4.82 years. The average time to fall asleep was 20.6 ± 14.9 min, TST was 7.0 ± 0.8 h and SE was 85.9 ± 5.3%. Average sleep quality was 5.2 ± 2.2 and tended to decrease as the competition progressed. Pre-competition sleep time in female athletes was significantly higher compared to the competition day (P = 0.05). Pre-competition SL was significantly longer in women than in men (P = 0.021). During training and pre-competition, the tension, fatigue, depression, and emotional disturbance were significantly lower in athletes with good sleep quality. Athletes with good sleep quality had significantly more energy. The PSQI total score positively correlated with cognitive anxiety (r = 0.471, P < 0.01), and somatic anxiety (r = 0.585, P < 0.01), and negatively correlated with energy (− 0.504, P < 0.01) and self-confidence scores (r = − 0.523, P < 0.01). Conclusion Poor sleep quality negatively impacted the mood of athletes; however, sleep indices and competition performance of athletes during competitions were not significantly correlated.
Collapse
Affiliation(s)
- Jiaojiao Lu
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Yan An
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China
| | - Jun Qiu
- Shanghai Research Institute of Sports Science (Shanghai Anti-Doping Agency), Shanghai, China.
| |
Collapse
|
103
|
Romigi A, Feola T, Cappellano S, De Angelis M, Pio G, Caccamo M, Testa F, Vitrani G, Centonze D, Colonnese C, Esposito V, Jaffrain-Rea ML. Sleep Disorders in Patients With Craniopharyngioma: A Physiopathological and Practical Update. Front Neurol 2022; 12:817257. [PMID: 35222233 PMCID: PMC8863754 DOI: 10.3389/fneur.2021.817257] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022] Open
Abstract
Sleep disorders (SDs) represent an important issue in patients with craniopharyngioma (CP). Nearly 70% of these patients complain of sleep-wake cycle alterations and/or excessive diurnal somnolence due to sleep-related breathing disorders, such as obstructive sleep apnea (OSA) and/or central hypersomnia, including secondary narcolepsy. SDs may severely reduce quality of life, increase disease-related cardiorespiratory and cardiovascular morbidity, and finally play a major role in increased long-term mortality reported on patients with CP. A major risk factor for SDs is represented by the hypothalamic syndrome, which may develop because of direct hypothalamic damage by the tumor itself and/or complications of the treatments, neurosurgery and/or radiotherapy, and typically includes permanent neuroendocrine dysfunctions, morbid obesity, and secondary metabolic disorders. Despite increasing attention to SDs in the general population, and in particular to OSA as a risk factor for cardio-metabolic diseases and excessive daytime somnolence, sleep evaluation is still not routinely proposed to patients with CP. Hence, SDs are often underdiagnosed and undertreated. The aim of this paper is to update current knowledge of the pathogenesis and prevalence of SDs in patients with CP and propose practical algorithms for their evaluation and management in clinical practice. Particular attention is paid to screening and diagnostic tools for appropriate characterization of SDs, identification of risk factors, and potential role of hypothalamic sparing surgery in the prevention of morbid obesity and SDs. Available tools in sleep medicine, including lifestyle interventions, drugs, and respiratory devices, are discussed, as well as the importance of optimal hormone replacement and metabolic interventions. Current limits in the diagnosis and treatment of SDs in patients with CP and possible future avenues for research agenda are also considered.
Collapse
Affiliation(s)
- Andrea Romigi
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Tiziana Feola
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Simone Cappellano
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | | | - Giacomo Pio
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Marco Caccamo
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Federica Testa
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Giuseppe Vitrani
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Diego Centonze
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Claudio Colonnese
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
| | - Vincenzo Esposito
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
- Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marie-Lise Jaffrain-Rea
- Neuromed Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Pozzilli, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- *Correspondence: Marie-Lise Jaffrain-Rea
| |
Collapse
|
104
|
Miner B, Stone KL, Zeitzer JM, Han L, Doyle M, Blackwell T, Gill TM, Redeker NS, Hajduk A, Yaggi HK. Self-reported and actigraphic short sleep duration in older adults. J Clin Sleep Med 2022; 18:403-413. [PMID: 34338629 PMCID: PMC8804982 DOI: 10.5664/jcsm.9584] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Persons > 65 years with short sleep duration (≤ 6 hours) are at risk for adverse outcomes, but the accuracy of self-reported sleep duration may be affected by reduced symptom awareness. We evaluated the performance characteristics of self-reported vs objectively measured sleep duration in this age group. METHODS In 2,980 men from the Osteoporotic Fractures in Men Sleep Study and 2,855 women from the Study of Osteoporotic Fractures we examined the agreement and accuracy of self-reported vs actigraphy-measured short and normal (> 6 but < 9 hours) sleep duration. We evaluated associations of select factors (demographics; medical, physical, and neuropsychiatric conditions; medication and substance use; and sleep-related measures) with risk of false-negative (normal sleep duration by self-report but short sleep duration by actigraphy) and false-positive (short sleep duration by self-report and normal sleep duration by actigraphy) designations, respectively, using logistic regression. RESULTS Average ages were 76.3 ± 5.5 and 83.5 ± 3.7 years in men and women, respectively. There was poor agreement between self-reported and actigraphic sleep duration (kappa ≤ 0.24). False negatives occurred in nearly half and false positives in over a quarter of older persons. In multivariable models in men and women, false negatives were independently associated with obesity, daytime sleepiness, and napping, while false positives were significantly lower with obesity. CONCLUSIONS Under- and overreporting of short sleep is common among older persons. Reliance on self-report may lead to missed opportunities to prevent adverse outcomes or unnecessary interventions. Self-reported sleep duration should be objectively confirmed when evaluating the effect of sleep duration on health outcomes. CITATION Miner B, Stone KL, Zeitzer JM, et al. Self-reported and actigraphic short sleep duration in older adults. J Clin Sleep Med. 2022;18(2):403-413.
Collapse
Affiliation(s)
- Brienne Miner
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Address correspondence to: Brienne Miner, MD, 333 Cedar Street, New Haven, CT 06520; Tel: (203) 688-9423; Fax (203) 688-4209;
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
| | - Margaret Doyle
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nancy S. Redeker
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Yale School of Nursing, West Haven, Connecticut
| | - Alexandra Hajduk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Henry Klar Yaggi
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
| | | |
Collapse
|
105
|
Maisey G, Cattani M, Devine A, Lo J, Fu SC, Dunican IC. Digging for data: How sleep is losing out to roster design, sleep disorders, and lifestyle factors. APPLIED ERGONOMICS 2022; 99:103617. [PMID: 34700190 DOI: 10.1016/j.apergo.2021.103617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/10/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
Shift workers employed at a remote mining operation may experience sleep loss, impaired alertness, and consequently negative health and safety outcomes. This study determined the sleep behaviors and prevalence of risk for sleep disorders among shift workers; and quantified alertness for a roster cycle. Sleep duration was significantly less following; night shift by 77 ± 7 min and day shift by 30 ± 7 min. The wake after sleep onset was less by 23 ± 3 min for night shifts and 22 ± 3 min for day shifts (p < 0.05 for all). The prevalence of risk for sleep apnea was 31%, insomnia was 8%, and shiftwork disorder was 44%. Average alertness for all working hours was 75%. Shiftwork in remote mining operations is a significant factor that leads to sleep loss and reduced alertness, which is exacerbated by the high prevalence of risk for sleep disorders.
Collapse
Affiliation(s)
- Gemma Maisey
- School of Medical and Health Science, Edith Cowan University, Perth, W.A., Australia.
| | - Marcus Cattani
- School of Medical and Health Science, Edith Cowan University, Perth, W.A., Australia
| | - Amanda Devine
- School of Medical and Health Science, Edith Cowan University, Perth, W.A., Australia
| | - Johnny Lo
- School of Science, Edith Cowan University, Perth, W.A., Australia
| | - Shih Ching Fu
- School of Science, Edith Cowan University, Perth, W.A., Australia
| | - Ian C Dunican
- School of Medical and Health Science, Edith Cowan University, Perth, W.A., Australia
| |
Collapse
|
106
|
Liset R, Grønli J, Henriksen RE, Henriksen TEG, Nilsen RM, Pallesen S. A randomized controlled trial on the effects of blue-blocking glasses compared to partial blue-blockers on sleep outcomes in the third trimester of pregnancy. PLoS One 2022; 17:e0262799. [PMID: 35089982 PMCID: PMC8797219 DOI: 10.1371/journal.pone.0262799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Sleep disturbances are common in pregnancy. Blocking blue light has been shown to improve sleep and may be a suitable intervention for sleep problems during pregnancy. The present study investigated the effects of blue light blocking in the evening and during nocturnal awakenings among pregnant women on primary sleep outcomes in terms of total sleep time, sleep efficiency and mid-point of sleep. METHODS In a double-blind randomized controlled trial, 60 healthy nulliparous pregnant women in the beginning of the third trimester were included. They were randomized, using a random number generator, either to a blue-blocking glass intervention (n = 30) or to a control glass condition constituting partial blue-blocking effect (n = 30). Baseline data were recorded for one week and outcomes were recorded in the last of two intervention/control weeks. Sleep was measured by actigraphy, sleep diaries, the Bergen Insomnia Scale, the Karolinska Sleepiness Scale and the Pre-Sleep Arousal Scale. RESULTS The results on the primary outcomes showed no significant mean difference between the groups at posttreatment, neither when assessed with sleep diary; total sleep time (difference = .78[min], 95%CI = -19.7, 21.3), midpoint of sleep (difference = -8.9[min], 95%CI = -23.7, 5.9), sleep efficiency (difference = -.06[%], 95%CI = -1.9, 1.8) and daytime functioning (difference = -.05[score points], 95%CI = -.33, .22), nor by actigraphy; total sleep time (difference = 13.0[min], 95%CI = -9.5, 35.5), midpoint of sleep (difference = 2.1[min], 95%CI = -11.6, 15.8) and sleep efficiency (difference = 1.7[%], 95%CI = -.4, 3.7). On the secondary outcomes, the Bergen Insomnia Scale, the Karolinska Sleepiness Scale and the Pre-Sleep Arousal Scale the blue-blocking glasses no statistically significant difference between the groups were found. Transient side-effects were reported in both groups (n = 3). CONCLUSIONS The use of blue-blocking glasses compared to partially blue-blocking glasses in a group of healthy pregnant participants did not show statistically significant effects on sleep outcomes. Research on the effects of blue-blocking glasses for pregnant women with sleep-problems or circadian disturbances is warranted. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov (NCT03114072).
Collapse
Affiliation(s)
- Randi Liset
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Janne Grønli
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Roger E. Henriksen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tone E. G. Henriksen
- Division of Mental Health Care, Fonna Local Health Authority, Valen Hospital, Valen, Norway
| | - Roy M. Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
- Optentia, The Vaal Triangle Campus of The North-West University, Vanderbijlpark, South-Africa
| |
Collapse
|
107
|
Smits EJ, Salomoni S, Costa N, Rodríguez-Romero B, Hodges PW. How reliable is measurement of posture during sleep: real-world measurement of body posture and movement during sleep using accelerometers. Physiol Meas 2022; 43. [PMID: 34986463 DOI: 10.1088/1361-6579/ac482f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/05/2022] [Indexed: 11/12/2022]
Abstract
Objective Understanding sleeping behaviours could improve prevention and treatment of sleep problems and associated health conditions. This study aimed to evaluate a method to assess body posture and movement during sleep using trunk-worn accelerometers for 28 days. Approach Participants (50 adults with low back pain (66% female); aged 32(±9) years) wore two activPAL-micro sensors (thigh, trunk) during their normal daily life for 28 consecutive days. Parameters related to body posture (e.g., time spent lying supine or prone) and movement (e.g., number of turns) during sleep were calculated for each night. Average values for each parameter were identified for different periods, the Spearman-Brown Prophecy Formula was used to estimate the minimum number of nights required to obtain a reliable estimate of each parameter, and repeatability of measures between different weeks was calculated. Main Results Participants spent 8.1(±0.8) hours asleep and most time (44%) was spent in a supine posture. The minimum number of nights required for reliable estimates varied between sleep parameters, range 4-21 nights. The most stable parameters (i.e., requiring less than seven nights) were "average activity", "no. of turns", "time spent prone", and "posture changes in the first hour". Some measures differed substantially between weeks. Significance Most sleep parameters related to body posture and movement require a week or more of monitoring to provide reliable estimates of behaviour over one month. Notably, one week may not reflect behaviour in another week, and the time varying nature of sleep needs to be considered.
Collapse
Affiliation(s)
- Esther Josefina Smits
- School of Health and Rehabilitation Sciences, The University of Queensland, 84A Services Road, Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Sauro Salomoni
- School of Health and Rehabilitation Sciences, The University of Queensland, 84A services Road, Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Nathalia Costa
- School of Health and Rehabilitation Sciences, The University of Queensland, 84A services road, Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Beatriz Rodríguez-Romero
- Department of Physiotherapy, Medicine and Biomedical Sciences, University of A Coruna, Campus de Oza, A Coruna, A Coruna, 15001, SPAIN
| | - Paul W Hodges
- NHMRC Centre for Clinical Research Excellence in Spinal Pain, Injury and Health, The University of Queensland, 84A Services Rd, Saint Lucia, Queensland, 4072, AUSTRALIA
| |
Collapse
|
108
|
How can light be used to optimize sleep and health in older adults? PROGRESS IN BRAIN RESEARCH 2022; 273:331-355. [DOI: 10.1016/bs.pbr.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
109
|
Bondopadhyay U, Diaz-Orueta U, Coogan AN. A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder. J Atten Disord 2022; 26:149-224. [PMID: 33402013 DOI: 10.1177/1087054720978556] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Children and adults with ADHD often report sleep disturbances that may form part of the etiology and/or symptomatology of ADHD. We review the evidence for sleep changes in children with ADHD. METHODS Systematic review with narrative synthesis assessing sleep and circadian function in children aged 5 to 13 years old with a diagnosis of ADHD. RESULTS 148 studies were included for review, incorporating data from 42,353 children. We found that sleep disturbances in ADHD are common and that they may worsen behavioral outcomes; moreover, sleep interventions may improve ADHD symptoms, and pharmacotherapy for ADHD may impact sleep. CONCLUSION Sleep disturbance may represent a clinically important feature of ADHD in children, which might be therapeutically targeted in a useful way. There are a number of important gaps in the literature. We set out a manifesto for future research in the area of sleep, circadian rhythms, and ADHD.
Collapse
Affiliation(s)
- Upasana Bondopadhyay
- Department of Psychology, Maynooth University, National University of Ireland, Maynooth
| | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, National University of Ireland, Maynooth
| | - Andrew N Coogan
- Department of Psychology, Maynooth University, National University of Ireland, Maynooth
| |
Collapse
|
110
|
Vyhlídal T, Dygrýn J, Chmelík F. Actigraphy-Based Characteristics of Sleep in Paediatric Cancer Patients in Remission and a Comparison with Their Healthy Peers in the Recovery Stay. Nat Sci Sleep 2022; 14:1449-1456. [PMID: 36045915 PMCID: PMC9423104 DOI: 10.2147/nss.s374234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous research has demonstrated that paediatric cancer survivors (PCS) have lower sleep quality than their healthy peers. However, the research to date has focused mainly on self-reported data. Therefore, the aim of this cross-sectional study was to characterise selected sleep parameters in PCS using objective monitoring techniques and to compare them with a control group (CG) of their healthy peers during a structured recovery stay. A specific objective was to characterise sleep with respect to gender, age, and cancer type. METHODS 26 PCS and 38 CG aged 7-15 years participated in the study. Selected sleep indicators (time in bed, total sleep time, sleep efficiency) were objectively assessed with an Actigraph wGT3X-BT accelerometer for 12 days during the recovery stay. RESULTS No significant differences were found between the PCS and CG groups in terms of the selected sleep parameters. The total time in bed was 543.1 min/day in the PCS and 537.2 min/day in the CG (p=0.91). The total sleep time was 455.3 min/day in the PCS and 457.5 min/day in the CG (p=0.57). Sleep efficiency was 85.3% in the PCS and 86.3% in the CG (p=0.36). Sleep efficiency >85% was achieved by 62% of the PCS (n=16) and 68% of the CG (n=26). There were no significant differences in sleep parameters in terms of variables such as gender, age, or cancer type. CONCLUSION The results of our study suggest that - under the same conditions - the PCS did not differ from their healthy peers in terms of the indicators of time in bed, total sleep time, and sleep efficiency. No significant differences according to age, gender, or cancer type were found.
Collapse
Affiliation(s)
- Tomáš Vyhlídal
- Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
| | - Jan Dygrýn
- Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
| | - František Chmelík
- Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czech Republic
| |
Collapse
|
111
|
Kelly MR, Zeidler MR, DeCruz S, Oldenkamp CL, Josephson KR, Mitchell MN, Littner M, Ancoli-Israel S, Badr MS, Alessi CA, Martin JL. Actigraphy prior to Multiple Sleep Latency Test: nighttime total sleep time predicts sleep-onset latency. J Clin Sleep Med 2022; 18:161-170. [PMID: 34310278 PMCID: PMC8807926 DOI: 10.5664/jcsm.9528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To evaluate the clinical utility of actigraphy as compared with sleep questionnaires prior to the Multiple Sleep Latency Test (MSLT) in a sleep disorders clinic population. METHODS Twenty-eight clinically referred participants (mean age: 42.3 ± 18.8 years) completed the study protocol. On day 1, participants completed the following questionnaires: Epworth Sleepiness Scale (ESS), Insomnia Severity Index, Pittsburgh Sleep Quality Index (PSQI), Visual Analog Scale (affect, vigor), Patient Health Questionnaire, and Multidimensional Fatigue Symptom Inventory-Short Form. On days 1-8, participants wore an actigraph and completed a sleep diary to assess mean nighttime and mean daytime total sleep time and sleep efficiency or sleep percentage. On day 9, participants repeated the ESS and completed an MSLT. Correlations assessed mean MSLT sleep-onset latency (MSLT-SOL) vs actigraphy, sleep diary, and questionnaires. Chi-square analyses assessed abnormal MSLT-SOL (≤ 8 minutes) or daytime sleepiness (ESS ≥ 10) and referral question (ie, sleep-disordered breathing vs hypersomnolence disorder). RESULTS Mean MSLT-SOL was correlated with nighttime total sleep time assessed via both actigraphy and diary, but not with questionnaires. Significant correlations emerged for ESS score on day 1 vs 9, actigraphy vs sleep diary mean nighttime total sleep time, and PSQI vs mean sleep diary sleep efficiency. There was no significant relationship between mean MSLT-SOL and referral question. CONCLUSIONS Our finding that total sleep time measured by actigraphy was associated with MSLT-SOL suggests it is useful in informing the interpretation of MSLT findings; however, it does not appear to be a viable substitute for MSLT for the measurement of objective sleepiness in clinical settings. CITATION Kelly MR, Zeidler MR, DeCruz S, et al. Actigraphy prior to Multiple Sleep Latency Test: nighttime total sleep time predicts sleep-onset latency. J Clin Sleep Med. 2022;18(1):161-170.
Collapse
Affiliation(s)
- Monica R. Kelly
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California
| | - Michelle R. Zeidler
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California,Veterans Affairs Greater Los Angeles Healthcare System, Division of Pulmonary Medicine, North Hills, California
| | - Sharon DeCruz
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Caitlin L. Oldenkamp
- Department of Emergency Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Karen R. Josephson
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California
| | - Michael N. Mitchell
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California
| | - Michael Littner
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | | | - M. Safwan Badr
- Wayne State University, Detroit, Michigan,John D. Dingell Veterans Affairs Medical Center, Detroit, Michigan
| | - Cathy A. Alessi
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jennifer L. Martin
- Veterans Affairs Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, North Hills, California,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California,Address correspondence to: Jennifer L. Martin, PhD, VA Sepulveda Ambulatory Care Center, 16111 Plummer Street (11E), North Hills, CA 91343;
| |
Collapse
|
112
|
Ghorbani S, Golkashani HA, Chee NIYN, Teo TB, Dicom AR, Yilmaz G, Leong RLF, Ong JL, Chee MWL. Multi-Night at-Home Evaluation of Improved Sleep Detection and Classification with a Memory-Enhanced Consumer Sleep Tracker. Nat Sci Sleep 2022; 14:645-660. [PMID: 35444483 PMCID: PMC9015046 DOI: 10.2147/nss.s359789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/31/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate the benefits of applying an improved sleep detection and staging algorithm on minimally processed multi-sensor wearable data collected from older generation hardware. PATIENTS AND METHODS 58 healthy, East Asian adults aged 23-69 years (M = 37.10, SD = 13.03, 32 males), each underwent 3 nights of PSG at home, wearing 2nd Generation Oura Rings equipped with additional memory to store raw data from accelerometer, infra-red photoplethysmography and temperature sensors. 2-stage and 4-stage sleep classifications using a new machine-learning algorithm (Gen3) trained on a diverse and independent dataset were compared to the existing consumer algorithm (Gen2) for whole-night and epoch-by-epoch metrics. RESULTS Gen 3 outperformed its predecessor with a mean (SD) accuracy of 92.6% (0.04), sensitivity of 94.9% (0.03), and specificity of 78.5% (0.11); corresponding to a 3%, 2.8% and 6.2% improvement from Gen2 across the three nights, with Cohen's d values >0.39, t values >2.69, and p values <0.01. Notably, Gen 3 showed robust performance comparable to PSG in its assessment of sleep latency, light sleep, rapid eye movement (REM), and wake after sleep onset (WASO) duration. Participants <40 years of age benefited more from the upgrade with less measurement bias for total sleep time (TST), WASO, light sleep and sleep efficiency compared to those ≥40 years. Males showed greater improvements on TST and REM sleep measurement bias compared to females, while females benefitted more for deep sleep measures compared to males. CONCLUSION These results affirm the benefits of applying machine learning and a diverse training dataset to improve sleep measurement of a consumer wearable device. Importantly, collecting raw data with appropriate hardware allows for future advancements in algorithm development or sleep physiology to be retrospectively applied to enhance the value of longitudinal sleep studies.
Collapse
Affiliation(s)
- Shohreh Ghorbani
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hosein Aghayan Golkashani
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Nicholas I Y N Chee
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Teck Boon Teo
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrew Roshan Dicom
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gizem Yilmaz
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ruth L F Leong
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ju Lynn Ong
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael W L Chee
- Centre for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
113
|
Santana KDGFP, Confortin SC, Bragança MLBM, Batista RFL, Santos IDSD, Silva AAMD. Associações entre duração de sono e índices de massa gorda, muscular e corporal em adolescentes de São Luís, Maranhão, Brasil. CAD SAUDE PUBLICA 2022; 38:e00078721. [DOI: 10.1590/0102-311x00078721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/03/2021] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi avaliar a associação entre duração de sono e composição corporal em adolescentes. Estudo transversal, com 1.269 adolescentes de 18 e 19 anos da coorte de nascimentos de 1997/1998 de São Luís, Maranhão, Brasil. A duração do sono foi avaliada a partir dos dados registrados por acelerometria. A composição corporal foi avaliada pelo o índice de massa gorda (IMG), índice de massa muscular (IMM) e índice de massa corporal (IMC). Os fatores de confusão foram identificados em gráfico acíclico direcionado no programa DAGitty 3.0. Foram realizadas análises descritivas para todas as variáveis e, posteriormente, regressão linear, com estimativa dos coeficientes de regressão brutos e ajustados, com os respectivos intervalos de 95% de confiança (IC95%). Nos adolescentes do sexo masculino, cada hora a mais de sono associou-se a reduções de 0,30kg/m2 do IMM (IC95%: -0,45; -0,15), de 0,26kg/m2 do IMG (IC95%: -0,48; -0,03) e 0,61kg/m2 do IMC (IC95%: -0,93; -0,30). Nas adolescentes, cada hora a mais de sono associou-se à redução de 0,22kg/m2 do IMM (IC95%: -0,36; -0,07). A maior duração do sono associou-se a menor IMM em ambos os sexos e menor IMG e IMC no sexo masculino, o que evidencia a importância de ter adequadas horas de sono para melhorar os índices de composição corporal.
Collapse
|
114
|
Shin S, Kim SH, Jeon B. Objective Assessment of Sleep Patterns among Night-Shift Workers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413236. [PMID: 34948844 PMCID: PMC8701940 DOI: 10.3390/ijerph182413236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
In this scoping review of the literature, we identified the types and the parameters of objective measurements to assess sleep patterns among night-shift workers. We conducted a literature search using electronic databases for studies published from 1991 to 2020 and charted and summarized key information. We included 32 studies in the review. Polysomnography was used in 6 studies and wearable sleep detection devices were utilized in 26 studies. The duration of sleep assessment using the wearable devices ranged from 1 day to ≥4 weeks, and more than half of the studies collected data for >2 weeks. The majority of the studies used subjective questionnaires, such as the Karolinska Sleepiness Scale, Epworth Sleepiness Scale, and Pittsburgh Sleep Quality Index, in addition to objective sleep measurements. Total sleep time was the most common parameter, followed by sleep efficiency, sleep onset latency, and time or frequency of being awake. As the utilization of wearable devices to assess the sleep patterns of night-shift workers is expected to increase, further evaluation of device accuracy and precision, optimal data collection period, and key parameters is warranted.
Collapse
Affiliation(s)
- Seunghwa Shin
- Department of Nursing, Andong Science College, Kyungpook, Andong 36616, Korea;
| | - Su-Hyun Kim
- College of Nursing, Kyungpook National University, Daegu 41944, Korea;
- Research Institute of Nursing Science, College of Nursing, Kyungpook National University, Gukchaebosang-ro 680, Daegu 41944, Korea
- Correspondence: ; Tel.: +82-53-420-4928; Fax: +82-53-421-2758
| | - Bomin Jeon
- College of Nursing, Kyungpook National University, Daegu 41944, Korea;
| |
Collapse
|
115
|
Parsons CE, Schofield B, Batziou SE, Ward C, Young KS. Sleep quality is associated with emotion experience and adaptive regulation of positive emotion: An experience sampling study. J Sleep Res 2021; 31:e13533. [DOI: 10.1111/jsr.13533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/10/2021] [Accepted: 11/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Christine E. Parsons
- Interacting Minds Center Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Beatrice Schofield
- Centre for Language Studies Radboud University Nijmegen The Netherlands
- Department of Experimental and Neurocognitive Psychology The Free University of Berlin Berlin Germany
| | - Sofia E. Batziou
- Social, Genetic and Developmental Psychiatry Centre Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Camilla Ward
- Social, Genetic and Developmental Psychiatry Centre Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
| | - Katherine S. Young
- Social, Genetic and Developmental Psychiatry Centre Institute of Psychiatry, Psychology and Neuroscience King's College London London UK
- NIHR Maudsley Biomedical Research Centre King's College London London UK
| |
Collapse
|
116
|
Giordano NA, Seilern Und Aspang J, Baker J, Rice CW, Barrell B, Kirk L, Ortega E, Wallace M, Steck A, Schenker ML. The effect of a Life Care Specialist on pain management and opioid-related outcomes among patients with orthopedic trauma: study protocol for a randomized controlled trial. Trials 2021; 22:858. [PMID: 34838101 PMCID: PMC8626911 DOI: 10.1186/s13063-021-05841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orthopedic trauma patients face complex pain management needs and are frequently prescribed opioids, leaving them at-risk for prolonged opioid use. To date, post-trauma pain management research has placed little emphasis on individualized risk assessments for misuse and systematically implementing non-pharmacologic pain management strategies. Therefore, a community-academic partnership was formed to design a novel position in the healthcare field (Life Care Specialist (LCS)), who will educate patients on the risks of opioids, tapering usage, safe disposal practices, and harm reduction strategies. In addition, the LCS teaches patients behavior-based strategies for pain management, utilizing well-described techniques for coping and resilience. This study aims to determine the effects of LCS intervention on opioid utilization, pain control, and patient satisfaction in the aftermath of orthopedic trauma. METHODS In total, 200 orthopedic trauma patients will be randomized to receive an intervention (LCS) or a standard-of-care control at an urban level 1 trauma center. All patients will be assessed with comprehensive social determinants of health and substance use surveys immediately after surgery (baseline). Follow-up assessments will be performed at 2, 6, and 12 weeks postoperatively, and will include pain medication utilization (morphine milligram equivalents), pain scores, and other substance use. In addition, overall patient wellness will be evaluated with objective actigraphy measures and patient-reported outcomes. Finally, a survey of patient understanding of risks of opioid use and misuse will be collected, to assess the influence of LCS opioid education. DISCUSSION There is limited data on the role of individualized, multimodal, non-pharmacologic, behavioral-based pain management intervention in opioid-related risk-mitigation in high-risk populations, including the orthopedic trauma patients. The findings from this randomized controlled trial will provide scientific and clinical evidence on the efficacy and feasibility of the LCS intervention. Moreover, the final aim will provide early evidence into which patients benefit most from LCS intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04154384 . Registered on 11/6/2019 (last updated on 6/10/2021).
Collapse
Affiliation(s)
- Nicholas A Giordano
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Jesse Seilern Und Aspang
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA
| | - J'Lynn Baker
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA
| | | | | | | | - Erika Ortega
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA
| | | | - Alaina Steck
- Emory University Department of Emergency Medicine, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA
| | - Mara L Schenker
- Emory University Orthopaedic Surgery, Grady Memorial Hospital, 80 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA. .,Grady Memorial Hospital, Atlanta, GA, USA.
| |
Collapse
|
117
|
Schneider J, Fárková E, Bakštein E. Human chronotype: Comparison of questionnaires and wrist-worn actigraphy. Chronobiol Int 2021; 39:205-220. [PMID: 34806526 DOI: 10.1080/07420528.2021.1992418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In this work, we investigated the accuracy of chronotype estimation from actigraphy while evaluating the required recording length and stability over time. Chronotypes have an important role in chronobiological and sleep research. In outpatient studies, chronotypes are typically evaluated by questionnaires. Alternatively, actigraphy provides potential means for measuring chronotype characteristics objectively, which opens many applications in chronobiology research. However, studies providing objective, critical evaluation of agreement between questionnaire-based and actigraphy-based chronotypes are lacking. We recorded 3-months of actigraphy and collected Morningness-Eveningness Questionnaire (MEQ), and Munich Chronotype Questionnaire (MCTQ) results from 122 women. Regression models were applied to evaluate the questionnaire-based chronotypes scores using selected actigraphy features. Changes in predictive strength were evaluated based on actigraphy recordings of different duration. The actigraphy was significantly associated with the questionnaire-based chronotype, and the best single-feature-based models explained 37% of the variability (R2) for MEQ (p < .001), 47% for mid-sleep time MCTQ-MSFsc (p < .001), and 19% for social jetlag MCTQ-SJLrel (p < .001). Concerning stability in time, the Mid-sleep and Acrophase features showed high levels of stability (test-retest R ~ 0.8), and actigraphy-based MSFscacti and SJLrelacti showed high temporal variability (test-retest R ~ 0.45). Concerning required recording length, features estimated from recordings with 3-week and longer observation periods had sufficient predictive power on unseen data. Additionally, our data showed that the subjectively reported extremes of the MEQ, MCTQ-MSFsc, and MCTQ-SJLrel are commonly overestimated compared to objective activity peak and middle of sleep differences measured by actigraphy. Such difference may be associated with chronotype time-variation. As actigraphy is considered accurate in sleep-wake cycle detection, we conclude that actigraphy-based chronotyping is appropriate for large-scale studies, especially where higher temporal variability in chronotype is expected.
Collapse
Affiliation(s)
- Jakub Schneider
- Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czech Republic.,Sleep Medicine and Chronobiology, Czech Technical University in Prague, Prague, Czech Republic
| | - Eva Fárková
- Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czech Republic
| | - Eduard Bakštein
- Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czech Republic.,Sleep Medicine and Chronobiology, Czech Technical University in Prague, Prague, Czech Republic
| |
Collapse
|
118
|
Ransing R, Patil P, Patil S, Agrawal S. Comparison of actigraphy indices among patients with depression and schizophrenia: A preliminary study. J Family Med Prim Care 2021; 10:3406-3410. [PMID: 34760765 PMCID: PMC8565142 DOI: 10.4103/jfmpc.jfmpc_1693_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/27/2020] [Accepted: 11/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Schizophrenia (SCZ) and depression (MDD) are associated with changes in sleep and activity patterns. However, because of a lack of objective evaluation, the diagnostic or clinical value of these sleep-activity patterns is unknown. In this study, we attempted to assess and compare the sleep and activity patterns using actigraphy. Materials and Methods: We have recruited 35 patients with SCZ (mean age: 29.29 ± 7.54 years) and 42 patients with MDD (mean age: 27.5 ± 5.59 years) in this cross-sectional study. The actigraphy indices [Time in bed (minutes), Onset latency (minutes), Total sleep time (Minutes), Sleep efficiency (%), WASO (minutes), number of awakening, and activity duration (minutes) were compared among the two groups using unpaired t-test and Fisher exact test. Results: In the MDD group, the time in bed (minutes) was significantly higher than in the SCZ group (402.7 ± 41.97 vs. 379.1 ± 40.45, P = 0.01), while the sleep efficiency was lower in the SCZ group than in the MDD group (60.04 ± 9.25 vs. 65.05 ± 7.16, P = 0.0092). An increase in onset latency (minutes) was observed in the SCZ group compared to the MDD group (49.06 ± 16.09 vs. 43.6 ± 10.14, P = 0.074). The difference in WASO (minutes), the number of awakenings, and activity duration (minutes) among the two groups were insignificant. Conclusion: Actigraphy parameters such as sleep efficiency and time in bed may be a useful sleep process, etiological, and prognostic markers in patients with SCZ and MDD. The longitudinal studies are needed to estimate the predictive role of these parameters for therapeutic outcome in these patients.
Collapse
Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Pradeep Patil
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Swaroopa Patil
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Shruti Agrawal
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| |
Collapse
|
119
|
Whibley D, Goldstein C, Kratz AL, Braley TJ. A multidimensional approach to sleep health in multiple sclerosis. Mult Scler Relat Disord 2021; 56:103271. [PMID: 34614459 PMCID: PMC8678321 DOI: 10.1016/j.msard.2021.103271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although sleep disturbances are common among people with Multiple Sclerosis (PwMS), understanding of their impact has been stymied by limitations in approaches to sleep measurement within this population. The aim of this study was to comprehensively phenotype sleep patterns in PwMS through application of an emerging seven-domain framework that includes sleep duration, continuity, timing, quality, rhythmicity, regularity, and sleepiness. METHODS Sleep domains were estimated from wrist-worn accelerometry, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index responses. Extreme sleep values within each domain were constructed using previously published guidelines. A composite score of extreme values was calculated for each participant. Associations between sleep domains and severity of MS symptoms were explored (pain, fatigue, depressive symptoms, and cognitive dysfunction). RESULTS Among n = 49 participants, median total sleep time was 456.3 min. Median time spent awake after sleep onset was 37 min. Sleepiness, abnormal sleep timing, and poor sleep quality affected 33%, 35%, and 45% of participants, respectively. Seventy-six percent had ≥2 sleep domains in extreme ranges. PwMS had longer sleep duration and decreased sleep regularity compared to a non-MS historical cohort of older men. Greater daytime sleepiness, poorer sleep quality, and higher composite sleep health score were associated with more depressive symptoms, and lower sleep rhythmicity was associated with higher fatigue. Associations were observed between measures of cognitive function and sleep fragmentation, duration, quality, rhythmicity, and composite score. CONCLUSION Application of a seven-domain sleep health framework that captures the dynamic and multifaceted aspects of sleep is feasible in PwMS, and offers potential for an improved understanding of the scope and impact of sleep disturbances in PwMS.
Collapse
Affiliation(s)
- Daniel Whibley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom; Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Cathy Goldstein
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, United States
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Tiffany J Braley
- Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, MI, United States; Division of Multiple Sclerosis and Neuroimmunology, Department of Neurology, University of Michigan, C728 Med-Inn Building, 1500 E Medical Center Dr, Ann Arbor, MI 48109, United States; Department of Neurology, Ann Arbor VA, Ann Arbor, United States.
| |
Collapse
|
120
|
Moon E, Yang M, Seon Q, Linnaranta O. Relevance of Objective Measures in Psychiatric Disorders-Rest-Activity Rhythm and Psychophysiological Measures. Curr Psychiatry Rep 2021; 23:85. [PMID: 34714422 PMCID: PMC8556205 DOI: 10.1007/s11920-021-01291-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW We present a review of recent methods of objective measurement in psychiatry and psychology with a focus on home monitoring and its utility in guiding treatment. RECENT FINDINGS For individualized diagnostics and treatment of insomnia, actigraphy can generate clinically useful graphical presentations of sleep timing and patterns. Psychophysiological measures may complement psychometrics by tracking parallel changes in physiological responses and emotional functioning, especially during therapy for trauma symptoms and emotion regulation. It seems that rather than defining universal cut-offs, an individualised range of variability could characterize treatment response. Wearable actigraphy and psychophysiological sensors are promising devices to provide biofeedback and guide treatment. Use of feasible and reliable technology during experimental and clinical procedures may necessitate defining healthy and abnormal responses in different populations and pathological states. We present a "call for action" towards further collaborative work to enable large scale use of objective measures.
Collapse
Affiliation(s)
- Eunsoo Moon
- Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Psychiatry and Biomedical Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Michelle Yang
- Interdisciplinary Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Quinta Seon
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Mental Health Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
- Douglas Centre for Sleep and Biological Rhythms, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.
| |
Collapse
|
121
|
Li X, Kane M, Zhang Y, Sun W, Song Y, Dong S, Lin Q, Zhu Q, Jiang F, Zhao H. Circadian Rhythm Analysis Using Wearable Device Data: Novel Penalized Machine Learning Approach. J Med Internet Res 2021; 23:e18403. [PMID: 34647895 PMCID: PMC8554674 DOI: 10.2196/18403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/23/2020] [Accepted: 05/13/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Wearable devices have been widely used in clinical studies to study daily activity patterns, but the analysis remains a major obstacle for researchers. OBJECTIVE This study proposes a novel method to characterize sleep-activity rhythms using actigraphy and further use it to describe early childhood daily rhythm formation and examine its association with physical development. METHODS We developed a machine learning-based Penalized Multiband Learning (PML) algorithm to sequentially infer dominant periodicities based on the Fast Fourier Transform (FFT) algorithm and further characterize daily rhythms. We implemented and applied the algorithm to Actiwatch data collected from a cohort of 262 healthy infants at ages 6, 12, 18, and 24 months, with 159, 101, 111, and 141 participants at each time point, respectively. Autocorrelation analysis and Fisher test in harmonic analysis with Bonferroni correction were applied for comparison with the PML. The association between activity rhythm features and early childhood motor development, assessed using the Peabody Developmental Motor Scales-Second Edition (PDMS-2), was studied through linear regression analysis. RESULTS The PML results showed that 1-day periodicity was most dominant at 6 and 12 months, whereas one-day, one-third-day, and half-day periodicities were most dominant at 18 and 24 months. These periodicities were all significant in the Fisher test, with one-fourth-day periodicity also significant at 12 months. Autocorrelation effectively detected 1-day periodicity but not the other periodicities. At 6 months, PDMS-2 was associated with the assessment seasons. At 12 months, PDMS-2 was associated with the assessment seasons and FFT signals at one-third-day periodicity (P<.001) and half-day periodicity (P=.04), respectively. In particular, the subcategories of stationary, locomotion, and gross motor were associated with the FFT signals at one-third-day periodicity (P<.001). CONCLUSIONS The proposed PML algorithm can effectively conduct circadian rhythm analysis using time-series wearable device data. The application of the method effectively characterized sleep-wake rhythm development and identified the association between daily rhythm formation and motor development during early childhood.
Collapse
Affiliation(s)
- Xinyue Li
- School of Data Science, City University of Hong Kong, Hong Kong, China (Hong Kong).,Child Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Michael Kane
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
| | - Yunting Zhang
- Child Health Advocacy Institute, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,School of Public Health, Shanghai Jiao Tong University, Shanghai, China
| | - Wanqi Sun
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanjin Song
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shumei Dong
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qingmin Lin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Zhu
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Jiang
- School of Public Health, Shanghai Jiao Tong University, Shanghai, China.,Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongyu Zhao
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States.,Yale Joint Center for Biostatistics, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
122
|
Cimenser A, Hempel E, Travers T, Strozewski N, Martin K, Malchano Z, Hajós M. Sensory-Evoked 40-Hz Gamma Oscillation Improves Sleep and Daily Living Activities in Alzheimer's Disease Patients. Front Syst Neurosci 2021; 15:746859. [PMID: 34630050 PMCID: PMC8500065 DOI: 10.3389/fnsys.2021.746859] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/30/2021] [Indexed: 01/18/2023] Open
Abstract
Pathological proteins contributing to Alzheimer’s disease (AD) are known to disrupt normal neuronal functions in the brain, leading to unbalanced neuronal excitatory-inhibitory tone, distorted neuronal synchrony, and network oscillations. However, it has been proposed that abnormalities in neuronal activity directly contribute to the pathogenesis of the disease, and in fact it has been demonstrated that induction of synchronized 40 Hz gamma oscillation of neuronal networks by sensory stimulation reverses AD-related pathological markers in transgenic mice carrying AD-related human pathological genes. Based on these findings, the current study evaluated whether non-invasive sensory stimulation inducing cortical 40 Hz gamma oscillation is clinically beneficial for AD patients. Patients with mild to moderate AD (n = 22) were randomized to active treatment group (n = 14; gamma sensory stimulation therapy) or to sham group (n = 8). Participants in the active treatment group received precisely timed, 40 Hz visual and auditory stimulations during eye-closed condition to induce cortical 40 Hz steady-state oscillations in 1-h daily sessions over a 6-month period. Participants in the sham group were exposed to similar sensory stimulation designed to not evoke cortical 40 Hz steady-state oscillations that are observed in the active treatment patients. During the trial, nighttime activities of the patients were monitored with continuous actigraphy recordings, and their functional abilities were measured by Alzheimer’s Disease Cooperative Study – Activities of Daily Living (ADCS-ADL) scale. Results of this study demonstrated that 1-h daily therapy was well tolerated throughout the 6-month treatment period by all subjects. Patients receiving gamma sensory stimulation showed significantly reduced nighttime active periods, in contrast, to deterioration in sleep quality in sham group patients. Patients in the sham group also showed the expected, significant decline in ADCS-ADL scores, whereas patients in the gamma sensory stimulation group fully maintained their functional abilities over the 6-month period. These findings confirm the safe application of 40 Hz sensory stimulation in AD patients and demonstrate a high adherence to daily treatment. Furthermore, this is the first time that beneficial clinical effects of the therapy are reported, justifying expanded and longer trials to explore additional clinical benefits and disease-modifying properties of gamma sensory stimulation therapy. Clinical Trial Registration:clinicaltrials.gov, identifier: NCT03556280.
Collapse
Affiliation(s)
- Aylin Cimenser
- Cognito Therapeutics, Inc., Cambridge, MA, United States
| | - Evan Hempel
- Cognito Therapeutics, Inc., Cambridge, MA, United States
| | - Taylor Travers
- Cognito Therapeutics, Inc., Cambridge, MA, United States
| | | | - Karen Martin
- Cognito Therapeutics, Inc., Cambridge, MA, United States
| | - Zach Malchano
- Cognito Therapeutics, Inc., Cambridge, MA, United States
| | - Mihály Hajós
- Cognito Therapeutics, Inc., Cambridge, MA, United States.,Department of Comparative Medicine, Yale University School of Medicine, New Haven, CT, United States
| |
Collapse
|
123
|
Trivedi R, Man H, Madut A, Mather M, Elder E, Dhillon HM, Brand A, Howle J, Mann G, DeFazio A, Amis T, Cain SW, Phillips AJK, Kairaitis K. Irregular Sleep/Wake Patterns Are Associated With Reduced Quality of Life in Post-treatment Cancer Patients: A Study Across Three Cancer Cohorts. Front Neurosci 2021; 15:700923. [PMID: 34630009 PMCID: PMC8494030 DOI: 10.3389/fnins.2021.700923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/31/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Cancer patients often describe poor sleep quality and sleep disruption as contributors to poor quality of life (QoL). In a cross-sectional study of post-treatment breast, endometrial, and melanoma cancer patients, we used actigraphy to quantify sleep regularity using the sleep regularity index (SRI), and examined relationships with reported sleep symptoms and QoL. Methods: Participants were recruited post-primary treatment (35 diagnosed with breast cancer, 24 endometrial cancer, and 29 melanoma) and wore an actigraphy device for up to 2 weeks and SRI was calculated. Self-report questionnaires for cancer-related QoL [European Organization for Research and Treatment of Cancer EORTC (QLQ-C30)] were completed. Data were compared using analysis of variance (ANOVA) or Chi-Square tests. Multivariate linear regression analysis was used to determine independent variable predictors for questionnaire-derived data. Results: Age distribution was similar between cohorts. Endometrial and breast cancer cohorts were predominantly female, as expected, and body mass index (BMI) was higher in the endometrial cancer cohort, followed by breast and melanoma. There were no differences between tumor groups in: total sleep time, sleep onset latency, bedtime, and SRI (breast 80.9 ± 8.0, endometrial 80.3 ± 12.2, and melanoma 81.4 ± 7.0) (all p > 0.05). A higher SRI was associated with both better functional and symptom scores, including increased global QoL, better physical functioning, less sleepiness and fatigue, better sleep quality, and associated with less nausea/vomiting, dyspnea, and diarrhea (all p < 0.05). Conclusion: In cancer patients post-treatment, greater sleep regularity is associated with increased global QoL, as well as better physical functioning and fewer cancer related symptoms. Improving sleep regularity may improve QoL for cancer patients.
Collapse
Affiliation(s)
- Ritu Trivedi
- Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Hong Man
- Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Ayey Madut
- Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Marius Mather
- Sydney Informatics Hub, The University of Sydney, Camperdown, NSW, Australia
| | - Elisabeth Elder
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Westmead Breast Cancer Institute, Westmead Hospital, Westmead, NSW, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia.,Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Camperdown, NSW, Australia
| | - Alison Brand
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Gynecological Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - Julie Howle
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Crown Princess Mary Cancer Centre, Westmead and Blacktown Hospitals, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Graham Mann
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia
| | - Anna DeFazio
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Gynecological Oncology, Westmead Hospital, Westmead, NSW, Australia.,Centre for Cancer Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia.,Sydney West Translational Cancer Research Centre, Westmead, NSW, Australia
| | - Terence Amis
- Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia.,Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney West Translational Cancer Research Centre, Westmead, NSW, Australia.,Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Sean W Cain
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Andrew J K Phillips
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Kristina Kairaitis
- Ludwig Engel Centre for Respiratory Research, The Westmead Institute for Medical Research, Westmead, NSW, Australia.,Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney West Translational Cancer Research Centre, Westmead, NSW, Australia.,Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, NSW, Australia
| |
Collapse
|
124
|
Effects of financial incentives on volunteering for clinical trials: A randomized vignette experiment. Contemp Clin Trials 2021; 110:106584. [PMID: 34597837 DOI: 10.1016/j.cct.2021.106584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 09/01/2021] [Accepted: 09/24/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Financial incentives may aid recruitment to clinical trials, but evidence regarding risk/burden-driven variability in participant preferences for incentives is limited. We developed and tested a framework to support real-world decisions on recruitment budget. METHODS We included two phases: an Anchoring Survey, to ensure we could capture perceived unpleasantness on a range of life events, and a Vignette Experiment, to explore relationships between financial incentives and participants' perceived risk/burden and willingness to participate in high- and low-risk/burden versions of five vignettes drawn from common research activities. We compared vignette ratings to identify similarly rated life events from the Anchoring Survey to contextualize ratings of study risk. RESULTS In our Anchoring Survey (n = 643), mean ratings (scale 1 = lowest risk/burden to 5 = highest risk/burden) indicated that the questions made sense to participants, with highest risk assigned to losing house in a fire (4.72), and lowest risk assigned to having blood pressure taken (1.13). In the Vignette Experiment (n = 534), logistic regression indicated that amount of offered financial incentive and perceived risk/burden level were the top two drivers of willingness to participate in four of the five vignettes. Comparison of event ratings in the Anchoring Survey with the Vignette Experiment ratings suggested reasonable concordance on severity of risk/burden. CONCLUSIONS We demonstrated feasibility of a framework for assessing participant perceptions of risk for study activities and discerned directionality of relationship between financial incentives and willingness to participate. Future work will explore use of this framework as an evidence-gathering approach for gauging appropriate incentives in real-world study contexts.
Collapse
|
125
|
Wainberg M, Jones SE, Beaupre LM, Hill SL, Felsky D, Rivas MA, Lim ASP, Ollila HM, Tripathy SJ. Association of accelerometer-derived sleep measures with lifetime psychiatric diagnoses: A cross-sectional study of 89,205 participants from the UK Biobank. PLoS Med 2021; 18:e1003782. [PMID: 34637446 PMCID: PMC8509859 DOI: 10.1371/journal.pmed.1003782] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sleep problems are both symptoms of and modifiable risk factors for many psychiatric disorders. Wrist-worn accelerometers enable objective measurement of sleep at scale. Here, we aimed to examine the association of accelerometer-derived sleep measures with psychiatric diagnoses and polygenic risk scores in a large community-based cohort. METHODS AND FINDINGS In this post hoc cross-sectional analysis of the UK Biobank cohort, 10 interpretable sleep measures-bedtime, wake-up time, sleep duration, wake after sleep onset, sleep efficiency, number of awakenings, duration of longest sleep bout, number of naps, and variability in bedtime and sleep duration-were derived from 7-day accelerometry recordings across 89,205 participants (aged 43 to 79, 56% female, 97% self-reported white) taken between 2013 and 2015. These measures were examined for association with lifetime inpatient diagnoses of major depressive disorder, anxiety disorders, bipolar disorder/mania, and schizophrenia spectrum disorders from any time before the date of accelerometry, as well as polygenic risk scores for major depression, bipolar disorder, and schizophrenia. Covariates consisted of age and season at the time of the accelerometry recording, sex, Townsend deprivation index (an indicator of socioeconomic status), and the top 10 genotype principal components. We found that sleep pattern differences were ubiquitous across diagnoses: each diagnosis was associated with a median of 8.5 of the 10 accelerometer-derived sleep measures, with measures of sleep quality (for instance, sleep efficiency) generally more affected than mere sleep duration. Effect sizes were generally small: for instance, the largest magnitude effect size across the 4 diagnoses was β = -0.11 (95% confidence interval -0.13 to -0.10, p = 3 × 10-56, FDR = 6 × 10-55) for the association between lifetime inpatient major depressive disorder diagnosis and sleep efficiency. Associations largely replicated across ancestries and sexes, and accelerometry-derived measures were concordant with self-reported sleep properties. Limitations include the use of accelerometer-based sleep measurement and the time lag between psychiatric diagnoses and accelerometry. CONCLUSIONS In this study, we observed that sleep pattern differences are a transdiagnostic feature of individuals with lifetime mental illness, suggesting that they should be considered regardless of diagnosis. Accelerometry provides a scalable way to objectively measure sleep properties in psychiatric clinical research and practice, even across tens of thousands of individuals.
Collapse
Affiliation(s)
- Michael Wainberg
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Canada
| | - Samuel E. Jones
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- University of Exeter Medical School, Exeter, United Kingdom
| | - Lindsay Melhuish Beaupre
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Sean L. Hill
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Daniel Felsky
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Manuel A. Rivas
- Department of Genetics, Stanford University, Stanford, California, United States of America
| | - Andrew S. P. Lim
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Hanna M. Ollila
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shreejoy J. Tripathy
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
- * E-mail:
| |
Collapse
|
126
|
Effects on sleep from group activity with a robotic seal for nursing home residents with dementia: a cluster randomized controlled trial. Int Psychogeriatr 2021; 33:1045-1056. [PMID: 32985396 DOI: 10.1017/s1041610220001787] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Sleep disturbances are common in people with dementia and increase with the severity of the disease. Sleep disturbances are complex and caused by several factors and are difficult to treat. There is a need for more robust and systematic studies dealing with sleep disturbances in older people with dementia. The aim of this study was to investigate effects from robot-assisted (Paro) group activity on sleep patterns in nursing home (NH) residents with dementia. DESIGN A cluster randomized controlled trial. SETTING Special care units in 10 NH in Norway. PARTICIPANTS A total of 60 participants over 65 years with dementia were recruited. Thirty participants were recruited to the intervention group and 30 participants to the control group. INTERVENTION Participants participated in group activity with Paro for 30 minutes twice a week over 12 weeks or in control group (treatment as usual). MEASUREMENTS Sleep-wake patterns were assessed objectively by 7 days of wrist actigraphy before and after the intervention. Data were collected between March 2013 and September 2014. Data were analyzed using mixed models. RESULTS Positive effects on change in sleep were found in the intervention group as compared with the control group. The intervention group increased percentage of sleep efficiency, increased the amount of total sleep time and reduced number of nocturnal awakenings. In addition, a significant effect was found in reduced awakenings after sleep onset. CONCLUSIONS Social stimulation through engaging group activity could contribute to improved sleep in people with dementia in NH. Increased sleep efficiency and total sleep time, in addition to fewer night awakenings, affect central indicators of good sleep quality across the life span. Improved sleep quality will also affect quality of life and comorbidities in vulnerable groups. We believe group activity with Paro to be an accessible and feasible non-pharmacological treatment for those who enjoy Paro.
Collapse
|
127
|
Cheah KL, Norhayati MN, Husniati Yaacob L, Abdul Rahman R. Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis. PLoS One 2021; 16:e0257843. [PMID: 34559859 PMCID: PMC8462692 DOI: 10.1371/journal.pone.0257843] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/10/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To determine the effect of Ashwagandha extract on sleep. METHODS A comprehensive search was conducted in CENTRAL, MEDLINE, SCOPUS, Google Scholars, World Health Organization Trials Portal, ClinicalTrials.gov, Clinical Trial Registry of India, and AYUSH Research Portal for all appropriate trials. Randomized controlled trials that examined the effect of Ashwagandha extract versus placebo on sleep in human participants 18 years old and above were considered. Two authors independently read all trials and independently extracted all relevant data. The primary outcomes were sleep quantity and sleep quality. The secondary outcomes were mental alertness on rising, anxiety level, and quality of life. RESULTS A total of five randomized controlled trials containing 400 participants were analyzed. Ashwagandha extract exhibited a small but significant effect on overall sleep (Standardized Mean Difference -0.59; 95% Confidence Interval -0.75 to -0.42; I2 = 62%). The effects on sleep were more prominent in the subgroup of adults diagnosed with insomnia, treatment dosage ≥600 mg/day, and treatment duration ≥8 weeks. Ashwagandha extract was also found to improve mental alertness on rising and anxiety level, but no significant effect on quality of life. No serious side effects were reported. CONCLUSION Ashwagandha extract appears to has a beneficial effect in improving sleep in adults. However, data on the serious adverse effects of Ashwagandha extract are limited, and more safety data would be needed to assess whether it would be safe for long-term use.
Collapse
Affiliation(s)
- Kae Ling Cheah
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Lili Husniati Yaacob
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
- * E-mail:
| | - Razlina Abdul Rahman
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| |
Collapse
|
128
|
Osorio RS, Martínez-García MÁ, Rapoport DM. Sleep apnoea in the elderly: a great challenge for the future. Eur Respir J 2021; 59:13993003.01649-2021. [PMID: 34561285 DOI: 10.1183/13993003.01649-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/25/2021] [Indexed: 11/05/2022]
Abstract
Due in part to overall improvements in health, the population of elderly individuals is increasing rapidly. Similarly, obstructive sleep apnoea (OSA) is both gaining increased recognition and also increasing due to the worldwide obesity epidemic. The overlap of OSA and aging is large, but there is strong plausibility for causation in both directions: OSA is associated with pathological processes that may accelerate aging and aging related processes; aging may cause physical and neurological changes that predispose to obstructive (and central) apnoea. In addition, the common symptoms (e.g. excessive daytime somnolence, defects in memory and cognition), possible physiological consequences of OSA (e.g. accelerated cardiovascular and cerebrovascular atherosclerosis), and changes in metabolic and inflammatory markers overlap with the symptoms and associated conditions seen in aging. There is also the possibility of synergy in the effects of these symptoms and conditions on quality of life, as well as a need to separate treatable consequences of OSA from age-related complaints. Taken together, the above make it essential to review the interaction of OSA and aging, both proven and suspected. The present review examines some aspects of what is known and points to the need for further investigation of the relationships, given the large number of potentially affected subjects.
Collapse
Affiliation(s)
- Ricardo S Osorio
- Department of Psychiatry, New York University (NYU) Grossman School of Medicine, New York, New York, USA.,Clinical Research Division, Nathan Kline Institute (NKI), Orangeburg, New York, USA
| | - Miguel Ángel Martínez-García
- Respirology Department, University and Politechnic la Fe Hospital, Valencia, Valencian Community, Spain .,CIBERES de Enfermedades Respiratorias, Madrid, Spain
| | - David M Rapoport
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
129
|
On the Unification of Common Actigraphic Data Scoring Algorithms. SENSORS 2021; 21:s21186313. [PMID: 34577520 PMCID: PMC8472753 DOI: 10.3390/s21186313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/25/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
Actigraphy is a well-known, inexpensive method to investigate human movement patterns. Sleep and circadian rhythm studies are among the most popular applications of actigraphy. In this study, we investigate seven common sleep-wake scoring algorithms designed for actigraphic data, namely Cole-Kripke algorithm, two versions of Sadeh algorithm, Sazonov algorithm, Webster algorithm, UCSD algorithm and Scripps Clinic algorithm. We propose a unified mathematical framework describing five of them. One of the observed novelties is that five of these algorithms are in fact equivalent to low-pass FIR filters with very similar characteristics. We also provide explanations about the role of some factors defining these algorithms, as none were given by their Authors who followed empirical procedures. Proposed framework provides a robust mathematical description of discussed algorithms, which for the first time allows one to fully understand their operation and basics.
Collapse
|
130
|
Smith P, Kandakatla A, Frankel CW, Bacon DR, Bush E, Mentz RJ, Snyder LD. Sleep quality, depressive symptoms, and transplant outcomes: Follow-up analyses from the ADAPT prospective pilot study. Gen Hosp Psychiatry 2021; 72:53-58. [PMID: 34298477 DOI: 10.1016/j.genhosppsych.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 06/14/2021] [Accepted: 06/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Previous studies suggested that depressive symptoms and sleep quality may be important for long-term clinical outcomes following cardiothoracic transplant. Few studies, however, have systematically examined objective markers of these behavioral factors among ambulatory transplant recipients, or their association with clinical outcomes. METHODS We examined sleep quality and depressive symptoms with subsequent clinical outcomes (hospitalizations and death) in a sample of 66 lung or heart transplant recipients using a single-center, prospective cohort study. Recipients were assessed at approximately 6 months post-transplant and completed one week of actigraphy assessment to examine sleep quality and self-report measures of mood (Centers for Epidemiologic Studies of Depression [CESD]). Recipients were followed for clinical outcomes. RESULTS At 6-months following transplantation, recipients spent the majority of daytime activity at a sedentary level (61% of daily activity [SD = 10]) and elevated depressive symptoms were common (subclinical = 17%, mild = 12%, or moderate = 8%). Over a median follow-up of 4.5 years (IQR = 0.9, 5.1), 51 participants (77%) had at least one unplanned hospitalization and 11 (17%) participants died. In addition, sleep efficiency measurements suggested that a subset of participants exhibited suboptimal sleep (mean efficiency = 87% [SD = 7]). Poorer sleep quality, indexed by lower sleep efficiency and greater sleep fragmentation, was associated with greater depressive symptoms (r's = 0.37-0.50, P < .01). Better sleep quality at 6-months (HR = 0.75 [0.60, 0.95], P = .015), including sleep efficiency (HR = 0.74 [0.56, 0.99], P = .041) and sleep fragmentation (HR = 0.71 [0.53, 0.95], P = .020) were associated with lower risk of hospitalization or death. Compared with individuals without elevated depressive symptoms or sleep difficulties, individuals with either factor (HR = 1.72 [1.05, 2.81], P = .031) or both factors (HR = 2.37 [1.35, 4.18], P = .003) exhibited greater risk of clinical events in adjusted analyses. CONCLUSIONS Sleep quality is associated with depressive symptoms among cardiothoracic transplant recipients and enhances the prognostic association between biobehavioral risk factors and clinical outcomes.
Collapse
Affiliation(s)
- PatrickJ Smith
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, United States of America; Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America.
| | - Apoorva Kandakatla
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Courtney W Frankel
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Daniel R Bacon
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, United States of America
| | - Erika Bush
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America
| | - Robert J Mentz
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America
| | - Laurie D Snyder
- Duke University Medical Center, Department of Medicine, Durham, NC, United States of America; Duke Clinical Research Institute, Durham, NC, United States of America
| |
Collapse
|
131
|
Perry MA, Dawkins-Henry OS, Awojoodu RE, Blumenthal J, Asaro LA, Wypij D, Kudchadkar SR, Zuppa AF, Curley MA. Study protocol for a two-center test of a nurse-implemented chronotherapeutic restoring bundle in critically ill children: RESTORE Resilience (R 2). Contemp Clin Trials Commun 2021; 23:100840. [PMID: 34466711 PMCID: PMC8385396 DOI: 10.1016/j.conctc.2021.100840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/03/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Often, pediatric intensive care environments are not conducive to healing the sick. Critically ill children experience disruptions in their circadian rhythms, which can contribute to delayed recovery and poor outcomes. We aim to test the hypothesis that children managed via RESTORE Resilience (R2), a nurse-implemented chronotherapeutic bundle, will experience restorative circadian rhythms compared to children receiving usual care. In this two-phased, prospective cohort study, two separate pediatric intensive care units in the United Sates will enroll a total of 20 baseline subjects followed by 40 intervention subjects, 6 months to less than 18 years of age, requiring invasive mechanical ventilation. During the intervention phase, we will implement the R2 bundle, which includes: (1) a focused effort to replicate the child's pre-hospitalization daily routine, (2) cycled day-night lighting and sound modulation, (3) minimal yet effective sedation (RESTORE), (4) nighttime fasting with bolus enteral daytime feedings, (5) early progressive mobility (PICU Up!), (6) continuity in nursing care, and (7) parent diaries. Our primary outcome is circadian activity ratio post-extubation. We hypothesize that children receiving R2 will experience restored circadian rhythms as evidenced by decreased nighttime activity while in the PICU. Our exploratory outcomes include salivary melatonin levels; electroencephalogram (EEG) slow-wave activity; R2 feasibility, adherence, and system barriers; levels of patient comfort; exposure to sedative medications; time to physiological stability; and parent perception of being well cared for. This paper describes the design, rationale, and implementation of R2. CLINICALTRIALSGOV IDENTIFIER NCT04695392.
Collapse
Key Words
- CINC, continuity in nursing care
- Circadian rhythm
- DARE, daytime activity ratio estimate
- DCC, Data Coordinating Center
- DMS, data management system
- EEG, electroencephalography
- FCCS, Family-Centered Care Scale
- ICU, intensive care unit
- Mechanical ventilation
- Nurse-implemented interventions
- PCPC, Pediatric Cerebral Performance Category
- PICU, pediatric intensive care unit
- POPC, Pediatric Overall Performance Category
- PRISM III-12, Pediatric Risk of Mortality III score from first 12 h in the PICU
- Pediatric critical care
- WAT-1, Withdrawal Assessment Tool-1
Collapse
Affiliation(s)
- Mallory A. Perry
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ronke E. Awojoodu
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins Medicine, Baltimore, MD, USA
- University of Maryland Baltimore School of Nursing, Baltimore, MD, USA
| | - Jennifer Blumenthal
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa A. Asaro
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sapna R. Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Charlotte R. Bloomberg Children's Center, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Athena F. Zuppa
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Martha A.Q. Curley
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| |
Collapse
|
132
|
Heglum HSA, Kallestad H, Vethe D, Langsrud K, Sand T, Engstrøm M. Distinguishing sleep from wake with a radar sensor: a contact-free real-time sleep monitor. Sleep 2021; 44:zsab060. [PMID: 33705555 PMCID: PMC8361351 DOI: 10.1093/sleep/zsab060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/07/2021] [Indexed: 11/17/2022] Open
Abstract
This work aimed to evaluate whether a radar sensor can distinguish sleep from wakefulness in real time. The sensor detects body movements without direct physical contact with the subject and can be embedded in the roof of a hospital room for completely unobtrusive monitoring. We conducted simultaneous recordings with polysomnography, actigraphy, and radar on two groups: healthy young adults (n = 12, four nights per participant) and patients referred to a sleep examination (n = 28, one night per participant). We developed models for sleep/wake classification based on principles commonly used by actigraphy, including real-time models, and tested them on both datasets. We estimated a set of commonly reported sleep parameters from these data, including total-sleep-time, sleep-onset-latency, sleep-efficiency, and wake-after-sleep-onset, and evaluated the inter-method reliability of these estimates. Classification results were on-par with, or exceeding, those often seen for actigraphy. For real-time models in healthy young adults, accuracies were above 92%, sensitivities above 95%, specificities above 83%, and all Cohen's kappa values were above 0.81 compared to polysomnography. For patients referred to a sleep examination, accuracies were above 81%, sensitivities about 89%, specificities above 53%, and Cohen's kappa values above 0.44. Sleep variable estimates showed no significant intermethod bias, but the limits of agreement were quite wide for the group of patients referred to a sleep examination. Our results indicate that the radar has the potential to offer the benefits of contact-free real-time monitoring of sleep, both for in-patients and for ambulatory home monitoring.
Collapse
Affiliation(s)
- Hanne Siri Amdahl Heglum
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Novelda AS, Trondheim, Norway
| | - Håvard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Daniel Vethe
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Knut Langsrud
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
| | - Morten Engstrøm
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
133
|
Howell CM, McCullough SJ, Doyle L, Murphy MH, Saunders KJ. Reliability and validity of the Actiwatch and Clouclip for measuring illumination in real-world conditions. Ophthalmic Physiol Opt 2021; 41:1048-1059. [PMID: 34387902 DOI: 10.1111/opo.12860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare real-world measures of illumination obtained with the Actiwatch-2 and Clouclip-M2 with 'gold standard' photometry measures and to evaluate the ability of Actiwatch-2 to correctly identify photometer-defined conditions: scotopic (≤0.01 lux), mesopic (0.02-3 lux), indoor photopic (>3-1,000 lux) and outdoor photopic (>1,000 lux); and Clouclip to correctly identify photometer-defined conditions within its operating range (>1 lux). Inter-device reliability of Clouclip for illumination and viewing distance measures was also investigated. METHODS A Hagner-S2 photometer was used as reference. Measures of illumination were obtained from a range of real-world conditions. To investigate inter-device reliability, five Clouclips were simultaneously exposed to varied light conditions and object distances. RESULTS Strong correlations existed between illumination measured with the photometer and both Actiwatch-2 (ρ = 0.99, p < 0.0001) and Clouclip (ρ = 0.99, p < 0.0001). However, both devices underestimated illumination compared to the photometer; disparity increased with increasing illumination and was greater for Actiwatch-2 than Clouclip measures. Actiwatch-2 successfully categorised illumination level (scotopic, mesopic, indoor and outdoor photopic) in 71.2% of cases. Clouclip successfully categorised illumination levels as scotopic/mesopic (≤3 lux) and indoor and outdoor photopic in 100% of cases. Mean differences and limits of agreement (LOA) were 430.92 ± 1,828.74 and 79.35 ± 407.33 lux, between the photometer and Actiwatch-2 and photometer and Clouclip, respectively. The Intra-class Correlation Coefficients for illumination and viewing distance measured with five Clouclips were 0.85 and 0.96, respectively. CONCLUSION These data illustrate that different Clouclip devices produce comparable measures of viewing distance and illumination in real-world settings. Both Actiwatch-2 and Clouclip underestimate illumination in the field compared to gold standard photometer measures. The disparity increases at higher levels of illumination and the discrepancy was greater for Actiwatch-2 measures. For researchers interested in categorising light exposure, Clouclip classifies illumination levels >2 lux more accurately than Actiwatch-2 but cannot discriminate between scotopic and low mesopic light.
Collapse
Affiliation(s)
- Colleen M Howell
- Optometry and Vision Science Research Group, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Sara J McCullough
- Optometry and Vision Science Research Group, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Lesley Doyle
- Optometry and Vision Science Research Group, School of Biomedical Sciences, Ulster University, Coleraine, UK
| | - Marie H Murphy
- Sport and Exercise Sciences Research Institute, School of Sport, Ulster University, Jordanstown, UK
| | - Kathryn J Saunders
- Optometry and Vision Science Research Group, School of Biomedical Sciences, Ulster University, Coleraine, UK
| |
Collapse
|
134
|
Wrist actigraphic approach in primary, secondary and tertiary care based on the principles of predictive, preventive and personalised (3P) medicine. EPMA J 2021; 12:349-363. [PMID: 34377218 PMCID: PMC8342270 DOI: 10.1007/s13167-021-00250-5] [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: 06/14/2021] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
Abstract Sleep quality and duration as well as activity-rest-cycles at individual level are crucial for maintaining physical and mental health. Although several methods do exist to monitor these parameters, optimal approaches are still under consideration and technological development. Wrist actigraphy is a non-invasive electro-physical method validated in the field of chronobiology to record movements and to allow for monitoring human activity-rest-cycles. Based on the continuous recording of motor activity and light exposure, actigraphy provides valuable information about the quality and quantity of the sleep–wake rhythm and about the amount of motor activity at day and night that is highly relevant for predicting a potential disease and its targeted prevention as well as personalisation of medical services provided to individuals in suboptimal health conditions and patients. Being generally used in the field of sleep medicine, actigraphy demonstrates a great potential to be successfully implemented in primary, secondary and tertiary care, psychiatry, oncology, and intensive care, military and sports medicines as well as epidemiological monitoring of behavioural habits as well as well-being medical support, amongst others. Prediction of disease development and individual outcomes Activity-rest-cycles have been demonstrated to be an important predictor for many diseases including but not restricted to the development of metabolic, psychiatric and malignant pathologies. Moreover, activity-rest-cycles directly impact individual outcomes in corresponding patient cohorts. Targeted prevention Data acquired by actigraphy are instrumental for the evidence-based targeted prevention by analysing individualised patient profiles including light exposure, sleep duration and quality, activity-rest-cycles, intensity and structure of motion pattern. Personalised therapy Wrist actigraphic approach is increasingly used in clinical care. Personalised measurements of sedation/agitation rhythms are useful for ICU patients, for evaluation of motor fatigue in oncologic patients, for an individual enhancement of performance in military and sport medicine. In the framework of personalised therapy intervention, patients can be encouraged to optimise their behavioural habits improving recovery and activity patterns. This opens excellent perspectives for the sleep-inducing medication and stimulants replacement as well as for increasing the role of participatory medicine by visualising and encouraging optimal behavioural patterns of the individual.
Collapse
|
135
|
Duivon M, Giffard B, Desgranges B, Perrier J. Are Sleep Complaints Related to Cognitive Functioning in Non-Central Nervous System Cancer? A Systematic Review. Neuropsychol Rev 2021; 32:483-505. [PMID: 34355305 DOI: 10.1007/s11065-021-09521-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
Patients with non-central nervous system (CNS) cancer frequently report cognitive complaints, that are recurrent and affect their quality of life. In order to improve supportive care of these cognitive difficulties, it is important to identify associated factors. Sleep disturbance is a good candidate to study, as patients with non-CNS cancer frequently report sleep disorders, and sleep plays a key role in cognitive functioning. The objective of the present systematic review was to summarize the results of studies evaluating the relationship between cognition and sleep in non-CNS cancer, and to highlight the need for further studies. PubMed [Medline] and Scopus databases were screened from April to November 2020 for studies published in English evaluating the association between cognition and sleep in adults with non-CNS cancer. The characteristics and risk of bias for each of the 30 included studies have been reported. Greater cognitive complaints in patients with non-CNS cancer were related to poorer self-reported sleep quality in almost all studies (n = 22/24). By contrast, around half of the studies reported a significant association between poorer neuropsychological performances and sleep complaints (n = 5/11). The studies were found to have several limitations, such as the lack of a control group, which would have shed the light on the period of occurrence of this association (e.g. after cancer diagnosis or after cancer treatments). Our review also identified factors that may influence the relationship between cognition and sleep. Recommendations are given for improving the methodology of future studies and extending the impact of their results.
Collapse
Affiliation(s)
- Mylène Duivon
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, GIP Cyceron, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Bénédicte Giffard
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, GIP Cyceron, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France.,Ligue Contre Le Cancer, Cancer & Cognition Platform, 14076, Caen, France
| | - Béatrice Desgranges
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, GIP Cyceron, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Joy Perrier
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, GIP Cyceron, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France.
| |
Collapse
|
136
|
Regulation of microRNA Expression in Sleep Disorders in Patients with Epilepsy. Int J Mol Sci 2021; 22:ijms22147370. [PMID: 34298990 PMCID: PMC8307836 DOI: 10.3390/ijms22147370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/20/2021] [Accepted: 07/02/2021] [Indexed: 12/03/2022] Open
Abstract
The effects of epilepsy on sleep and the activating effects of sleep on seizures are well documented in the literature. To date, many sleep-related and awake-associated epilepsy syndromes have been described. The relationship between sleep and epilepsy has led to the recognition of polysomnographic testing as an important diagnostic tool in the diagnosis of epilepsy. The authors analyzed the available medical database in search of other markers that assess correlations between epilepsy and sleep. Studies pointing to microRNAs, whose abnormal expression may be common to epilepsy and sleep disorders, are promising. In recent years, the role of microRNAs in the pathogenesis of epilepsy and sleep disorders has been increasingly emphasized. MicroRNAs are a family of single-stranded, non-coding, endogenous regulatory molecules formed from double-stranded precursors. They are typically composed of 21–23 nucleotides, and their main role involves post-transcriptional downregulation of expression of numerous genes. Learning more about the role of microRNAs in the pathogenesis of sleep disorder epilepsy may result in its use as a biomarker in these disorders and application in therapy.
Collapse
|
137
|
Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, Sateia MJ, Troxel WM, Zhou ES, Kazmi U, Heald JL, Martin JL. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2021; 17:263-298. [PMID: 33164741 DOI: 10.5664/jcsm.8988] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. METHODS The American Academy of Sleep Medicine commissioned a task force of 9 experts in sleep medicine and sleep psychology. A systematic review was conducted to identify randomized controlled trials that addressed behavioral and psychological interventions for the treatment of chronic insomnia disorder in adults. Statistical analyses were performed to determine if the treatments produced clinically significant improvements in a range of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation process was used to evaluate the evidence for making specific treatment recommendations. RESULTS The literature search identified 1,244 studies; 124 studies met the inclusion criteria, and 89 studies provided data suitable for statistical analyses. Evidence for the following interventions is presented in this review: cognitive-behavioral therapy for insomnia, brief therapies for insomnia, stimulus control, sleep restriction therapy, relaxation training, sleep hygiene, biofeedback, paradoxical intention, intensive sleep retraining, and mindfulness. This review provides a detailed summary of the evidence along with the quality of evidence, the balance of benefits vs harms, patient values and preferences, and resource use considerations.
Collapse
Affiliation(s)
- Jack D Edinger
- National Jewish Health, Denver, Colorado.,Duke University Medical Center, Durham, North Carolina
| | - J Todd Arnedt
- Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Suzanne M Bertisch
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Eric S Zhou
- Harvard Medical School, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | - Uzma Kazmi
- American Academy of Sleep Medicine, Darien, Illinois
| | | | - Jennifer L Martin
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California
| |
Collapse
|
138
|
Peter-Derex L, Subtil F, Lemaitre G, Ricordeau F, Bastuji H, Bridoux A, Onen F, Onen SH. Observation and Interview-based Diurnal Sleepiness Inventory for measurement of sleepiness in patients referred for narcolepsy or idiopathic hypersomnia. J Clin Sleep Med 2021; 16:1507-1515. [PMID: 32406372 DOI: 10.5664/jcsm.8574] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES First, to determine whether the 3-item Observation and Interview-based Diurnal Sleepiness Inventory (ODSI) measures the degree of excessive daytime sleepiness in patients with suspected narcolepsy or idiopathic hypersomnia (IH). Second, to assess the correlation between the ODSI and the Epworth Sleepiness Scale (ESS) as well as objective polysomnographic measurements. Third, to test the accuracy of the ODSI to detect narcolepsy or IH (narcolepsy/IH) compared with the ESS. METHODS A total of 181 patients complaining of excessive daytime sleepiness filled in the ESS and the ODSI and underwent measurements including actigraphy, full-night polysomnography, Multiple Sleep Latency Test, and 24-hour bedrest sleep recording. RESULTS Narcolepsy or IH was diagnosed in 76 patients. The ODSI found excessive daytime sleepiness in 92.3% of all patients and in 98.7% of those diagnosed with narcolepsy/IH. In the whole population, the ODSI was significantly positively correlated with the ESS (R = .547; 95% confidence interval: .436, .642; P < .001) and weakly with 24-hour total sleep time on bedrest recording (R = .208; 95% confidence interval: .056, .350; P = .047) but not with the Multiple Sleep Latency Test. The ODSI offered a higher negative (92.9%) and positive (44.9%) predictive value to detect narcolepsy/IH than did the ESS (66.7% and 43.3%, respectively). In the IH group, the ODSI's third-item score (daily sleepiness duration) was significantly higher in patients with than without increased 24-hour total sleep time (P = .023). CONCLUSIONS The ODSI is a brief, simple first-line questionnaire that explores both intensity and duration of daytime sleepiness and offers a high sensitivity to detect narcolepsy and IH.
Collapse
Affiliation(s)
- Laure Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon 1 University, Lyon, France.,Lyon Neuroscience Research Center, CNRS 5292, INSERM U1028, Lyon, France
| | - Fabien Subtil
- Lyon 1 University, Lyon, France.,Service de Biostatistiques, Hospices Civils de Lyon, Lyon, France.,Laboratoire de Biométrie et Biologie Évolutive, CNRS UMR 5558, Villeurbanne, France
| | | | - François Ricordeau
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Hélène Bastuji
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon Neuroscience Research Center, CNRS 5292, INSERM U1028, Lyon, France
| | - Agathe Bridoux
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fannie Onen
- Centre Hospitalier Universitaire Bichat Claude Bernard, Service de gériatrie, Assistance Publique, Hôpitaux de Paris, Paris, France.,INSERM 1178 and Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris Sud, Paris, France.,Center for Sleep and Circadian Neurobiology, Division of Sleep Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - S-Hakki Onen
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,Lyon Neuroscience Research Center, CNRS 5292, INSERM U1028, Lyon, France
| |
Collapse
|
139
|
Milanti A, Chan DNS, Li C, So WKW. Actigraphy-measured rest-activity circadian rhythm disruption in patients with advanced cancer: a scoping review. Support Care Cancer 2021; 29:7145-7169. [PMID: 34142279 DOI: 10.1007/s00520-021-06317-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/25/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Patients with later-stage cancer have been reported to demonstrate more disrupted rest-activity circadian rhythms (RACR) than those with earlier-stage cancer, but consolidated evidence of this is lacking. The aim of this review was to examine and map the existing evidence on actigraphy-measured RACR in terms of their (1) pattern, (2) prevalence, (3) related factors, and (4) outcomes in advanced cancer patients. METHODS A comprehensive scoping review was conducted using Arksey and O'Malley's framework. A literature search was performed using nine databases: MEDLINE, Embase, PsycINFO, CINAHL, British Nursing Index, Cochrane Library, Scopus, Web of Science, and SINTA. RESULTS Twenty-one studies were included in the review. Compared with the healthy population, advanced cancer patients were more likely to display weaker RACR, manifesting as lower activity levels during the day, more frequent and longer daytime naps, and fragmented nighttime sleep. The prevalence of RACR disruption among advanced cancer patients ranged from 31.3 to 54.9%. It was found to be linked to the presence of physical and psychological symptoms (fatigue, appetite loss, pain, dyspnoea, sleep disturbance, depression, and anxiety), chemotherapy, male sex, and also predict the lower quality of life and survival. CONCLUSION Disruption of the RACR is prevalent in advanced cancer patients and is associated with a set of physical and psychological symptoms. It was also found to be a predictor of the quality of life and survival among these patients. These results indicate the importance of interventions to restabilise the disrupted RACR among advance cancer patients to improve their health outcomes.
Collapse
Affiliation(s)
- Ariesta Milanti
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
| | - Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Caixia Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| |
Collapse
|
140
|
Savage CLG, Orth RD, Jacome AM, Bennett ME, Blanchard JJ. "Assessing the Psychometric Properties of the PROMIS Sleep Measures in Persons with Psychosis.". Sleep 2021; 44:6292152. [PMID: 34086964 DOI: 10.1093/sleep/zsab140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/28/2021] [Indexed: 11/14/2022] Open
Abstract
An accumulation of research has indicated that persons with psychotic disorders experience a variety of sleep disturbances. However, few studies have examined the psychometric properties of sleep assessments that are utilized in this population. We conducted two studies to examine the reliability and validity of the PROMISTM Sleep Disturbance and Sleep-Related Impairment scales in outpatient samples of persons with psychosis. In Study 1, we examined the internal consistency and convergent validity of the PROMIS sleep scales in individuals with various psychotic disorders (N = 98) and healthy controls (N = 22). The PROMIS sleep scales showed acceptable internal consistency and convergent validity in both healthy controls and individuals with psychotic disorders. In addition, replicating prior research, the PROMIS scales identified greater sleep disturbance and sleep-related impairment in participants with psychotic disorders compared to healthy controls. In Study 2, we examined the test-retest reliability (M = 358 days) of the PROMIS sleep scales in a subset (N = 37) of persons with psychotic disorders who previously participated in Study 1. We also assessed the relation between these self-report measures and actigraph sleep parameters. The results showed that PROMIS sleep measures demonstrated modest temporal stability in the current sample. Contrary to our hypothesis, there was a lack of correspondence between these scales and actigraph sleep parameters. Overall, these findings indicate that the PROMIS sleep scales are psychometrically sound measures for populations with psychosis and highlight the importance of utilizing a multi-method approach to assess sleep.
Collapse
Affiliation(s)
| | - Ryan D Orth
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Anyela M Jacome
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| |
Collapse
|
141
|
Sleep, evening light exposure and perceived stress in healthy nulliparous women in the third trimester of pregnancy. PLoS One 2021; 16:e0252285. [PMID: 34081723 PMCID: PMC8174691 DOI: 10.1371/journal.pone.0252285] [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: 08/28/2020] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
Objective Sleep disturbances are common in pregnancy, and the prevalence increases during the third trimester. The aim of the present study was to assess sleep patterns, sleep behavior and prevalence of insomnia in pregnant women in the third trimester, by comparing them to a group of non-pregnant women. Further, how perceived stress and evening light exposure were linked to sleep characteristics among the pregnant women were examined. Methods A total of 61 healthy nulliparous pregnant women in beginning of the third trimester (recruited from 2017 to 2019), and 69 non-pregnant women (recruited in 2018) were included. Sleep was monitored by actigraphy, sleep diaries and the Bergen Insomnia Scale. The stress scales used were the Relationship Satisfaction Scale, the Perceived Stress Scale and the Pre-Sleep Arousal Scale. Total white light exposure three hours prior to bedtime were also assessed. Results The prevalence of insomnia among the pregnant women was 38%, with a mean score on the Bergen Insomnia Scale of 11.2 (SD = 7.5). The corresponding figures in the comparing group was 51% and 12.3 (SD = 7.7). The pregnant women reported lower sleep efficiency (mean difference 3.8; 95% CI = 0.3, 7.3), longer total sleep time derived from actigraphy (mean difference 59.0 minutes; 95% CI = 23.8, 94.2) and higher exposure to evening light (mean difference 0.7; 95% CI = 0.3, 1.2), compared to the non-pregnant group. The evening light exposure was inversely associated with total sleep time derived from actigraphy (B = -8.1; 95% CI = -14.7, -1.5), and an earlier midpoint of sleep (B = -10.3, 95% CI = -14.7, -5.9). Perceived stressors were unrelated to self-reported and actigraphy assessed sleep. Conclusion In healthy pregnant participants sleep in the third trimester was preserved quite well. Even so, the data suggest that evening light exposure was related to shorter sleep duration among pregnant women.
Collapse
|
142
|
Boggero IA, Krietsch KN, Pickerill HM, Byars KC, Homan KJ, Williams SE, King CD. Improvements in Sleep Correlate With Improvements in Clinical Outcomes Among Adolescents Undergoing Intensive Interdisciplinary Pain Treatment. Clin J Pain 2021; 37:443-453. [PMID: 33782245 PMCID: PMC8102426 DOI: 10.1097/ajp.0000000000000936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 03/09/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Intensive interdisciplinary pain treatment (IIPT) programs have been shown to restore function, improve coping, and reduce pain in adolescents with chronic pain. Yet, little is known about patients' sleep during IIPT and whether or not improvements in pain treatment outcomes are associated with changes in sleep pre-to-post IIPT treatment. The objectives of the current study were to describe sleep among adolescents entering IIPT and examine associations between sleep parameters and IIPT treatment effects. MATERIALS AND METHODS Self-reported sleep measures and clinical outcomes (eg, functional disability, coping, average pain), were collected from 44 adolescents (mean age=14.57, 68.2% female) at admission and discharge from an inpatient IIPT program. Wrist-worn actigraphy data and sleep diaries from participants' first week and last week in the program were analyzed to characterize sleep parameters. RESULTS Participants self-reported poor sleep/wake patterns, high levels of insomnia symptoms, and subclinical problems with daytime sleepiness upon admission into IIPT, although actigraphic indices of sleep from the first week of IIPT admission were only just under clinical guidelines for healthy adolescent sleep. Better self-reported sleep quality assessed via aggregated sleep diaries from the first week was associated with improvement in average pain and disability over the course of the program. Furthermore, improvements in insomnia symptoms and daytime sleepiness throughout the program were positively correlated with concurrent improvements in functional disability and coping. DISCUSSION Taken together, results suggest that sleep may be associated with IIPT treatment effects and pave the way for future research to continue examining these relationships.
Collapse
Affiliation(s)
- Ian A. Boggero
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center (CCHMC)
- Department of Oral Health Science, University of Kentucky College of Dentistry
| | - Kendra N. Krietsch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center (CCHMC)
- Department of Psychology, St. Louis Children’s Hospital
- School of Medicine, Washington University
| | - Hannah M. Pickerill
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center (CCHMC)
| | - Kelly C. Byars
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center (CCHMC)
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Pulmonary Medicine, CCHMC
| | - Kendra J. Homan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center (CCHMC)
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Sara E. Williams
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center (CCHMC)
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Christopher D. King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center (CCHMC)
- Department of Pediatrics, University of Cincinnati College of Medicine
| |
Collapse
|
143
|
Evangelista E, Rassu AL, Barateau L, Lopez R, Chenini S, Jaussent I, Dauvilliers Y. Characteristics associated with hypersomnia and excessive daytime sleepiness identified by extended polysomnography recording. Sleep 2021; 44:6010320. [PMID: 33249509 DOI: 10.1093/sleep/zsaa264] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/19/2020] [Indexed: 12/20/2022] Open
Abstract
STUDY OBJECTIVES Hypersomnolence, defined by excessive daytime sleepiness (EDS) or excessive quantity of sleep (EQS), has been associated with increased morbidity. The aim of this study was to determine the clinical and polysomnographic characteristics associated with EQS and EDS assessed objectively during extended polysomnography recording. METHODS A total of 266 drug-free subjects (201 women; mean age: 26.5 years [16.08; 60.87]) underwent 32-h bed-rest polysomnography recording preceded by polysomnography and modified multiple sleep latency test (mMSLT). Participants were categorized according to their total sleep time (bed-rest TST ≥19 h, hypersomnia), objective EDS (mean sleep latency on MSLT ≤8 min), and self-reported EDS (Epworth sleepiness scale score >10) and EQS (≥9 h/24 h per week). RESULTS Subjects with hypersomnia were often younger, with normal sleep architecture, high nighttime sleep efficiency, and severe objective EDS. No association with sex, body mass index, Epworth sleepiness scale, EQS, and depressive symptoms was detected. Subjects with objective EDS had less EQS, higher sleep efficiency, and increased hypersomnia. Discrepancies were observed between objective and self-reported measures of sleep duration and EDS. Finally, 71 subjects were identified who had objective hypersomnia and/or EDS, no medical and psychiatric conditions and normal polysomnography parameters, and therefore met the stringent criteria of idiopathic hypersomnia, an orphan disorder. CONCLUSIONS Sleep duration and EDS should be quantified using self-reported and objective measures in a controlled procedure to differentiate long sleepers, patients with hypersomnia, and patients with idiopathic hypersomnia. This will help to better understand their biology, to identify specific biomarkers, and to assess related health outcomes.
Collapse
Affiliation(s)
- Elisa Evangelista
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France.,Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| | - Anna Laura Rassu
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France
| | - Lucie Barateau
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France.,Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| | - Régis Lopez
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France.,Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| | - Sofiène Chenini
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France
| | - Isabelle Jaussent
- Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| | - Yves Dauvilliers
- Sleep Disorder Unit, Narcolepsy and Hypersomnia National Reference Center, Neurology Department, Gui-de-Chauliac Hospital, University Montpellier, France.,Institute for Neurosciences of Montpellier INM, University Montpellier, INSERM, Montpellier, France
| |
Collapse
|
144
|
Mansukhani MP, Dhankikar S, Kotagal S, Kolla BP. The influence of antidepressants and actigraphy-derived sleep characteristics on pediatric multiple sleep latency testing. J Clin Sleep Med 2021; 17:2179-2185. [PMID: 34013880 DOI: 10.5664/jcsm.9338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Research evaluating the influence of rapid eye movement suppressing antidepressants (REMS-AD) on multiple sleep latency test (MSLT) results and the value of performing actigraphy prior to this test in children and adolescents is lacking. We examined the impact of REMS-AD and actigraphy parameters on mean sleep latency (MSL) and sleep-onset REM episodes (SOREMs) on MSLT in a pediatric clinical sample. METHODS This was a retrospective chart review at a quarternary referral center. We identified 164 MSLTs conducted in patients aged less than 18 years between 2014-2017. Correlations between REMS-AD, self-reported sleep duration, actigraphy parameters and each of the outcomes (MSL and SOREMs) were examined. Regression analyses accounting for clinical characteristics were performed. RESULTS Mean age of the sample was 11.9±4.19 years, 62% were female, 28 (17%) were on REMS-AD (48% of whom were able to discontinue these medications prior to MSLT) and mean pediatric daytime sleepiness score was 21.7±6.1. MSL was 11.27±5.77 min and mean number of SOREMs 0.55±1.04. Patients on a REMS-AD at initial assessment had fewer SOREMs compared to those not taking these medications (0.17±0.19 versus 0.62±0.09; p=0.04); no difference was noted in MSL (10.36±1.10 versus 11.47±0.50; p=0.36). Increased time in bed on actigraphy (TIBa) correlated with a longer MSL and fewer SOREMs (r=0.23; p=0.04 and r=0.316; p=0.004 respectively). Following regression analyses, use of REMS-AD continued to remain associated with fewer SOREMs; greater TIBa, but not self-reported sleep duration, was associated with a longer MSL (all p<0.05). CONCLUSIONS Clinicians should account for the use of REMS-AD and utilize actigraphy to determine time in bed while interpreting the results of a pediatric MSLT.
Collapse
Affiliation(s)
| | | | - Suresh Kotagal
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN.,Department of Pediatric Neurology, Mayo Clinic, Rochester, MN
| | - Bhanu Prakash Kolla
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN.,Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| |
Collapse
|
145
|
Duffy JF, Abbott SM, Burgess HJ, Crowley SJ, Emens JS, Epstein LJ, Gamble KL, Hasler BP, Kristo DA, Malkani RG, Rahman SA, Thomas SJ, Wyatt JK, Zee PC, Klerman EB. Workshop report. Circadian rhythm sleep-wake disorders: gaps and opportunities. Sleep 2021; 44:zsaa281. [PMID: 33582815 PMCID: PMC8120340 DOI: 10.1093/sleep/zsaa281] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/02/2020] [Indexed: 01/09/2023] Open
Abstract
This White Paper presents the results from a workshop cosponsored by the Sleep Research Society (SRS) and the Society for Research on Biological Rhythms (SRBR) whose goals were to bring together sleep clinicians and sleep and circadian rhythm researchers to identify existing gaps in diagnosis and treatment and areas of high-priority research in circadian rhythm sleep-wake disorders (CRSWD). CRSWD are a distinct class of sleep disorders caused by alterations of the circadian time-keeping system, its entrainment mechanisms, or a misalignment of the endogenous circadian rhythm and the external environment. In these disorders, the timing of the primary sleep episode is either earlier or later than desired, irregular from day-to-day, and/or sleep occurs at the wrong circadian time. While there are incomplete and insufficient prevalence data, CRSWD likely affect at least 800,000 and perhaps as many as 3 million individuals in the United States, and if Shift Work Disorder and Jet Lag are included, then many millions more are impacted. The SRS Advocacy Taskforce has identified CRSWD as a class of sleep disorders for which additional high-quality research could have a significant impact to improve patient care. Participants were selected for their expertise and were assigned to one of three working groups: Phase Disorders, Entrainment Disorders, and Other. Each working group presented a summary of the current state of the science for their specific CRSWD area, followed by discussion from all participants. The outcome of those presentations and discussions are presented here.
Collapse
Affiliation(s)
- Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Sabra M Abbott
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Helen J Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | - Stephanie J Crowley
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Jonathan S Emens
- Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Lawrence J Epstein
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Karen L Gamble
- Department of Psychiatry University of Alabama at Birmingham, Birmingham, AL
| | - Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - David A Kristo
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Roneil G Malkani
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shadab A Rahman
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - S Justin Thomas
- Department of Psychiatry University of Alabama at Birmingham, Birmingham, AL
| | - James K Wyatt
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
146
|
Fedele B, McKenzie D, Williams G, Giles R, Olver J. Assessing Sleep Architecture With Polysomnography During Posttraumatic Amnesia After Traumatic Brain Injury: A Pilot Study. Neurorehabil Neural Repair 2021; 35:622-633. [PMID: 33978535 DOI: 10.1177/15459683211011241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early-onset sleep disturbance is common following moderate to severe traumatic brain injury (TBI) and often emerges while patients are in posttraumatic amnesia (PTA). However, sleep disruptions during this subacute recovery phase are not well-defined, and research often utilizes indirect measures (actigraphy) that quantify sleep based on activity. This study aims to examine sleep macro-architecture and sleep quality directly with ambulatory polysomnography (PSG) and measure endogenous salivary melatonin levels for patients experiencing PTA following moderate to severe TBI. METHOD Participants were recruited from an inpatient TBI rehabilitation unit. Nighttime PSG was administered at the patient's bedside. Two saliva specimens were collected for melatonin testing on a separate evening (24:00 and 06:00 hours) using melatonin hormone profile test kits. RESULTS Of 27 patients in whom PSG was recorded, the minimum required monitoring time occurred in n =17 (adherence: 63%) at a median of 37.0 days (quartile 1 [Q1] to quartile 3 [Q3]: 21.5-50.5) postinjury. Median non-rapid eye movement (NREM) and REM sleep proportions were similar to normal estimates. Slow-wave sleep was reduced and absent in 35.3% of patients. Sleep periods appeared fragmented, and median sleep efficiency was reduced (63.4%; Q1-Q3: 55.1-69.2). Median melatonin levels at both timepoints were outside the normal range of values specified for this test (from Australian Clinical Labs). CONCLUSION This study reports that ambulatory PSG and salivary melatonin assessment are feasible for patients experiencing PTA and offers new insight into the extent of sleep disturbance. Further research is necessary to understand associations between PTA and sleep disturbance.
Collapse
Affiliation(s)
- Bianca Fedele
- Epworth HealthCare, Melbourne, Victoria, Australia.,Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Dean McKenzie
- Epworth HealthCare, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Gavin Williams
- Epworth HealthCare, Melbourne, Victoria, Australia.,Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Victoria, Australia.,The University of Melbourne, Melbourne, Victoria, Australia
| | - Robert Giles
- Epworth HealthCare, Melbourne, Victoria, Australia
| | - John Olver
- Epworth HealthCare, Melbourne, Victoria, Australia.,Epworth Monash Rehabilitation Medicine (EMReM) Unit, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
147
|
Kundel V, Reid M, Fayad Z, Ayappa I, Mani V, Rueschman M, Redline S, Shea S, Shah N. Sleep duration and vascular inflammation using hybrid positron emission tomography/magnetic resonance imaging: results from the Multi-Ethnic Study of Atherosclerosis (MESA). J Clin Sleep Med 2021; 17:2009-2018. [PMID: 33969819 DOI: 10.5664/jcsm.9382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Short sleep duration (SD) is associated with cardiovascular disease (CVD). We investigated the relationship between objective SD and subclinical atherosclerosis employing hybrid PET/MRI with 18F-FDG tracer in the MESA cohort. METHODS We utilized data from MESA-SLEEP and MESA-PET ancillary studies. SD and sleep fragmentation index (SFI) were assessed using 7-day actigraphy. The primary and secondary outcomes were carotid inflammation, defined using target-to-background ratios (TBR), and measures of carotid wall remodeling (carotid wall thickness [CWT]), summarized by SD category. Multivariate linear regression was performed to assess the association between SD and SFI with the primary/secondary outcomes, adjusting for several covariates including apnea-hypopnea index (AHI), and CVD risk. RESULTS Our analytical sample (n=58) was 62% female (mean age 68±8.4 years). Average SD was 5.1±0.9 hours in the short SD group (≤6 hours/night, 31%), and 7.1±0.8 hours in the normal SD group (69%). Prevalence of pathologic vascular inflammation (TBRmax>1.6) was higher in the short SD group (89% vs. 53%, p=0.009). Those with short SD had a higher TBRmax (1.77 vs 1.71), though this was not statistically significant (p=0.39). CWT was positively correlated with SFI even after adjusting for covariates (Beta [SE]=0.073±[0.032], p=0.025). CONCLUSIONS Prevalence of pathologic vascular inflammation was higher among those who slept ≤6 hours, and vascular inflammation was higher among those with a SD of ≤6 hours. Interestingly, SFI was positively correlated with CWT even after adjustment for covariates. Our results are hypothesis-generating but suggest that both habitual SD and SFI should be investigated in future studies as potential risk factors for subclinical atherosclerosis.
Collapse
Affiliation(s)
- Vaishnavi Kundel
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Zahi Fayad
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Indu Ayappa
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Venkatesh Mani
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Steven Shea
- Department of Medicine, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Neomi Shah
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
148
|
Loock AS, Khan Sullivan A, Reis C, Paiva T, Ghotbi N, Pilz LK, Biller AM, Molenda C, Vuori-Brodowski MT, Roenneberg T, Winnebeck EC. Validation of the Munich Actimetry Sleep Detection Algorithm for estimating sleep-wake patterns from activity recordings. J Sleep Res 2021; 30:e13371. [PMID: 33960551 DOI: 10.1111/jsr.13371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Abstract
Periods of sleep and wakefulness can be estimated from wrist-locomotor activity recordings via algorithms that identify periods of relative activity and inactivity. Here, we evaluated the performance of our Munich Actimetry Sleep Detection Algorithm. The Munich Actimetry Sleep Detection Algorithm uses a moving 24-h threshold and correlation procedure estimating relatively consolidated periods of sleep and wake. The Munich Actimetry Sleep Detection Algorithm was validated against sleep logs and polysomnography. Sleep-log validation was performed on two field samples collected over 54 and 34 days (median) in 34 adolescents and 28 young adults. Polysomnographic validation was performed on a clinical sample of 23 individuals undergoing one night of polysomnography. Epoch-by-epoch analyses were conducted and comparisons of sleep measures carried out via Bland-Altman plots and correlations. Compared with sleep logs, the Munich Actimetry Sleep Detection Algorithm classified sleep with a median sensitivity of 80% (interquartile range [IQR] = 75%-86%) and specificity of 91% (87%-92%). Mean onset and offset times were highly correlated (r = .86-.91). Compared with polysomnography, the Munich Actimetry Sleep Detection Algorithm reached a median sensitivity of 92% (85%-100%) but low specificity of 33% (10%-98%), owing to the low frequency of wake episodes in the night-time polysomnographic recordings. The Munich Actimetry Sleep Detection Algorithm overestimated sleep onset (~21 min) and underestimated wake after sleep onset (~26 min), while not performing systematically differently from polysomnography in other sleep parameters. These results demonstrate the validity of the Munich Actimetry Sleep Detection Algorithm in faithfully estimating sleep-wake patterns in field studies. With its good performance across daytime and night-time, it enables analyses of sleep-wake patterns in long recordings performed to assess circadian and sleep regularity and is therefore an excellent objective alternative to sleep logs in field settings.
Collapse
Affiliation(s)
- Ann-Sophie Loock
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | - Ameena Khan Sullivan
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany.,School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Catia Reis
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany.,ISAMB - Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,CENC - Sleep Medicine Center, Lisboa, Portugal
| | - Teresa Paiva
- ISAMB - Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,CENC - Sleep Medicine Center, Lisboa, Portugal
| | - Neda Ghotbi
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Luisa K Pilz
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany.,Laboratório de Cronobiologia e Sono (HCPA/UFRGS)/Graduate Program in Psychiatry and Behavioral Sciences (Universidade Federal do Rio Grande do Sul), Porto Alegre, Brazil
| | - Anna M Biller
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany.,Graduate School of Systemic Neurosciences, Ludwig Maximilian University Munich, Munich, Germany
| | - Carmen Molenda
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | | | - Till Roenneberg
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | - Eva C Winnebeck
- Institute of Medical Psychology, Ludwig Maximilian University Munich, Munich, Germany
| |
Collapse
|
149
|
Tsai SY, Lee PL, Gordon C, Cayanan E, Lee CN. Objective sleep efficiency but not subjective sleep quality is associated with longitudinal risk of depression in pregnant women: A prospective observational cohort study. Int J Nurs Stud 2021; 120:103966. [PMID: 34051587 DOI: 10.1016/j.ijnurstu.2021.103966] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 04/13/2021] [Accepted: 04/21/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleep disturbances are one of the most frequent chief complaints brought to the healthcare professionals during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide with women more likely to be affected than men. However, limited studies have prospectively investigated the association between sleep disturbances and longitudinal risk of depression in pregnant women, with no studies using actigraphy to objectively estimate daytime and nighttime sleep duration and the extent of sleep disruption. OBJECTIVES To examine the predictive and longitudinal association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women. DESIGN A prospective observational cohort study. METHODS 204 1st trimester pregnant women recruited from a university-affiliated hospital provided socio-demographic and health information, wore a wrist actigraph for 7 days, and completed Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies - Depression Scale, and Epworth Sleepiness Scale. Identical data collection procedures were implemented again in the 2nd and 3rd trimester, with each data collection scheduled at least 8 weeks apart. We estimated unadjusted and multivariable adjusted odds ratios and 95% confidence intervals to evaluate various types of sleep disturbances at 1st trimester and risk of depression at follow-ups. RESULTS 121 (59.3%) 1st trimester women had a sleep efficiency of < 85% by actigraphy, and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores > 5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency < 85% was associated with 2.71-, 3.87-, and 5.27-fold increased odds having risk of depression at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively. CONCLUSIONS Healthy pregnant women experience both objective and subjective sleep disturbances during the early trimester, with a substantial proportion of them also having high depressive symptoms throughout the pregnancy. Objectively assessed poor sleep quality in the 1st trimester, but not self-reported characteristics of disturbed sleep, may play a role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether an early intervention aiming at improving sleep may help reduce high depressive symptom risk and lower depression rate in women during pregnancy. Tweetable abstract: Objectively assessed poor sleep efficiency in the 1st trimester predicts both elevated and persistent high depressive symptoms in pregnancy.
Collapse
Affiliation(s)
- Shao-Yu Tsai
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Adjunct Supervisor, National Taiwan University Hospital, Taipei, Taiwan.
| | - Pei-Lin Lee
- Department of Internal Medicine, National Taiwan University, Taipei, Taiwan; Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; Attending Physician, Division of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Christopher Gordon
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
| | - Elizabeth Cayanan
- Academic Fellow, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; NeuroSleep, National Health and Medical Research Council Centre of Research Excellence, Sydney, Australia.
| | - Chien-Nan Lee
- Department of Obstetrics and Gynecology, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
150
|
Snow AL, Loup J, Morgan RO, Richards K, Parmelee PA, Baier RR, McCreedy E, Frank B, Brady C, Fry L, McCullough M, Hartmann CW. Enhancing sleep quality for nursing home residents with dementia: a pragmatic randomized controlled trial of an evidence-based frontline huddling program. BMC Geriatr 2021; 21:281. [PMID: 33906631 PMCID: PMC8076882 DOI: 10.1186/s12877-021-02189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/02/2021] [Indexed: 11/19/2022] Open
Abstract
Background Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency. Methods This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability. Discussion This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia. Trial registration NCT04533815, ClinicalTrials.gov, August 20, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02189-8.
Collapse
Affiliation(s)
- A Lynn Snow
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA. .,Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA.
| | - Julia Loup
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA.,Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, AL, 35404, USA
| | - Robert O Morgan
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, USA
| | - Kathy Richards
- School of Nursing, The University of Texas at Austin, Austin, TX, 78701-1412, USA
| | - Patricia A Parmelee
- Alabama Research Institute on Aging and the Department of Psychology, The University of Alabama, Gordon Palmer Hall, Tuscaloosa, AL, 35487, USA
| | - Rosa R Baier
- Brown University School of Public Health, Providence, RI, 02912, USA
| | - Ellen McCreedy
- Brown University School of Public Health, Providence, RI, 02912, USA
| | | | | | - Liam Fry
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, 78712, USA
| | - Megan McCullough
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Christine W Hartmann
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, 01854, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| |
Collapse
|