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Pascoe MM, Wollet AR, De La Cruz Minyety J, Vera E, Miller H, Celiku O, Leeper H, Fernandez K, Reyes J, Young D, Acquaye-Mallory A, Adegbesan K, Boris L, Burton E, Chambers CP, Choi A, Grajkowska E, Kunst T, Levine J, Panzer M, Penas-Prado M, Pillai V, Polskin L, Wu J, Gilbert MR, Mendoza T, King AL, Shuboni-Mulligan D, Armstrong TS. Assessing sleep in primary brain tumor patients using smart wearables and patient-reported data: Feasibility and interim analysis of an observational study. Neurooncol Pract 2024; 11:640-651. [PMID: 39279778 PMCID: PMC11398942 DOI: 10.1093/nop/npae048] [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: 09/18/2024] Open
Abstract
Background Sleep-wake disturbances are common and disabling in primary brain tumor (PBT) patients but studies exploring longitudinal data are limited. This study investigates the feasibility and relationship between longitudinal patient-reported outcomes (PROs) and physiologic data collected via smart wearables. Methods Fifty-four PBT patients ≥ 18 years wore Fitbit smart-wearable devices for 4 weeks, which captured physiologic sleep measures (eg, total sleep time, wake after sleep onset [WASO]). They completed PROs (sleep hygiene index, PROMIS sleep-related impairment [SRI] and Sleep Disturbance [SD], Morningness-Eveningness Questionnaire [MEQ]) at baseline and 4 weeks. Smart wearable use feasibility (enrollment/attrition, data missingness), clinical characteristics, test consistency, PROs severity, and relationships between PROs and physiologic sleep measures were assessed. Results The majority (72%) wore their Fitbit for the entire study duration with 89% missing < 3 days, no participant withdrawals, and 100% PRO completion. PROMIS SRI/SD and MEQ were all consistent/reliable (Cronbach's alpha 0.74-0.92). Chronotype breakdown showed 39% morning, 56% intermediate, and only 6% evening types. Moderate-severe SD and SRI were reported in 13% and 17% at baseline, and with significant improvement in SD at 4 weeks (P = .014). Fitbit-recorded measures showed a correlation at week 4 between WASO and SD (r = 0.35, P = .009) but not with SRI (r = 0.24, P = .08). Conclusions Collecting sleep data with Fitbits is feasible, PROs are consistent/reliable, > 10% of participants had SD and SRI that improved with smart wearable use, and SD was associated with WASO. The skewed chronotype distribution, risk and impact of sleep fragmentation mechanisms warrant further investigation. Trial Registration NCT04 669 574.
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Affiliation(s)
- Maeve M Pascoe
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alex R Wollet
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hope Miller
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Orieta Celiku
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Heather Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kelly Fernandez
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, Maryland
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Demarrius Young
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Alvina Acquaye-Mallory
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Kendra Adegbesan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Lisa Boris
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, Maryland
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Claudia P Chambers
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, Maryland
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ewa Grajkowska
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tricia Kunst
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, Maryland
| | - Jason Levine
- Center for Cancer Research Office of Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Marissa Panzer
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, Maryland
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Valentina Pillai
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, Maryland
| | - Lily Polskin
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, Maryland
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tito Mendoza
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Amanda L King
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Dorela Shuboni-Mulligan
- Frederick National Laboratory for Cancer Research, Leidos Biomedical Research, Inc, Frederick, Maryland
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Gnarra O, van der Meer J, Warncke JD, Fregolente LG, Wenz E, Zub K, Nwachukwu U, Zhang Z, Khatami R, von Manitius S, Miano S, Acker J, Strub M, Riener R, Bassetti CLA, Schmidt MH. The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study: feasibility of long-term monitoring with Fitbit smartwatches in central disorders of hypersomnolence and extraction of digital biomarkers in narcolepsy. Sleep 2024; 47:zsae083. [PMID: 38551123 DOI: 10.1093/sleep/zsae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/11/2024] [Indexed: 09/10/2024] Open
Abstract
The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (SPHYNCS) is a multicenter research initiative to identify new biomarkers in central disorders of hypersomnolence (CDH). Whereas narcolepsy type 1 (NT1) is well characterized, other CDH disorders lack precise biomarkers. In SPHYNCS, we utilized Fitbit smartwatches to monitor physical activity, heart rate, and sleep parameters over 1 year. We examined the feasibility of long-term ambulatory monitoring using the wearable device. We then explored digital biomarkers differentiating patients with NT1 from healthy controls (HC). A total of 115 participants received a Fitbit smartwatch. Using a adherence metric to evaluate the usability of the wearable device, we found an overall adherence rate of 80% over 1 year. We calculated daily physical activity, heart rate, and sleep parameters from 2 weeks of greatest adherence to compare NT1 (n = 20) and HC (n = 9) participants. Compared to controls, NT1 patients demonstrated findings consistent with increased sleep fragmentation, including significantly greater wake-after-sleep onset (p = .007) and awakening index (p = .025), as well as standard deviation of time in bed (p = .044). Moreover, NT1 patients exhibited a significantly shorter REM latency (p = .019), and sleep latency (p = .001), as well as a lower peak heart rate (p = .008), heart rate standard deviation (p = .039) and high-intensity activity (p = .009) compared to HC. This ongoing study demonstrates the feasibility of long-term monitoring with wearable technology in patients with CDH and potentially identifies a digital biomarker profile for NT1. While further validation is needed in larger datasets, these data suggest that long-term wearable technology may play a future role in diagnosing and managing narcolepsy.
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Affiliation(s)
- Oriella Gnarra
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Switzerland
| | - Julia van der Meer
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan D Warncke
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Livia G Fregolente
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Elena Wenz
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Kseniia Zub
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Uchendu Nwachukwu
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zhongxing Zhang
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Ramin Khatami
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
| | - Sigrid von Manitius
- Clinic Barmelweid, Center for Sleep Medicine and Sleep Research, Barmelweid, Switzerland
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Silvia Miano
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Neurocenter of Southern Switzerland, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Sleep Medicine Unit, Ospedale Civico, Lugano, Switzerland
| | - Jens Acker
- Neurocenter of Southern Switzerland, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Sleep Medicine Unit, Ospedale Civico, Lugano, Switzerland
- Clinic for Sleep Medicine, Bad Zurzach, Switzerland
| | - Mathias Strub
- Clinic for Sleep Medicine, Bad Zurzach, Switzerland
- Zentrum für Schlafmedizin Basel, Basel, Switzerland
| | - Robert Riener
- Sensory-Motor Systems Lab, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Switzerland
- Zentrum für Schlafmedizin Basel, Basel, Switzerland
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Claudio L A Bassetti
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus H Schmidt
- Sleep-Wake Epilepsy Center, NeuroTec, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
- Ohio Sleep Medicine Institute, Dublin, USA
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Pellegrini M, Lannin NA, Mychasiuk R, Graco M, Kramer SF, Giummarra MJ. Measuring Sleep Quality in the Hospital Environment with Wearable and Non-Wearable Devices in Adults with Stroke Undergoing Inpatient Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3984. [PMID: 36900995 PMCID: PMC10001748 DOI: 10.3390/ijerph20053984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/02/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Sleep disturbances are common after stroke and may affect recovery and rehabilitation outcomes. Sleep monitoring in the hospital environment is not routine practice yet may offer insight into how the hospital environment influences post-stroke sleep quality while also enabling us to investigate the relationships between sleep quality and neuroplasticity, physical activity, fatigue levels, and recovery of functional independence while undergoing rehabilitation. Commonly used sleep monitoring devices can be expensive, which limits their use in clinical settings. Therefore, there is a need for low-cost methods to monitor sleep quality in hospital settings. This study compared a commonly used actigraphy sleep monitoring device with a low-cost commercial device. Eighteen adults with stroke wore the Philips Actiwatch to monitor sleep latency, sleep time, number of awakenings, time spent awake, and sleep efficiency. A sub-sample (n = 6) slept with the Withings Sleep Analyzer in situ, recording the same sleep parameters. Intraclass correlation coefficients and Bland-Altman plots indicated poor agreement between the devices. Usability issues and inconsistencies were reported between the objectively measured sleep parameters recorded by the Withings device compared with the Philips Actiwatch. While these findings suggest that low-cost devices are not suitable for use in a hospital environment, further investigations in larger cohorts of adults with stroke are needed to examine the utility and accuracy of off-the-shelf low-cost devices to monitor sleep quality in the hospital environment.
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Affiliation(s)
- Michael Pellegrini
- Department of Neuroscience, The Alfred Centre, Monash University, Melbourne, VIC 3004, Australia
| | - Natasha A. Lannin
- Department of Neuroscience, The Alfred Centre, Monash University, Melbourne, VIC 3004, Australia
- Alfred Health, Melbourne, VIC 3053, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, The Alfred Centre, Monash University, Melbourne, VIC 3004, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Austin Health, Melbourne, VIC 3084, Australia
- Department of Physiotherapy, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Sharon Flora Kramer
- Department of Neuroscience, The Alfred Centre, Monash University, Melbourne, VIC 3004, Australia
- Institute for Health Transformation, Deakin University, Melbourne, VIC 3125, Australia
| | - Melita J. Giummarra
- Department of Neuroscience, The Alfred Centre, Monash University, Melbourne, VIC 3004, Australia
- Alfred Health, Melbourne, VIC 3053, Australia
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Liu X, Yan G, Bullock L, Barksdale DJ, Logan JG. An Examination of Psychological Stress, Fatigue, Sleep, and Physical Activity in Chinese Americans. J Immigr Minor Health 2023; 25:168-175. [PMID: 35478278 DOI: 10.1007/s10903-022-01365-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 01/07/2023]
Abstract
Chinese Americans comprise the largest Asian subgroup in the U.S. Yet, little research has focused on the well-being of this population. This study aimed to (1) examine psycho-physiological health (psychological stress and fatigue) and lifestyle behaviors (sleep and physical activity) between Chinese Americans and whites, and (2) investigate whether race and lifestyle behaviors were independent predictors of psycho-physiological health. This study included 87 middle-aged healthy adults (41 Chinese Americans, 46 whites). Each participant underwent a two-night actigraphy-based sleep assessment. Chinese Americans reported higher psychological stress and fatigue, had poorer objective sleep outcomes (shorter sleep duration, lower sleep efficiency, and longer sleep onset), and engaged in lower physical activity levels than whites. Race and poor perceived sleep quality were independently associated with high psychological stress and fatigue. The findings warrant further exploration of social and cultural determinants of health in this minority group to reduce health disparities.
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Affiliation(s)
- Xiaoyue Liu
- Johns Hopkins University School of Nursing, 525 N Wolfe St Suite 530, Baltimore, MD, 21205, USA.
| | - Guofen Yan
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Linda Bullock
- University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Debra J Barksdale
- University of North Carolina at Greensboro School of Nursing, Greensboro, NC, USA
| | - Jeongok G Logan
- University of Virginia School of Nursing, Charlottesville, VA, USA
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5
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Goergen CJ, Tweardy MJ, Steinhubl SR, Wegerich SW, Singh K, Mieloszyk RJ, Dunn J. Detection and Monitoring of Viral Infections via Wearable Devices and Biometric Data. Annu Rev Biomed Eng 2022; 24:1-27. [PMID: 34932906 PMCID: PMC9218991 DOI: 10.1146/annurev-bioeng-103020-040136] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mounting clinical evidence suggests that viral infections can lead to detectable changes in an individual's normal physiologic and behavioral metrics, including heart and respiration rates, heart rate variability, temperature, activity, and sleep prior to symptom onset, potentially even in asymptomatic individuals. While the ability of wearable devices to detect viral infections in a real-world setting has yet to be proven, multiple recent studies have established that individual, continuous data from a range of biometric monitoring technologies can be easily acquired and that through the use of machine learning techniques, physiological signals and warning signs can be identified. In this review, we highlight the existing knowledge base supporting the potential for widespread implementation of biometric data to address existing gaps in the diagnosis and treatment of viral illnesses, with a particular focus on the many important lessons learned from the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Craig J Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA;
| | | | - Steven R Steinhubl
- physIQ Inc., Chicago, Illinois, USA
- Scripps Research Translational Institute, La Jolla, California, USA
| | | | - Karnika Singh
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | | | - Jessilyn Dunn
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
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Yang Y, Li C, Zhao L, Li J, Han F, Xiao F. Factors Associated with Depression and Sub-Dimension Symptoms in Adolescent Narcolepsy. Nat Sci Sleep 2021; 13:1075-1082. [PMID: 34262378 PMCID: PMC8273757 DOI: 10.2147/nss.s312000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/10/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We evaluate the association between depression symptoms, clinical features (disease onset-age, disease duration, sleep-related hallucination), sleepiness, and polysomnography parameters in adolescent narcolepsy type 1 patients. METHODS Eighty-three adolescent narcolepsy type 1 patients were involved in this cross-sectional study. Patients completed questionnaires evaluating depression symptoms (Center for Epidemiologic Studies Depression Scale) and sleepiness (Epworth Sleepiness Scale). Parameters from polysomnography and multiple sleep latency test were also collected. RESULTS Patients with depression symptoms (62.7%) have later disease onset-age. Depression symptoms were associated with sleep-related hallucination (OR = 2.75). Six independent variables were associated with sub-dimensional depression symptoms, including sleep latency, sleep efficiency, sleep-related hallucination, Epworth sleepiness scale, disease duration, and disease onset-age. CONCLUSION Sleep-related hallucination is associated with total depression symptoms in adolescent narcolepsy. Subjective sleepiness is associated with depressed affect, somatic symptoms, and interpersonal problems. Lower sleep efficiency is associated with a lack of positive affect.
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Affiliation(s)
- Yang Yang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China
| | - Chenyang Li
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China
| | - Long Zhao
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China
| | - Jing Li
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China
| | - Fang Han
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China
| | - Fulong Xiao
- Department of General Internal Medicine, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China
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Liu X, Yan G, Bullock L, Barksdale DJ, Logan JG. Sleep moderates the association between arterial stiffness and 24-hour blood pressure variability. Sleep Med 2021; 83:222-229. [PMID: 34049040 DOI: 10.1016/j.sleep.2021.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/12/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Arterial stiffness and increased blood pressure variability (BPV) are important subclinical cardiovascular diseases (CVDs). Evidence is accumulating that poor sleep is associated with subclinical CVDs. The purpose of our study was to investigate how sleep was related to arterial stiffness and BPV. We also explored whether sleep moderated the association between arterial stiffness and BPV. METHODS We conducted a cross-sectional study including 78 healthy adults aged between 35 and 64 years. Variables of interest were: 1) objective seep characteristics, assessed with a wrist actigraphy for two consecutive nights; 2) arterial stiffness, measured by carotid-femoral pulse wave velocity (cfPWV); and 3) BPV, measured using an ambulatory blood pressure monitor over 24 h and estimated by average real variability. RESULTS Lower sleep efficiency was an independent predictor of higher cfPWV and higher systolic BPV, while longer wake after sleep onset (WASO) was an independent predictor of higher cfPWV only. In addition, cfPWV showed a positive relationship with systolic BPV, and this relationship was moderated by sleep efficiency and WASO, respectively. The relationship between cfPWV and systolic BPV became stronger among individuals who had a level of sleep efficiency lower than 84% and who had WASO higher than 67 min, respectively. CONCLUSION Our study showed that poor sleep not only directly linked with arterial stiffness and BPV but also moderated the relationship between these two subclinical CVDs. These findings suggest that improving sleep quality could be a target intervention to promote cardiovascular health in clinical practice.
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Affiliation(s)
- Xiaoyue Liu
- School of Nursing, University of Virginia, United States.
| | - Guofen Yan
- School of Medicine, University of Virginia, United States
| | - Linda Bullock
- School of Nursing, University of Virginia, United States
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8
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Villarreal B, Powell T, Brock MS, Hansen S. Diagnosing narcolepsy in the active duty military population. Sleep Breath 2021; 25:995-1002. [PMID: 33629215 DOI: 10.1007/s11325-020-02163-5] [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: 07/08/2020] [Revised: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Narcolepsy type I and type II are central hypersomnias characterized by excessive daytime sleepiness and nocturnal sleep disruptions. These rare disorders make the diagnosis complex, as multiple sleep disorders are known to cause false-positive results on testing. There is a high incidence of sleep disorders in the military, and the diagnosis of narcolepsy can have serious career implications. This study looked to assess for the presence of confounding disorders in patients previously diagnosed with narcolepsy. METHODS We conducted a retrospective analysis of patients aged 18-65 previously diagnosed with narcolepsy at an outside facility, referred for repeat evaluation at the Wilford Hall Sleep Disorders Center. Previous test results from the time of original diagnosis were reviewed if available and compared with repeat evaluation which included actigraphy, in-laboratory polysomnography, and multiple sleep latency testing. RESULTS Of the 23 patients, 2 (9%) retained a diagnosis of narcolepsy after repeat testing. Ten patients (43%) had insufficient sleep syndrome, five (22%) had significant circadian rhythm sleep-wake disorders, and nine (39%) patients were diagnosed with mild obstructive sleep apnea (OSA). Four of the nine patients with OSA (44%) had supine predominant OSA. CONCLUSION Diagnostic testing for narcolepsy may be influenced by the presence of comorbid sleep disorders including sleep-disordered breathing, insufficient sleep duration, and circadian misalignment which are common in active military personnel. This study emphasizes the importance of excluding these comorbid diagnoses in this population.
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Affiliation(s)
- Bernadette Villarreal
- Department of Sleep Medicine, San Antonio Military Medical Center, Joint Base San Antonio Lackland, 2200 Bergquist Drive, Suite 1, San Antonio, TX, 78236, USA.
| | - Tyler Powell
- Department of Sleep Medicine, San Antonio Military Medical Center, Joint Base San Antonio Lackland, 2200 Bergquist Drive, Suite 1, San Antonio, TX, 78236, USA
| | - Matthew S Brock
- Department of Sleep Medicine, San Antonio Military Medical Center, Joint Base San Antonio Lackland, 2200 Bergquist Drive, Suite 1, San Antonio, TX, 78236, USA
| | - Shana Hansen
- Department of Sleep Medicine, San Antonio Military Medical Center, Joint Base San Antonio Lackland, 2200 Bergquist Drive, Suite 1, San Antonio, TX, 78236, USA
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Doroudgar S, Talwar M, Burrowes S, Wang J, Perry PJ. Use of actigraphy and sleep diaries to assess sleep and academic performance in pharmacy students. CURRENTS IN PHARMACY TEACHING & LEARNING 2021; 13:57-62. [PMID: 33131619 DOI: 10.1016/j.cptl.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 07/06/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Sleep parameters have been shown to correlate with academic performance. Current studies assessing sleep in doctor of pharmacy (PharmD) students rely on self-reported sleep parameters and academic performance. The objectives of this study were to describe and compare sleep parameters in pharmacy students using actigraphy and sleep diaries and to assess the correlation of sleep parameters with academic performance. METHODS This prospective cohort study with convenience sampling assessed sleep parameters in pharmacy students. Thirty-five students completing the second year of a PharmD program participated in the study. Participants wore actigraph watches and maintained sleep diaries for seven consecutive days during the spring and fall semesters, while classes were in session, except for one week prior to exams and the week of exams. Academic performance was tracked during fall and spring semesters. RESULTS Actigraphy and sleep diaries showed significant differences in sleep latency (SL), actual sleep time (AST), wake bouts, and sleep efficiency (SE). Actigraphy results indicated that the participants fell asleep faster (SL), slept a shorter duration (AST), had more wake bouts, and lower SE than results reported in the sleep diaries. SE and SL from the sleep diaries positively correlated with the fall semester pharmaceutical sciences course and overall spring semester academic performance. Actigraphy recorded AST correlated with performance in both semesters' clinical sciences courses. CONCLUSIONS The results of actigraphy differed from the sleep diaries. More studies are needed to assess differences in detection of sleep parameters using sleep diaries and actigraphs.
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Affiliation(s)
- Shadi Doroudgar
- Touro University California, College of Pharmacy, 1310 Club Drive, Vallejo, CA 94592, United States; Department of Medicine, Stanford University School of Medicine, Stanford, California, United States.
| | - Mehek Talwar
- Touro University California, College of Pharmacy, 1310 Club Drive, Vallejo, CA 94592, United States.
| | - Sahai Burrowes
- Touro University California, College of Pharmacy, 1310 Club Drive, Vallejo, CA 94592, United States; Department of Medicine, Stanford University School of Medicine, Stanford, California, United States.
| | - John Wang
- Touro University California, College of Pharmacy, 1310 Club Drive, Vallejo, CA 94592, United States.
| | - Paul J Perry
- Touro University California, College of Pharmacy, 1310 Club Drive, Vallejo, CA 94592, United States.
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