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Meneo D, Baldi E, Cerolini S, Curati S, Bastianini S, Berteotti C, Simonazzi G, Manconi M, Zoccoli G, De Bartolo P, Gelfo F, Martire VL, Baglioni C. Promoting sleep health during pregnancy for enhancing women's health: a longitudinal randomized controlled trial combining biological, physiological and psychological measures, Maternal Outcome after THERapy for Sleep (MOTHERS). BMC Psychol 2024; 12:340. [PMID: 38858743 PMCID: PMC11165884 DOI: 10.1186/s40359-024-01827-1] [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: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Sleep is vital for maintaining individuals' physical and mental health and is particularly challenged during pregnancy. More than 70% of women during the gestational period report insomnia symptoms. Sleep dysfunction in the peripartum increases the risk for a cascade of negative health outcomes during late pregnancy, birth, and postpartum. While psychological interventions are considered the first line treatment for sleep difficulties, they are still scarcely offered during pregnancy and there is a lack of longitudinal research combining psychological and physiological indices. METHODS The present protocol outlines a randomized controlled trial aimed at testing the long-term effectiveness of an automatized digitalized psychoeducational intervention for insomnia for expectant mothers complaining insomnia symptoms without comorbidity. Outcomes include physiological, hormonal, and subjective indices of maternal psychopathology, stress, and emotional processes, and sleep and wellbeing of the family system. The trial is part of a longitudinal study evaluating expectant mothers from early pregnancy (within the 15th gestational week) to 6-months postpartum through 6 observational phases: baseline (BSL), 6- and 12-weeks from BSL (FU1-FU2), 2-to-4 weeks after delivery (FU3), and 3- and 6-months after delivery (FU4-5). We plan to recruit 38 women without sleep difficulties (Group A) and 76 women with sleep difficulties (Group B). Group B will be randomly assigned to digital psychological control intervention (B1) or experimental psychoeducational intervention targeting insomnia (B2). At 3 time points, an ecological-momentary-assessment (EMA) design will be used to collect data on sleep and emotions (diaries), sleep-wake parameters (actigraphy) and stress reactivity (salivary cortisol). We will also test the DNA methylation of genes involved in the stress response as biomarkers of prenatal poor sleep. Information on partner's insomnia symptoms and new-borns' sleep will be collected at each stage. DISCUSSION The proposed protocol aims at testing an easily accessible evidence-based psychoeducational intervention for expectant mothers to help them improving sleep, health, and wellbeing in the peripartum. The results could improve the understanding and management of sleep difficulties and peripartum depression. TRIAL REGISTRATION The study protocol has been registered on 22 April 2024 with ClinicalTrials.gov Protocol Registration and Results System (PRS), ID: NCT06379074. PROTOCOL VERSION April 23, 2024.
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Affiliation(s)
- Debora Meneo
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Elisabetta Baldi
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Silvia Cerolini
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Sara Curati
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Stefano Bastianini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Chiara Berteotti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuliana Simonazzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Mauro Manconi
- Sleep Medicine Unit, Faculty of Biomedical Sciences, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Università Della Svizzera Italiana, Lugano, Switzerland
- Dot. Of Neurology, Bern University, Bern, Switzerland
| | - Giovanna Zoccoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Paola De Bartolo
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
| | - Francesca Gelfo
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Viviana Lo Martire
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Chiara Baglioni
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy.
- Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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DeMasi A, Horger MN, Scher A, Berger SE. Infant motor development predicts the dynamics of movement during sleep. INFANCY 2023; 28:367-387. [PMID: 36453144 DOI: 10.1111/infa.12519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/29/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022]
Abstract
The characteristics of infant sleep change over the first year. Generally, infants wake and move less at night as they grow older. However, acquisition of new motor skills leads to temporary increases in night waking and movement at night. Indeed, sleep-dependent movement at night is important for sensorimotor development. Nevertheless, little is known about how movement during sleep changes as infants accrue locomotor experience. The current study investigated whether infant sleep and movement during sleep were predicted by infants' walking experience. Seventy-eight infants wore an actigraph to measure physical activity during sleep. Parents reported when their infants first walked across a room >10 feet without stopping or falling. Infants in the midst of walking skill acquisition had worse sleep than an age-group estimate. Infants with more walk experience had more temporally sporadic movement during sleep and a steeper hourly increase in physical activity over the course of the night. Ongoing motor skill consolidation changes the characteristics of movement during sleep and may alter sleep state-dependent memory consolidation. We propose a model whereby changes in gross motor activity during night sleep reflect movement-dependent consolidation.
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Affiliation(s)
- Aaron DeMasi
- Department of Psychology, The Graduate Center, City University of New York (CUNY), New York, New York, USA.,Department of Psychology, The College of Staten Island, CUNY, Staten Island, New York, USA
| | - Melissa N Horger
- Department of Psychology, The Graduate Center, City University of New York (CUNY), New York, New York, USA.,Department of Psychology, The College of Staten Island, CUNY, Staten Island, New York, USA.,Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Anat Scher
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel
| | - Sarah E Berger
- Department of Psychology, The Graduate Center, City University of New York (CUNY), New York, New York, USA.,Department of Psychology, The College of Staten Island, CUNY, Staten Island, New York, USA
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Schoch SF, Castro-Mejía JL, Krych L, Leng B, Kot W, Kohler M, Huber R, Rogler G, Biedermann L, Walser JC, Nielsen DS, Kurth S. From Alpha Diversity to Zzz: Interactions among sleep, the brain, and gut microbiota in the first year of life. Prog Neurobiol 2021; 209:102208. [PMID: 34923049 DOI: 10.1016/j.pneurobio.2021.102208] [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: 07/23/2021] [Revised: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022]
Abstract
Sleep disorders have been linked to alterations of gut microbiota composition in adult humans and animal models, but it is unclear how this link develops. With longitudinal assessments in 162 healthy infants, we present a so far unrecognized sleep-brain-gut interrelationship. First, we report a link between sleep habits and gut microbiota: daytime sleep is associated with bacterial diversity, and nighttime sleep fragmentation and variability link with bacterial maturity and enterotype. Second, we demonstrate a sleep-brain-gut link: bacterial diversity and enterotype are associated with sleep neurophysiology. Third, we show that the sleep-brain-gut link is relevant in development: sleep habits and bacterial markers predict behavioral-developmental outcomes. Our results demonstrate the dynamic interplay between sleep, gut microbiota, and the maturation of brain and behavior during infancy, which aligns with the lately emerging concept of a sleep-brain-gut axis. Importantly, sleep and gut microbiota represent promising health targets since both can be modified non-invasively. As many adult diseases root in early childhood, leveraging protective factors of adequate sleep and age-appropriate gut microbiota in infancy could constitute a health promoting factor across the entire human lifespan.
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Affiliation(s)
- S F Schoch
- Department of PulmonOlogy, University Hospital Zurich, Zurich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | | | - L Krych
- Department of Food Science, University of Copenhagen, Denmark
| | - B Leng
- Department of Food Science, University of Copenhagen, Denmark
| | - W Kot
- Department of Plant and Environmental Sciences, University of Copenhagen, Denmark
| | - M Kohler
- Department of PulmonOlogy, University Hospital Zurich, Zurich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - R Huber
- Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland; Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Switzerland
| | - G Rogler
- Department for Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - L Biedermann
- Department for Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - J C Walser
- Genetic Diversity Center, ETH Zurich, Zurich, Switzerland
| | - D S Nielsen
- Department of Food Science, University of Copenhagen, Denmark
| | - S Kurth
- Department of PulmonOlogy, University Hospital Zurich, Zurich, Switzerland; Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland; Department of Psychology, University of Fribourg, Fribourg, Switzerland.
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Schoch SF, Jenni OG, Kohler M, Kurth S. Actimetry in infant sleep research: an approach to facilitate comparability. Sleep 2019; 42:zsz083. [PMID: 30941431 PMCID: PMC6612674 DOI: 10.1093/sleep/zsz083] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/31/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Only standardized objective assessments reliably capture the large variability of sleep behavior in infancy, which is the most pronounced throughout the human lifespan. This is important for clinical practice as well as basic research. Actimetry is a cost-efficient method to objectively estimate infant sleep/wake behavior from limb movements. Nevertheless, the standardization of actimetry-based sleep/wake measures is limited by two factors: the use of different computational approaches and the bias towards measuring only nighttime sleep-neglecting ~20 % of sleep infants obtain during daytime. Thus, we evaluate the comparability of two commonly used actimetry algorithms in infants and propose adjustments to increase comparability. METHODS We used actimetry in 50 infants for 10 continuous days at ages 3, 6, and 12 months in a longitudinal approach. We analyzed the infants' sleep/wake behaviors by applying two algorithms: Sadeh and Oakley/Respironics. We compared minute-by-minute agreement and Kappa between the two algorithms, as well as the algorithms with sleep/wake measures from a comprehensive 24-hour parent-reported diary. RESULTS Agreement between uncorrected algorithms was moderate (77%-84%). By introducing a six-step adjustment, we increased agreement between algorithms (96%-97%) and with the diary. This decreased the difference in estimated sleep behaviors, e.g. Total Sleep Duration from 4.5 to 0.2 hours. CONCLUSIONS These adjustments enhance comparability between infant actimetry studies and the inclusion of parent-reported diaries allows the integration of daytime sleep. Objectively assessed infant sleep that is comparable across different studies supports the establishment of normative developmental trajectories and clinical cutoffs.
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Affiliation(s)
- Sarah F Schoch
- Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Oskar G Jenni
- Child Development Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center CRC, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland
| | - Salome Kurth
- Pulmonary Clinic, University Hospital Zurich, Zurich, Switzerland
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Ferreira ABD, Schaedler T, Mendes JV, Anacleto TS, Louzada FM. Circadian ontogeny through the lens of nonparametric variables of actigraphy. Chronobiol Int 2019; 36:1184-1189. [PMID: 31272231 DOI: 10.1080/07420528.2019.1636814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Studies focusing on human rhythmicity show that human circadian rhythm suffers constant changes across lifespan. Changes in rest-activity patterns can be studied through nonparametric variables of actigraphy: L5 (an individual's least active 5 h), M10 (an individual's most active 10 h) and RA (relative amplitude of the rest-activity rhythm). The variable RA is the normalized difference between L5 and M10 - the higher the RA, the greater the difference between these two variables. This study used the data bank of the Human Chronobiology Laboratory of Federal University of Paraná (Brazil). It analyzed actimetric data of 93 children between 4 and 11 years of age in their naturalistic context in order to describe the development of nonparametric variables. Correlation between age and L5 was significantly negative (rho = - 0.29, p = 0.004), while correlation between age and RA was significantly positive (rho = 0.31, p = 0.003). The variables M10, sL5 (start of L5) and sM10 (start of M10) did not show significant correlation to age. Furthermore, there were no statistical differences between genders. The population of this study, healthy children, has been poorly assessed by similar literature. Through our results, we have demonstrated that, as children age, L5 significantly decreases, which reflects a smaller fragmentation of circadian rhythm. As an expected consequence, RA significantly increases. In other words, these nonparametric variables of actimetry successfully demonstrate that children tend to reduce nocturnal activity as they age, a phenomenon that reflects the ongoing consolidation of circadian rhythm.
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Affiliation(s)
| | - Thais Schaedler
- a Department of Physiology, Federal University of Paraná , Curitiba , Brazil
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Atun-Einy O, Tonetti L, Boreggiani M, Natale V, Scher A. Infant motor activity during sleep: Simultaneous use of two actigraphs comparing right and left legs. Hum Mov Sci 2017; 57:357-365. [PMID: 28964551 DOI: 10.1016/j.humov.2017.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 01/21/2023]
Abstract
Motor asymmetry during the first hours of sleep documented in adults found higher activity in the non-dominant limb. The stage of development at which such asymmetries first appear is unknown. Twenty healthy infants were followed from 7 to 12months of age, at 3-week intervals, comparing motor activity of the right and left legs during sleep using twin actigraphs (AMI). Hour-by-hour analysis of the first seven hours of nocturnal sleep found no consistent difference in activity levels between the right and left legs. Using the standard algorithm for infants, which provides an overall estimate of sleep quality, revealed discrepancies in night waking episodes (Right versus Left) in 33% of the nights. Results pertaining to leg movement suggest that motor asymmetry is not yet present during the first year of life. However, given the large discrepancies in the detection of night waking, further investigation of the developmental course of circadian motor asymmetry is warranted.
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Affiliation(s)
- Osnat Atun-Einy
- Department of Physical Therapy, University of Haifa, Haifa, Israel.
| | - Lorenzo Tonetti
- Department of Psychology, University of Bologna, Bologna, Italy.
| | | | - Vincenzo Natale
- Department of Psychology, University of Bologna, Bologna, Italy.
| | - Anat Scher
- Department of Counseling and Human Development, University of Haifa, Haifa, Israel.
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