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Kudo M, Ayabe N, Takeshima M, Ogasawara M, Itoh Y, Yoshizawa K, Kitamura S, Mishima K. Association between sleep state misperception and bedtime behavior in patients with chronic insomnia. Sci Rep 2024; 14:13991. [PMID: 38886489 PMCID: PMC11183147 DOI: 10.1038/s41598-024-64355-3] [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: 01/12/2024] [Accepted: 06/07/2024] [Indexed: 06/20/2024] Open
Abstract
Previous studies on sleep state misperception have objectively evaluated sleep status in special environments using polysomnography. There is a paucity of data from studies that evaluated habitual sleep status in home environments. The present study aimed to investigate sleep state misperception in the home environment of patients with chronic insomnia using a lumbar-worn actigraphy to identify sleep habits associated with sleep state misperception severity. Thirty-one patients and 42 healthy volunteers were included in the insomnia and non-insomnia group, respectively. Participants recorded subjective assessments in sleep diaries, objective assessments with an actigraphy worn for 14 days, and self-assessments using questionnaires. Both groups had similar objective sleep ratings; however, insomnia group had significantly worse subjective ratings (total sleep time, wake after sleep onset, and sleep onset latency). A significant correlation was found between subjective and objective total sleep time scores in non-insomnia group but not in insomnia group. Insomnia group had earlier bedtimes, significantly longer bedtimes, and impaired daytime functioning (Sheehan Disability Scale score); additionally, they underestimated their total sleep time, particularly with earlier bedtimes and longer laying durations. Monitoring the sleep status and habits of individuals in home environments could be instrumental in identifying key points for targeted interventions on sleep hygiene and cognitive behavioral therapy for insomnia.
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Affiliation(s)
- Mizuki Kudo
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan
| | - Naoko Ayabe
- Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, 1-1 Tegata-Gakuenmachi, Akita, 010-8502, Japan
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan
| | - Masaya Ogasawara
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan
| | - Yu Itoh
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan
| | - Kazuhisa Yoshizawa
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan
| | - Shingo Kitamura
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan
| | - Kazuo Mishima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, 010-8543, Japan.
- Department of Sleep-Wake Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Tokyo, Japan.
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Klyne DM, Hall M. Is sleep the new treatment for pain? Two issues need resolving before deciding. Sleep 2024; 47:zsae089. [PMID: 38632974 PMCID: PMC11168756 DOI: 10.1093/sleep/zsae089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- David M Klyne
- NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Michelle Hall
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, University of Sydney, Sydney, NSW, Australia
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Hu S, Chen Y, Chen J, Guo Y, Li Y, Shao Y, Yao P, Lu L, Tang X, Sun H. The insensitivity of sleep to an unfamiliar sleeping environment in patients with insomnia disorder. Sleep Breath 2024; 28:467-473. [PMID: 37747601 DOI: 10.1007/s11325-023-02914-0] [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: 05/26/2023] [Revised: 08/14/2023] [Accepted: 09/04/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Sleeping in an unfamiliar environment, such as a sleep laboratory, is thought to disturb sleep in healthy individuals and could express a hyperarousal state called the first night effect. Insomnia disorder (ID) is a highly prevalent health problem characterized by increased arousal during the night and daytime. Whether or not a similar phenomenon occurs in patients with ID is unclear. This study aimed to investigate the effect of an unfamiliar environment on the sleep of patients with ID. METHODS In an unfamiliar sleep laboratory, polysomnographic recording testing was performed for two consecutive nights in patients with ID and age- and sex-matched healthy control subjects (HC). We collected sleep diaries and questionnaires regarding sleep, medical conditions, psychological status, and health history. Sleep continuity and architecture in both groups were compared and analyzed for two consecutive nights. RESULTS Participants with ID (n = 39) and HC (n = 35) demonstrated differentially poor sleep on laboratory adaptation after exposure to the sleep laboratory. Patients with ID had longer rapid eye movement (REM) latency on the first night than on the second sleep night. HC showed increased duration and percentage of N1, decreased duration and percentage of N3, and decreased REM percentage during initial nights compared to subsequent nights. The other sleep variables showed no differences between the first and second sleep nights in patients with ID and HC. CONCLUSIONS An unfamiliar sleep environment does not aggravate the disruption of sleep continuity and sleep architecture but only affects the REM latency in patients with ID compared with HC.
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Affiliation(s)
- Sifan Hu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Yun Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Jie Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Yupeng Guo
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Yuezhen Li
- Department of Neuropsychiatry, Behavioral Neurology and Sleep Center, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yan Shao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Ping Yao
- Mental Health Institute of Inner Mongolia Autonomous Region, The Third Hospital of Inner Mongolia Autonomous Region, Hohhot, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, State Key Laboratory of Biotherapy, Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, 51 Huayuan Bei Road, Beijing, 100191, China.
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Feigl B, Lewis SJ, Burr LD, Schweitzer D, Gnyawali S, Vagenas D, Carter DD, Zele AJ. Efficacy of biologically-directed daylight therapy on sleep and circadian rhythm in Parkinson's disease: a randomised, double-blind, parallel-group, active-controlled, phase 2 clinical trial. EClinicalMedicine 2024; 69:102474. [PMID: 38361993 PMCID: PMC10867415 DOI: 10.1016/j.eclinm.2024.102474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
Background New non-pharmacological treatments for improving non-motor symptoms in Parkinson's disease (PD) are urgently needed. Previous light therapies for modifying sleep behaviour lacked standardised protocols and were not personalised for an individual patient chronotype. We aimed to assess the efficacy of a biologically-directed light therapy in PD that targets retinal inputs to the circadian system on sleep, as well as other non-motor and motor functions. Methods In this randomised, double-blind, parallel-group, active-controlled trial at the Queensland University of Technology, Australia, participants with mild to moderate PD were computer randomised (1:1) to receive one of two light therapies that had the same photometric luminance and visual appearance to allow blinding of investigators and participants to the intervention. One of these biologically-directed lights matched natural daylight (Day Mel), which is known to stimulate melanopsin cells. The light therapy of the other treatment arm of the study, specifically supplemented the stimulation of retinal melanopsin cells (Enhanced Mel), targeting deficits to the circadian system. Both lights were administered 30 min per day over 4-weeks and personalised to an individual patient's chronotype, while monitoring environmental light exposure with actigraphy. Co-primary endpoints were a change from baseline in mean sleep macrostructure (polysomnography, PSG) and an endocrine biomarker of circadian phase (dim light melatonin secretion onset, DLMO) at weeks 4 and 6. Participants data were analysed using an intention to treat principle. All endpoints were evaluated by applying a mixed model analysis. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12621000077864. Findings Between February 4, 2021 and August 8, 2022, 144 participants with PD were consecutively screened, 60 enrolled and randomly assigned to a light intervention. There was no significant difference in co-primary outcomes between randomised groups overall or at any individual timepoint during follow-up. The mean (95% CI) for PSG, N3% was 24.15 (19.82-28.48) for Day Mel (n = 23) and 19.34 (15.20-23.47) for the Enhanced Mel group (n = 25) in week 4 (p = 0.12); and 21.13 (16.99-25.28) for Day Mel (n = 26) and 18.48 (14.34-22.62) for the Enhanced Mel group (n = 25) in week 6, (p = 0.37). The mean (95% CI) DLMO (decimal time) was 19.82 (19.20-20.44) for Day Mel (n = 22) and 19.44 (18.85-20.04) for the Enhanced Mel group (n = 24) in week 4 (p = 0.38); and 19.90 (19.27-20.53) for Day Mel (n = 23) and 19.04 (18.44-19.64) for the Enhanced Mel group (n = 25) in week 6 (p = 0.05). However, both the controlled daylight (Day Mel) and the enhanced melanopsin (Enhanced Mel) interventions demonstrated significant improvement in primary PSG sleep macrostructure. The restorative deep sleep phase (PSG, N3) significantly improved at week 6 in both groups [model-based mean difference to baseline (95% CI): -3.87 (-6.91 to -0.83), p = 0.04]. There was a phase-advance in DLMO in both groups which did not reach statistical significance between groups at any time-point. There were no safety concerns or severe adverse events related to the intervention. Interpretation Both the controlled daylight and melanopsin booster light showed efficacy in improving measures of restorative deep sleep in people with mild to moderate PD. That there was no significant difference between the two intervention groups may be due to the early disease stage. The findings suggest that controlled indoor daylight that is personalised to the individuals' chronotype could be effective for improving sleep in early to moderate PD, and further studies evaluating controlled daylight interventions are now required utilising this standardised approach, including in advanced PD. Funding The Michael J Fox Foundation for Parkinson's Research, Shake IT Up Australia, National Health and Medical Research Council, and Australian Research Council.
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Affiliation(s)
- Beatrix Feigl
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- Queensland Eye Institute, South Brisbane, QLD, 4101, Australia
| | - Simon J.G. Lewis
- Brain and Mind Centre, The University of Sydney, New South Wales, 2006, Australia
| | - Lucy D. Burr
- Department of Respiratory and Sleep Medicine, Mater Health, South Brisbane, QLD, 4101, Australia
- Mater Research, University of Queensland, QLD, 4072, Australia
| | - Daniel Schweitzer
- Centre of Neurosciences, Mater Health, South Brisbane, QLD, 4101, Australia
- Wesley Hospital, Auchenflower, QLD, 4066, Australia
| | - Subodh Gnyawali
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Drew D. Carter
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Andrew J. Zele
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
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Hu S, Shi L, Li Z, Ma Y, Li J, Bao Y, Lu L, Sun H. First-night effect in insomnia disorder: a systematic review and meta-analysis of polysomnographic findings. J Sleep Res 2024; 33:e13942. [PMID: 37254247 DOI: 10.1111/jsr.13942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 02/20/2023] [Accepted: 05/04/2023] [Indexed: 06/01/2023]
Abstract
Polysomnographic studies have been performed to investigate the first-night effect in insomnia disorder. However, these studies have revealed discrepant findings. This meta-analysis aimed to summarise and quantify the characteristics of the first-night effect in insomnia disorder. We performed a systematic search of the PubMed, Medline, EMBASE, Web of Science and PsycINFO databases to identify studies published through October 2019. A total of 11,862 articles were identified, and seven studies with eight independent populations were included in the meta-analysis. A total of 639 patients with insomnia disorder and 171 healthy controls underwent more than 2 consecutive nights of in-laboratory polysomnography. Pooled results demonstrated that both variables of sleep continuity and sleep architecture, other than slow-wave sleep were significantly altered in the first-night effect in insomnia disorder. Furthermore, the results indicated that patients with insomnia disorder had a disruption of sleep continuity in the first-night effect, including increased sleep onset latency and reduced total sleep time, compared to healthy controls. Overall, the findings show that patients with insomnia disorder experience the first-night effect, rather than reverse first-night effect, and the profiles of the first-night effect in patients with insomnia are different from healthy controls. These indicate that an adaptation night is necessary when sleep continuity and sleep architecture is to be studied in patients with insomnia disorder. More well-designed studies with large samples are needed to confirm the results.
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Affiliation(s)
- Sifan Hu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Le Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Zhe Li
- Sleep Medicine Center, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Yundong Ma
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jinyu Li
- Peking University Health Science Center, Beijing, China
| | - Yanping Bao
- National Institute on Drug Dependence, Peking University, Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
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Cox R, Rösler L, Weber FD, Blanken TF, Wassing R, Ramautar JR, Van Someren EJW. The first-night effect and the consistency of short sleep in insomnia disorder. J Sleep Res 2024; 33:e13897. [PMID: 37020309 DOI: 10.1111/jsr.13897] [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: 11/30/2022] [Revised: 02/15/2023] [Accepted: 03/16/2023] [Indexed: 04/07/2023]
Abstract
The nature and degree of objective sleep impairments in insomnia disorder remain unclear. This issue is complicated further by potential changes in sleep architecture on the first compared with subsequent nights in the laboratory. Evidence regarding differential first-night effects in people with insomnia disorder and controls is mixed. Here, we aimed to further characterize insomnia- and night-related differences in sleep architecture. A comprehensive set of 26 sleep variables was derived from two consecutive nights of polysomnography in 61 age-matched patients with insomnia and 61 good sleeper controls. People with insomnia expressed consistently poorer sleep than controls on several variables during both nights. While poorer sleep during the first night was observed in both groups, there were qualitative differences regarding the specific sleep variables expressing a first-night effect. Short sleep (total sleep time < 6 hr) was more likely during the first night and in insomnia, although approximately 40% of patients with insomnia presenting with short sleep on night 1 no longer met this criterion on night 2, which is important given the notion of short-sleeping insomnia as a robust subtype.
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Affiliation(s)
- Roy Cox
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Lara Rösler
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Frederik D Weber
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Tessa F Blanken
- Psychological Methods, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Rick Wassing
- Centre for Integrated Research and Understanding of Sleep (CIRUS), Woolcock Institute of Medical Research, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jennifer R Ramautar
- N=You Neurodevelopmental Precision Center, Amsterdam Neuroscience, Amsterdam Reproduction and Development, Amsterdam UMC, Amsterdam, The Netherlands
- Child and Adolescent Psychiatry and Psychosocial Care, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands
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Myers AM, Rech ME, Baran B, Palmer C, Mylonas D, Alfano CA. Sleep spindle activity is associated with state- and trait-based emotion in healthy school-aged children. Sleep Med 2024; 113:56-60. [PMID: 37984018 DOI: 10.1016/j.sleep.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/12/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND While connections between children's sleep and their daytime functioning are well established, less is known about the microstructural features of sleep that support emotional wellbeing. Investigating these relationships in healthy children may provide insight into adaptive emotional development. We therefore examined associations between non-rapid eye movement (N2) sleep spindles and both state- and trait-based measures of emotion. METHODS A sample of 30 children (7-11 years) without psychiatric disorders completed a baseline assessment, one night of at-home polysomnography (PSG), and an in-lab emotional state assessment the next day including self-reported arousal in response to affective images. Trait-based measures of anxiety and depression as well as savoring, a positive emotion regulatory strategy, were also completed. N2 sleep spindle parameters, including spindle density (number/min) and peak frequency in central regions, were detected using an automated algorithm. RESULTS Greater spindle density was significantly associated with decreased state-based emotional arousal towards negative affective images, and greater spindle peak frequency was associated with greater trait-based use of savoring. However, neither spindle parameter was associated with child anxiety or depressive symptoms. CONCLUSIONS Findings align with and expand on prior research to suggest that N2 sleep spindles support adaptive emotional functioning in school-aged children.
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Affiliation(s)
- Annika M Myers
- Department of Psychology, University of Houston, Health and Biomedical Sciences Building, 4349 Martin Luther King Boulevard, Houston, TX, 77204, USA
| | - Megan E Rech
- Department of Psychology, University of Houston, Health and Biomedical Sciences Building, 4349 Martin Luther King Boulevard, Houston, TX, 77204, USA
| | - Bengi Baran
- Department of Psychological and Brain Sciences, University of Iowa, 340 Iowa Ave, Iowa City, IA, 52242, USA
| | - Cara Palmer
- Department of Psychology, Montana State University, A.J.M. Johnson Hall, Bozeman, MT, 59715, USA
| | - Dimitrios Mylonas
- Massachusetts General Hospital, Harvard Medical School, 275 Cambridge St., Boston, MA, 02114, USA
| | - Candice A Alfano
- Department of Psychology, University of Houston, Health and Biomedical Sciences Building, 4349 Martin Luther King Boulevard, Houston, TX, 77204, USA.
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Lee J, Kim HC, Lee YJ, Lee S. Development of generalizable automatic sleep staging using heart rate and movement based on large databases. Biomed Eng Lett 2023; 13:649-658. [PMID: 37872992 PMCID: PMC10590335 DOI: 10.1007/s13534-023-00288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 10/25/2023] Open
Abstract
Purpose With the advancement of deep neural networks in biosignals processing, the performance of automatic sleep staging algorithms has improved significantly. However, sleep staging using only non-electroencephalogram features has not been as successful, especially following the current American Association of Sleep Medicine (AASM) standards. This study presents a fine-tuning based approach to widely generalizable automatic sleep staging using heart rate and movement features trained and validated on large databases of polysomnography. Methods A deep neural network is used to predict sleep stages using heart rate and movement features. The model is optimized on a dataset of 8731 nights of polysomnography recordings labeled using the Rechtschaffen & Kales scoring system, and fine-tuned to a smaller dataset of 1641 AASM-labeled recordings. The model prior to and after fine-tuning is validated on two AASM-labeled external datasets totaling 1183 recordings. In order to measure the performance of the model, the output of the optimized model is compared to reference expert-labeled sleep stages using accuracy and Cohen's κ as key metrics. Results The fine-tuned model showed accuracy of 76.6% with Cohen's κ of 0.606 in one of the external validation datasets, outperforming a previously reported result, and showed accuracy of 81.0% with Cohen's κ of 0.673 in another external validation dataset. Conclusion These results indicate that the proposed model is generalizable and effective in predicting sleep stages using features which can be extracted from non-contact sleep monitors. This holds valuable implications for future development of home sleep evaluation systems.
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Affiliation(s)
| | - Hee Chan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, 03080 South Korea
- Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, 08826 South Korea
| | - Yu Jin Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, 03080 South Korea
- Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul, 03080 South Korea
| | - Saram Lee
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, 03080 South Korea
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Kent D, Huyett P, Yu P, Roy A, Mehra R, Rundo JV, Stahl S, Manchanda S. Comparison of clinical pathways for hypoglossal nerve stimulation management: in-laboratory titration polysomnography vs home-based efficacy sleep testing. J Clin Sleep Med 2023; 19:1905-1912. [PMID: 37421320 PMCID: PMC10620657 DOI: 10.5664/jcsm.10712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVES We conducted this study to evaluate whether laboratory or home-based hypoglossal nerve stimulation (HNS) management would have equivalent objective and subjective obstructive sleep apnea outcomes 6 months after activation. METHODS Patients undergoing standard-of-care HNS implantation were randomly assigned in a prospective, multicenter clinical trial to either a 3-month postactivation in-laboratory titration polysomnography (tPSG) or an efficacy home sleep study (eHST) with tPSG by exception for eHST nonresponders at 5 months. Both groups underwent an eHST 6 months postactivation. RESULTS Sixty patients were randomly assigned. Patients experienced equivalent decreases in the apnea-hypopnea index (mean difference: -0.01 events/h [-8.75, 8.74]) across both groups with HNS; the selection of tPSG or eHST did not associate with therapy response rates (tPSG vs eHST: 63.2% vs 59.1%). The Epworth Sleepiness Scale (median of differences: 1 [-1, 3]) and device usage (median of differences: 0.0 hours [-1.3, 1.3]) outcomes were similar but did not meet a priori statistical equivalence criteria. CONCLUSIONS This prospective, multicenter, randomized clinical trial demonstrated that patients undergoing HNS implantation experienced statistically equivalent improvements in objective obstructive sleep apnea outcomes and similar improvements in daytime sleepiness regardless of whether they underwent tPSG. HNS titration with tPSG may not be required for all postoperative patients. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Inspire Home Study: Utilization of Home Monitoring During Therapy Optimization in Patients With an Inspire Upper Airway Stimulation System (Comparison of Home Sleep Testing vs. In-lab Polysomnography Testing) (HOME); URL: https://clinicaltrials.gov/ct2/show/NCT04416542; Identifier: NCT04416542. CITATION Kent D, Huyett P, Yu P, et al. Comparison of clinical pathways for hypoglossal nerve stimulation management: in-laboratory titration polysomnography vs home-based efficacy sleep testing. J Clin Sleep Med. 2023;19(11):1905-1912.
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Affiliation(s)
- David Kent
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Phillip Huyett
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts
| | - Phoebe Yu
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear, Boston, Massachusetts
| | - Asim Roy
- Ohio Sleep Medicine Institute, Columbus, Ohio
| | - Reena Mehra
- Sleep Disorders Center, Neurological Institute; Respiratory Institute; Cardiovascular and Metabolic Sciences, Lerner Research Institute; Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Jessica Vensel Rundo
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Stephanie Stahl
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Department of Medicine, and Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Shalini Manchanda
- Department of Otolaryngology-Head and Neck Surgery, and Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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Gervais NJ, Gravelsins L, Brown A, Reuben R, Perovic M, Karkaby L, Nicoll G, Laird K, Ramana S, Bernardini MQ, Jacobson M, Velsher L, Foulkes W, Rajah MN, Olsen RK, Grady C, Einstein G. Disturbed sleep is associated with reduced verbal episodic memory and entorhinal cortex volume in younger middle-aged women with risk-reducing early ovarian removal. Front Endocrinol (Lausanne) 2023; 14:1265470. [PMID: 37859979 PMCID: PMC10584319 DOI: 10.3389/fendo.2023.1265470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/05/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Women with early ovarian removal (<48 years) have an elevated risk for both late-life Alzheimer's disease (AD) and insomnia, a modifiable risk factor. In early midlife, they also show reduced verbal episodic memory and hippocampal volume. Whether these reductions correlate with a sleep phenotype consistent with insomnia risk remains unexplored. Methods We recruited thirty-one younger middleaged women with risk-reducing early bilateral salpingo-oophorectomy (BSO), fifteen of whom were taking estradiol-based hormone replacement therapy (BSO+ERT) and sixteen who were not (BSO). Fourteen age-matched premenopausal (AMC) and seventeen spontaneously peri-postmenopausal (SM) women who were ~10y older and not taking ERT were also enrolled. Overnight polysomnography recordings were collected at participants' home across multiple nights (M=2.38 SEM=0.19), along with subjective sleep quality and hot flash ratings. In addition to group comparisons on sleep measures, associations with verbal episodic memory and medial temporal lobe volume were assessed. Results Increased sleep latency and decreased sleep efficiency were observed on polysomnography recordings of those not taking ERT, consistent with insomnia symptoms. This phenotype was also observed in the older women in SM, implicating ovarian hormone loss. Further, sleep latency was associated with more forgetting on the paragraph recall task, previously shown to be altered in women with early BSO. Both increased sleep latency and reduced sleep efficiency were associated with smaller anterolateral entorhinal cortex volume. Discussion Together, these findings confirm an association between ovarian hormone loss and insomnia symptoms, and importantly, identify an younger onset age in women with early ovarian removal, which may contribute to poorer cognitive and brain outcomes in these women.
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Affiliation(s)
- Nicole J. Gervais
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, Netherlands
| | - Laura Gravelsins
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Alana Brown
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Rebekah Reuben
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Mateja Perovic
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Laurice Karkaby
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Gina Nicoll
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Kazakao Laird
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Shreeyaa Ramana
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Marcus Q. Bernardini
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Michelle Jacobson
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lea Velsher
- Genetics Program, North York General Hospital, Toronto, ON, Canada
| | - William Foulkes
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada
| | - M. Natasha Rajah
- Departments of Psychiatry and Douglas Research Centre, McGill University, Montreal, QC, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Rosanna K. Olsen
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Cheryl Grady
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Gillian Einstein
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
- Tema Genus, Linköping University, Linköping, Sweden
- Women’s College Research Institute, Toronto, ON, Canada
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11
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Reid MJ, Dave A, Rojo-Wissar DM, Mun CJ, Lerman SF, Buenaver L, Tennen H, Haythornthwaite J, Campbell CM, Finan P, Smith MT. Nocturnal Delta Power is Associated With Lower Next-Day Pain But Not Pain Catastrophizing: Results From a Cohort of Female Participants With Temporomandibular Joint Pain. THE JOURNAL OF PAIN 2023; 24:413-425. [PMID: 36244660 PMCID: PMC11177632 DOI: 10.1016/j.jpain.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022]
Abstract
Existing data demonstrate reduced delta power during sleep in patients with depression and chronic pain. However, there has been little examination of the relationship between delta power and pain-reports, or pain-catastrophizing. We recruited female participants (n = 111) with insomnia and temporomandibular disorder, and measured nocturnal and daytime measures of pain and pain catastrophizing, and calculated relative nocturnal delta (0.5-4 Hz) power during sleep. We fit linear regression models, and further examined the moderating effect of depressive symptom severity. Lower relative delta power across the whole night was significantly associated with greater nocturnal pain (B = -20.276, P = .025, R2 = 0.214). Lower relative delta power during the first-third of the night, was associated with greater nocturnal pain (B = -17.807, p = 0.019, R2 = 0.217), next-day pain (B = 13.876, P = .039, R2 = 0.195), and next-morning pain (B = -15.751, P = .022, R2 = 0.198). Lower relative delta power during the final-third of the night was significantly associated with greater nocturnal (B = -17.602, P = .029, R2 = 0.207) and next-morning pain (3rd: B = -14.943, P = .042, R2 = 0.187). Depressive symptom severity did not moderate these relationships. Delta power was not significantly associated with nocturnal or daytime pain catastrophizing. These findings demonstrate that greater relative delta power during sleep is associated with lower nocturnal and next-day pain in patients with temporomandibular disorder. This data may guide the use of sleep interventions in clinical pain populations, with the aim of improving pain outcomes. PERSPECTIVE: This article presents data demonstrating an association between increased nocturnal delta power and reduced next-day pain. These findings may help promote interventions which aim to increase nocturnal delta power in clinical pain populations, with the goal of improving pain outcomes.
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Affiliation(s)
- Matthew J Reid
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland.
| | - Abhishek Dave
- Department of Cognitive Sciences, University of California, Irvine, California
| | - Darlynn M Rojo-Wissar
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Chung Jung Mun
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland; Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Sheera F Lerman
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Luis Buenaver
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Howard Tennen
- Public Health Sciences, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jennifer Haythornthwaite
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Claudia M Campbell
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Patrick Finan
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Michael T Smith
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
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12
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Scott H, Lechat B, Manners J, Lovato N, Vakulin A, Catcheside P, Eckert DJ, Reynolds AC. Emerging applications of objective sleep assessments towards the improved management of insomnia. Sleep Med 2023; 101:138-145. [PMID: 36379084 DOI: 10.1016/j.sleep.2022.10.030] [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: 06/30/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
Self-reported sleep difficulties are the primary concern associated with diagnosis and treatment of chronic insomnia. This said, in-home sleep monitoring technology in combination with self-reported sleep outcomes may usefully assist with the management of insomnia. The rapid acceleration in consumer sleep technology capabilities together with their growing use by consumers means that the implementation of clinically useful techniques to more precisely diagnose and better treat insomnia are now possible. This review describes emerging techniques which may facilitate better identification and management of insomnia through objective sleep monitoring. Diagnostic techniques covered include insomnia phenotyping, better detection of comorbid sleep disorders, and identification of patients potentially at greatest risk of adverse outcomes. Treatment techniques reviewed include the administration of therapies (e.g., Intensive Sleep Retraining, digital treatment programs), methods to assess and improve treatment adherence, and sleep feedback to address concerns about sleep and sleep loss. Gaps in sleep device capabilities are also discussed, such as the practical assessment of circadian rhythms. Proof-of-concept studies remain needed to test these sleep monitoring-supported techniques in insomnia patient populations, with the goal to progress towards more precise diagnoses and efficacious treatments for individuals with insomnia.
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Affiliation(s)
- Hannah Scott
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia.
| | - Bastien Lechat
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Jack Manners
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Nicole Lovato
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Peter Catcheside
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute, Adelaide Institute for Sleep Health Flinders University, Australia
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13
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Gao C, Scullin MK. Longitudinal trajectories of spectral power during sleep in middle-aged and older adults. AGING BRAIN 2023; 3:100058. [PMID: 36911257 PMCID: PMC9997163 DOI: 10.1016/j.nbas.2022.100058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/09/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Age-related changes in sleep appear to contribute to cognitive aging and dementia. However, most of the current understanding of sleep across the lifespan is based on cross-sectional evidence. Using data from the Sleep Heart Health Study, we investigated longitudinal changes in sleep micro-architecture, focusing on whether such age-related changes are experienced uniformly across individuals. Participants were 2,202 adults (ageBaseline = 62.40 ± 10.38, 55.36 % female, 87.92 % White) who completed home polysomnography assessment at two study visits, which were 5.23 years apart (range: 4-7 years). We analyzed NREM and REM spectral power density for each 0.5 Hz frequency bin, including slow oscillation (0.5-1 Hz), delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), sigma (12-15 Hz), and beta-1 (15-20 Hz) bands. Longitudinal comparisons showed a 5-year decline in NREM delta (p <.001) and NREM sigma power density (p <.001) as well as a 5-year increase in theta power density during NREM (p =.001) and power density for all frequency bands during REM sleep (ps < 0.05). In contrast to the notion that sleep declines linearly with advancing age, longitudinal trajectories varied considerably across individuals. Within individuals, the 5-year changes in NREM and REM power density were strongly correlated (slow oscillation: r = 0.46; delta: r = 0.67; theta r = 0.78; alpha r = 0.66; sigma: r = 0.71; beta-1: r = 0.73; ps < 0.001). The convergence in the longitudinal trajectories of NREM and REM activity may reflect age-related neural de-differentiation and/or compensation processes. Future research should investigate the neurocognitive implications of longitudinal changes in sleep micro-architecture and test whether interventions for improving key sleep micro-architecture features (such as NREM delta and sigma activity) also benefit cognition over time.
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Affiliation(s)
- Chenlu Gao
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Michael K Scullin
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA
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14
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Petit JM, Strippoli MPF, Stephan A, Ranjbar S, Haba-Rubio J, Solelhac G, Heinzer R, Preisig M, Siclari F, Do KQ. Sleep spindles in people with schizophrenia, schizoaffective disorders or bipolar disorders: a pilot study in a general population-based cohort. BMC Psychiatry 2022; 22:758. [PMID: 36463186 PMCID: PMC9719140 DOI: 10.1186/s12888-022-04423-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sleep spindles have been involved in sleep stabilization and sleep-related memory mechanisms and their deficit emerged as possible biomarker in schizophrenia. However, whether this sleep phenotype is also present in other disorders that share psychotic symptoms remains unclear. To address this gap, we assessed sleep spindles in participants of a prospective population-based cohort who underwent psychiatric assessment (CoLaus|PsyCoLaus) and polysomnographic recording (HypnoLaus). METHODS Sleep was recorded using ambulatory polysomnography in participants (N = 1037) to the PsyCoLaus study. Sleep spindle parameters were measured in people with a lifelong diagnosis of schizophrenia (SZ), schizoaffective depressive (SAD), schizoaffective manic (SAM), bipolar disorder type I (BP-I) and type II (BP-II). The associations between lifetime diagnostic status (independent variables, SZ, SAD, SAM, BPD-I, BPD-II, controls) and spindle parameters (dependent variables) including density, duration, frequency and maximum amplitude, for all (slow and fast), slow- and fast-spindle were assessed using linear mixed models. Pairwise comparisons of the different spindle parameters between the SZ group and each of the other psychiatric groups was performed using a contrast testing framework from our multiple linear mixed models. RESULTS Our results showed a deficit in the density and duration of sleep spindles in people with SZ. They also indicated that participants with a diagnosis of SAD, SAM, BP-I and BP-II exhibited different sleep spindle phenotypes. Interestingly, spindle densities and frequencies were different in people with a history of manic symptoms (SAM, BP-I, and BP-II) from those without (SZ, SAD). CONCLUSIONS Although carried out on a very small number of participants due to the low prevalence of these disorders in general population, this pilot study brought new elements that argued in favor of a deficit of sleep spindles density and duration in people with schizophrenia. In addition, while we could expect a gradual change in intensity of the same sleep spindle parameters through psychotic diagnoses, our results seem to indicate a more complex situation in which the frequency of sleep spindles might be more impacted by diagnoses including a history of mania or hypomania. Further studies with a larger number of participants are required to confirm these effects.
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Affiliation(s)
- Jean-Marie Petit
- Center for Psychiatric Neuroscience (CNP), CHUV, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Route de Cery 11c, CH-1008, Prilly, Switzerland.
| | - Marie-Pierre F. Strippoli
- grid.9851.50000 0001 2165 4204Center for Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Aurélie Stephan
- grid.8515.90000 0001 0423 4662Center for Sleep Research and Investigation (CIRS), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Serateh Ranjbar
- grid.9851.50000 0001 2165 4204Center for Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - José Haba-Rubio
- grid.8515.90000 0001 0423 4662Center for Sleep Research and Investigation (CIRS), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Geoffroy Solelhac
- grid.8515.90000 0001 0423 4662Center for Sleep Research and Investigation (CIRS), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raphaël Heinzer
- grid.8515.90000 0001 0423 4662Center for Sleep Research and Investigation (CIRS), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Preisig
- grid.9851.50000 0001 2165 4204Center for Psychiatric Epidemiology and Psychopathology (CEPP), Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland
| | - Francesca Siclari
- grid.8515.90000 0001 0423 4662Center for Sleep Research and Investigation (CIRS), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Kim Q. Do
- grid.414250.60000 0001 2181 4933Center for Psychiatric Neuroscience (CNP), CHUV, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Route de Cery 11c, CH-1008 Prilly, Switzerland
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15
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Wolters F, van Middendorp H, van den Bergh O, Biermasz NR, Meijer OC, Evers AWM. Conditioning of the Cortisol Awakening Response in Healthy Males: Study Protocol for a Randomized, Controlled Trial (Preprint). JMIR Res Protoc 2022. [DOI: 10.2196/38087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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16
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Insomnia with objective short sleep duration in women with temporomandibular joint disorder: quantitative sensory testing, inflammation and clinical pain profiles. Sleep Med 2022; 90:26-35. [PMID: 35091170 PMCID: PMC8923986 DOI: 10.1016/j.sleep.2022.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/12/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/BACKGROUND Temporomandibular joint disorder (TMD) is a disabling facial pain syndrome with a high prevalence of insomnia that primarily affects women. Insomnia with objective short sleep duration (ISSD) is an emerging phenotype linked to cardiometabolic morbidity and increased mortality. The present report examines the association of ISSD on clinical and laboratory pain and systemic inflammation in TMD. METHODS We collected baseline data from 128 women with TMD and insomnia as part of a clinical trial evaluating psychological interventions for sleep and pain. Participants completed self-report questionnaires, one-night polysomnography, a two-week actigraphy assessment, quantitative sensory testing (QST) to assess cold pain tolerance, pain sensitivity and central sensitization and circulating Interleukin-6 levels were measured to assess systemic inflammation. RESULTS 24.2% (n = 31) of the sample met criteria for ISSD [polysomnography (sleep duration <6 h)]. Compared to those with insomnia and normal sleep duration, ISSD were older (40.4 vs. 34.9,p < 0.05) and a greater proportion self-identified as Black (48.4% vs 11.3%,p < 0.001). Multivariate regressions revealed that ISSD endorsed higher self-report pain severity and functional limitation of the jaw. ISSD also demonstrated increased generalized pain sensitivity, enhanced central sensitization, cold pressor tolerance and higher resting interleukin-6 levels. CONCLUSIONS This is the first study to characterize the ISSD phenotype in a chronic pain sample and expand the scope of its negative health outcomes to chronic pain. ISSD may be an important chronic pain phenotype associated with a more severe clinical and laboratory pain profile, and future studies should focus on implications for treatment response and disease trajectory. CLINICAL TRIAL ClinicalTrials.gov Identifier: NCT01794624.
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17
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Ding L, Chen B, Dai Y, Li Y. A meta-analysis of the first-night effect in healthy individuals for the full age spectrum. Sleep Med 2022; 89:159-165. [PMID: 34998093 DOI: 10.1016/j.sleep.2021.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/12/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The first-night effect (FNE) affects the accuracy of polysomnography (PSG) findings. However, the levels of FNE in different ages are unclear. METHODS We searched PubMed, Cochrane Library, Embase and Web of Science. The studies that reported sleep parameters by PSG for at least 2 consecutive nights from healthy individuals were included. The weighted mean differences were used to assess the effect size of differences in each sleep parameters between the first and second nights, as well as between the second and the third. RESULTS A total of 53 studies from 1422 subjects with mean age of 9.2-85.5 years were included. Meta-analyses showed that prolonged sleep onset latency, wake time after sleep onset and rapid eye movement sleep (REM) latency, accompanied by decreased total sleep time, sleep efficiency, and REM and increased non-rapid eye movement sleep stage 1 (N1) during the first night compared to the second (all P-value ≤ 0.001). No significant differences were observed in N2 and slow wave sleep, apnea-hypopnea index or periodic limb movement index (all P-value > 0.5). A non-linear association between FNE and age was observed: young adults (age 20-29 years) had the lowest level of FNE compared to other age ranges. Moreover, no significant differences were observed in most sleep parameters between the second and third night except more N2 and less REM in the second night (both P-value < 0.05). CONCLUSIONS The FNE exists in most cases but only in the first night of PSG recording and is less pronounced among young adults.
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Affiliation(s)
- Lei Ding
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, China; Sleep Medicine Center, Shantou University Medical College, Shantou, China
| | - Baixin Chen
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, China
| | - Yanyuan Dai
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, China; Sleep Medicine Center, Shantou University Medical College, Shantou, China
| | - Yun Li
- Department of Sleep Medicine, Shantou University Mental Health Center, Shantou, China
- Sleep Medicine Center, Shantou University Medical College, Shantou, China
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18
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Mainieri G, Loddo G, Castelnovo A, Balella G, Cilea R, Mondini S, Manconi M, Provini F. EEG Activation Does Not Differ in Simple and Complex Episodes of Disorders of Arousal: A Spectral Analysis Study. Nat Sci Sleep 2022; 14:1097-1111. [PMID: 35698590 PMCID: PMC9188335 DOI: 10.2147/nss.s360120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/24/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Disorders of arousal (DoA) are characterized by incomplete awakening from NREM sleep, with the admixture of both deep sleep and wake EEG activity. Previous observations suggested that changes in EEG activity could be detected in the seconds preceding DoA episodes. The aims of this work were to characterize the topography of EEG spectral changes prior to DoA episodes and to investigate whether or not behavioral complexity could be predicted by changes in EEG immediately preceding behavioral onsets. PATIENTS AND METHODS We collected 103 consecutive video-polysomnographic recordings of 53 DoA adult patients and classified all episodes as simple, rising and complex arousal movements. For each episode, a 5-second window preceding its motor onset ("pre-event") and a 60-second window from 2 to 3 minutes before the episodes ("baseline") were compared. Subsequently, a between-group comparison was performed for the pre-event of simpler versus the more complex episodes. RESULTS Spectral analysis over 325 DoA episodes showed an absolute significant increase prior to DoA episodes in all frequency bands excluding sigma, which displayed the opposite effect. In normalized maps, the increase was relatively higher over the central/anterior areas for both slow and fast frequency bands. No significant differences emerged from the comparison between simpler and more complex episodes. CONCLUSION Taken together, these results show that deep sleep and wake-like EEG rhythms coexist over overlapping areas before DoA episodes, suggesting an alteration of local sleep mechanisms. Episodes of different complexity are preceded by a similar EEG activation, implying that they possibly share a similar pathophysiology.
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Affiliation(s)
- Greta Mainieri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Loddo
- Department of Primary Care, Azienda AUSL di Bologna, Bologna, Italy
| | - Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Giulia Balella
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Rosalia Cilea
- Neurology Unit, "Morgagni-Pierantoni" Hospital, AUSL Romagna, Forlì, Italy
| | - Susanna Mondini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Federica Provini
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italia
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19
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Lunsford-Avery JR, Edinger JD, Krystal AD. Overnight Delta Dynamics Associated with Daytime Psychomotor Performance in Adults with Insomnia and Healthy Controls. Nat Sci Sleep 2022; 14:217-230. [PMID: 35210889 PMCID: PMC8860757 DOI: 10.2147/nss.s330939] [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: 07/29/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Sleep is vital to cognition, yet underlying mechanisms remain unclear. Although sleep duration and continuity are two well-established contributors, additional factors-including homeostatic sleep drive processes-may also underlie cognition-related sleep restoration. This study investigates the relative contributions of sleep EEG factors to psychomotor functioning in adults with insomnia and healthy controls (HC) to identify the most significant sleep factors supporting psychomotor functioning. MATERIALS AND METHODS Adults with insomnia (n = 37) and HC (n = 39) completed 3 nights of polysomnography and a complex psychomotor task (switching attention task; SAT). Univariate correlations identified the most significant predictors (traditional PSG, spectral EEG, initial delta peak, and overnight delta decline) of SAT performance, which were then entered into multivariable linear regressions examining whether predictors remained significant after accounting for shortened/fragmented sleep and whether relationships differed across groups. RESULTS In addition to greater wake after sleep onset (WASO; r = 0.33), a slower overnight delta decline (r = 0.50) and a lower initial delta peak (r = -0.38) were the most significant predictors of poorer SAT performance. Both overnight delta decline (F(7, 68) = 12.52, p < 0.001) and initial delta peak (F(7, 68) = 7.85, p = 0.007) remained significant predictors after controlling for demographics, total sleep time, and WASO. Relationships were analogous across subject groups. CONCLUSION Findings suggest that, in addition to sleep duration and continuity, processes related to recovery from and dissipation of homeostatic sleep drive may support psychomotor performance and broadly support daytime functioning in individuals with and without insomnia. Future research may examine overnight delta dynamics as transdiagnostic processes supporting cognition-related sleep restoration across a range of clinical populations.
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Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Jack D Edinger
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27710, USA.,Department of Medicine, National Jewish Health, Denver, CO, 80206, USA
| | - Andrew D Krystal
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, 27710, USA.,Departments of Psychiatry and Neurology, University of California San Francisco School of Medicine, San Francisco, CA, 94143, USA
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20
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Abstract
Digital phenotyping (DP) provides opportunities to study child and adolescent psychiatry from a novel perspective. DP combines objective data obtained from digital sensors with participant-generated "active data," in order to understand better an individual's behavior and environmental interactions. Although this new method has led to advances in adult psychiatry, its use in child psychiatry has been more limited. This review aims to demonstrate potential benefits of DP methodology and passive data collection by reviewing studies specifically in child and adolescent psychiatry. Twenty-six studies were identified that collected passive data from four different categories: accelerometer/actigraph data, physiological data, GPS data, and step count. Study topics ranged from the associations between manic symptomology and cardiac parameters to the role of daily emotions, sleep, and social interactions in treatment for pediatric anxiety. Reviewed studies highlighted the diverse ways in which objective data can augment naturalistic self-report methods in child and adolescent psychiatry to allow for more objective, ecologically valid, and temporally resolved conclusions. Though limitations exist-including a lack of participant adherence and device failure and misuse-DP technology may represent a new and effective method for understanding pediatric cognition, behavior, disease etiology, and treatment efficacy.
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21
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Lambert-Beaudet F, Journault WG, Rudziavic Provençal A, Bastien CH. Neurofeedback for insomnia: Current state of research. World J Psychiatry 2021; 11:897-914. [PMID: 34733650 PMCID: PMC8546766 DOI: 10.5498/wjp.v11.i10.897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/18/2021] [Accepted: 08/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic insomnia affects about 6%-13% of the Canadian population. Although treatments already exist, they each have their own issues. Neurofeedback is a neuromodulation technique that specifically targets abnormal brain activity and is gaining attention as a possible insomnia treatment.
AIM To review the latest studies pertaining to the use of neurofeedback in the treatment of insomnia.
METHODS In this non-systematic review, only experimental studies assessing the effects of neurofeedback on patients with insomnia were targeted across four bibliographic databases.
RESULTS A total of 12 studies were retained. All neurofeedback studies included in this study showed a clear improvement of subjective sleep. However, data concerning objective improvement are contradictory. Most studies regarding surface and z-score neurofeedback show that neurofeedback targeting the sensorimotor rhythm in the sensorimotor cortex may help improve subjective sleep. A placebo effect seems also to be present in some studies. Several limitations were present in each study.
CONCLUSION While studies concerning neurofeedback as a treatment for insomnia are encouraging, many methodological barriers remain to be resolved to prove its efficacy unequivocally. More studies using robust design parameters, as well as the replication of existing studies, are necessary to support neurofeedback as an effective treatment for insomnia.
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Affiliation(s)
| | | | | | - Célyne H Bastien
- Department of Psychology, School of Psychology Laval University, Québec G1V0A6, Canada
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22
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Wang C, Mattingly S, Payne J, Lizardo O, Hachen DS. The impact of social networks on sleep among a cohort of college students. SSM Popul Health 2021; 16:100937. [PMID: 34660878 PMCID: PMC8502769 DOI: 10.1016/j.ssmph.2021.100937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background Sleep duration and quality are associated with physical and mental wellbeing. This paper examines social network effects on individual level change in the sleep quantity and quality from late adolescence to emerging adulthood and its associated factors, including the influence of peers on sleep behavior and the impact of changes in network size. Methods We use sleep data from 619 undergraduates at the University of Notre Dame obtained via Fitbit devices as part of the NetHealth project. The data were collected between August 16, 2015 and May 13, 2017. We model trends in sleep behaviors using latent growth-curve models. Results Controlling for the many factors known to impact sleep quantity and quality, we find two social network effects: increasing network size is associated with less sleep and a student's sleep levels are influenced by his or her peers. While we do not find any consistent decline in sleep quantity over the 637 days, daily fluctuations in sleep quantity are associated with changes in network size and the composition of a student's network. As a student's network gets bigger, s/he sleeps less, and when a student's contacts sleep more (or less) than s/he does, the student becomes more like his or her contacts and sleeps more (or less). Conclusions Social networks can and do impact sleep, especially sleep quantity. In contexts where students want to have larger networks, the difficulties of increasing network size and maintaining larger networks negatively impact sleep. Because of peer influence, the effectiveness of interventions designed to improve sleep practices could be increased by leveraging student social networks to help diffuse better sleep habits. The sleep habits of 619 undergraduates were traced with Fitbit devices for 637 days. Their sleep quantity measures were relatively stable but affect by peers. Their sleep quality was slightly getting worse but not affected by peers.
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Affiliation(s)
- Cheng Wang
- Department of Sociology, Wayne State University, Detroit, MI, USA
| | - Stephen Mattingly
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Jessica Payne
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Omar Lizardo
- Department of Sociology, University of California Los Angeles, Los Angeles, CA, USA
| | - David S Hachen
- Department of Sociology, University of Notre Dame, Notre Dame, IN, USA
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23
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Stroemel-Scheder C, Lautenbacher S. Assessment of effects of total sleep deprivation and subsequent recovery sleep: a methodological strategy feasible without sleep laboratory. BMC Psychol 2021; 9:141. [PMID: 34526155 PMCID: PMC8442266 DOI: 10.1186/s40359-021-00641-3] [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: 02/26/2021] [Accepted: 08/24/2021] [Indexed: 11/11/2022] Open
Abstract
Background Sleep is critical for maintaining homeostasis in bodily and neurobehavioral functions. This homeostasis can be disturbed by sleep interruption and restored to normal by subsequent recovery sleep. Most research regarding recovery sleep (RS) effects has been conducted in specialized sleep laboratories, whereas small, less-well equipped research units may lack the possibilities to run studies in this area. Hence, the aims of the present study were to develop and validate an experimental protocol, which allows a thorough assessment of at-home recovery sleep after sleep deprivation. Methods The experimental protocol, comprising one night of baseline sleep (BL) at home, one night of monitored total sleep deprivation and a subsequent recovery night at home, was tested in a sample of 30 healthy participants. Subjects’ fatigue and alertness were assessed prior to and after each night. Sleep at home (BL, RS) was objectively assessed using portable polysomnography. To check whether our at-home sleep assessments yielded results that are comparable to those conducted in sleep laboratories, we compared the sleep data assessed in our study with sleep data assessed in laboratory studies. Results Sleep parameters assessed during RS exhibited changes as expected (prolonged total sleep time, better sleep efficiency, slow wave sleep rebound). Sleep parameters of BL and RS were in line with parameters assessed in previous studies examining sleep in a laboratory setting. Fatigue normalized after one night of RS; alertness partly recovered. Conclusions Our results suggest a successful implementation of our new experimental protocol, emphasizing it as a useful tool for future studies on RS outside of well-equipped sleep laboratories.
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Affiliation(s)
- Cindy Stroemel-Scheder
- Department of Physiological Psychology, University of Bamberg, Markusplatz 3, Bamberg, Germany.
| | - Stefan Lautenbacher
- Department of Physiological Psychology, University of Bamberg, Markusplatz 3, Bamberg, Germany
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24
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Harrison EI, Roth RH, Lobo JM, Kang H, Logan J, Patel SR, Kapur VK, Kwon Y. Sleep time and efficiency in patients undergoing laboratory-based polysomnography. J Clin Sleep Med 2021; 17:1591-1598. [PMID: 33739259 PMCID: PMC8656908 DOI: 10.5664/jcsm.9252] [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] [Indexed: 01/01/2023]
Abstract
STUDY OBJECTIVES Sleep quality in patients studied with laboratory-based polysomnography may differ from sleep quality in patients studied at home but remains clinically relevant and important to describe. We assessed objective sleep quality and explored factors associated with poor sleep in patients undergoing laboratory-based polysomnography. METHODS We reviewed diagnostic polysomnography studies from a 10-year period at a single sleep center. Total sleep time (TST) and sleep efficiency (SE) were assessed as markers of sleep quality. Poor sleep was defined as TST ≤ 4 hours or SE ≤ 50%. Multivariable analysis was performed to determine associations between objective sleep quality as an outcome and multiple candidate predictors including age, sex, race, body mass index, comorbidities, severity of obstructive sleep apnea, and central nervous system medications. RESULTS Among 4957 patients (age 53 ± 15 years), average TST and median SE were 5.8 hours and 79%, respectively. There were 556 (11%) and 406 (8%) patients who had poor sleep based on TST and SE, respectively. In multivariable analysis, those who were older (per 10 years: 1.48 [1.34, 1.63]), male (1.38 [1.14,1.68]), and had severe obstructive sleep apnea (1.76 [1.28, 2.43]) were more likely to have short sleep. Antidepressant use was associated with lower odds of short sleep (0.77 [0.59,1.00]). Older age (per 10 years: 1.48 [1.34, 1.62]), male sex (1.34 [1.07,1.68]), and severe obstructive sleep apnea (2.16 [1.47, 3.21]) were associated with higher odds of poor SE. CONCLUSIONS We describe TST and SE from a single sleep center cohort. Multiple demographic characteristics were associated with poor objective sleep in patients during laboratory-based polysomnography. CITATION Harrison EI, Roth RH, Lobo JM, et al. Sleep time and efficiency in patients undergoing laboratory-based polysomnography. J Clin Sleep Med. 2021;17(8):1591-1598.
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Affiliation(s)
- Elizabeth I. Harrison
- Division of Child Neurology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert H. Roth
- School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Jennifer M. Lobo
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Hyojung Kang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, Illinois
| | - Jeongok Logan
- Division of Child Neurology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sanjay R. Patel
- Division of Child Neurology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vishesh K. Kapur
- Division of Child Neurology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Younghoon Kwon
- Division of Child Neurology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania,Address correspondence to: Younghoon Kwon, MD, MS, Department of Medicine, University of Washington, Box 359748, 325 9th Avenue, Seattle, WA 98104;
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25
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Optimizing computation of overnight decline in delta power: Evidence for slower rate of decline in delta power in insomnia patients. Clin Neurophysiol 2021; 132:545-553. [PMID: 33450577 DOI: 10.1016/j.clinph.2020.12.004] [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: 01/22/2019] [Revised: 08/12/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the best of commonly used methods for computing the rate of decline in non-rapid eye movement (NREM) sleep EEG delta power overnight (Delta Decline) in terms of vulnerability to missing data and to evaluate whether this rate is slower in insomnia patients than healthy controls (HC). METHODS Fifty-one insomnia patients and 53 HC underwent 6 nights of polysomnography. Four methods for estimating Delta Decline were compared (exponential and linear best-fit functions using NREM (1) episode mean, (2) peak, and (3) total delta power and (4) delta power for all available NREM epochs). The best method was applied to compare groups on linear and exponential rates of Delta Decline. RESULTS Best-fit models using all available NREM epochs were significantly less vulnerable to deviation due to missing data than other methods. Insomnia patients displayed significantly slower linear and exponential Delta Decline than HC. CONCLUSIONS Computing Delta Decline using all available NREM epochs was the best of the methods studied for minimizing the effects of missing data. Insomnia patients display slower Delta Decline, which is not explained by differences in total sleep time or wake after sleep onset. SIGNIFICANCE This study supports using all available NREM epochs in Delta Decline computation and suggests a slower rate in insomnia.
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26
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Scott H, Lovato N, Lack L. The Development and Accuracy of the THIM Wearable Device for Estimating Sleep and Wakefulness. Nat Sci Sleep 2021; 13:39-53. [PMID: 33469399 PMCID: PMC7811468 DOI: 10.2147/nss.s287048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION THIM is a new wearable device worn on the finger that can passively monitor sleep and wakefulness overnight using actigraphy. This article showcases the development of the THIM sleep tracking algorithm (Study 1) and the testing of its accuracy against polysomnography (PSG) with an independent sample of good and poor sleepers (Study 2). The accuracy of THIM was compared to two popular wearables, Fitbit and Actiwatch devices. METHODS Twenty-five (Study 1) and twenty (Study 2) healthy individuals with good or poor sleep (defined by scores on the Insomnia Severity Index) slept overnight in the sleep laboratory on one night. Participants slept from their typical bedtime to their typical wake up time with simultaneous recording from PSG, THIM, Fitbit and Actiwatch devices. RESULTS In both studies, THIM had lower sensitivity (M = 0.89-0.91) compared to the Actiwatch (M = 0.95) and Fitbit devices (M = 0.96-0.98), yet higher specificity (M = 0.59 vs M = 0.32-0.59) in detecting sleep. There were no significant differences between PSG and THIM in either study for sleep onset latency, total sleep time, wake after sleep onset, or sleep efficiency, p > 0.06. Yet, there was high variability in the accuracy of all three actigraphy devices between individuals (evident on Bland-Altman plots) that was unexplained by sleep quality. DISCUSSION Together, these studies suggest that THIM is capable of monitoring sleep and wake overnight in good and poor sleepers to a similar degree of accuracy as two of the most popular actigraphy devices available. Future research will examine the accuracy of THIM for monitoring sleep in people with insomnia.
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Affiliation(s)
- Hannah Scott
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, 5001, Australia.,Adelaide Institute for Sleep Health: AFlinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, SA, 5001, Australia
| | - Nicole Lovato
- Adelaide Institute for Sleep Health: AFlinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, SA, 5001, Australia
| | - Leon Lack
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, 5001, Australia.,Adelaide Institute for Sleep Health: AFlinders Centre of Research Excellence, College of Medicine and Public Health, Flinders University, Adelaide, SA, 5001, Australia
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27
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Mouritzen NJ, Larsen LH, Lauritzen MH, Kjær TW. Assessing the performance of a commercial multisensory sleep tracker. PLoS One 2020; 15:e0243214. [PMID: 33306678 PMCID: PMC7732119 DOI: 10.1371/journal.pone.0243214] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/18/2020] [Indexed: 01/31/2023] Open
Abstract
Wearable sleep technology allows for a less intruding sleep assessment than PSG, especially in long-term sleep monitoring. Though such devices are less accurate than PSG, sleep trackers may still provide valuable information. This study aimed to validate a commercial sleep tracker, Garmin Vivosmart 4 (GV4), against polysomnography (PSG) and to evaluate intra-device reliability (GV4 vs. GV4). Eighteen able-bodied adults (13 females, M = 56.1 ± 12.0 years) with no self-reported sleep disorders were simultaneously sleep monitored by GV4 and PSG for one night while intra-device reliability was monitored in one participant for 23 consecutive nights. Intra-device agreement was considered sufficient (observed agreement = 0.85 ± 0.13, Cohen’s kappa = 0.68 ± 0.24). GV4 detected sleep with high accuracy (0.90) and sensitivity (0.98) but low specificity (0.28). Cohen’s kappa was calculated for sleep/wake detection (0.33) and sleep stage detection (0.20). GV4 significantly underestimated time awake (p = 0.001) including wake after sleep onset (WASO) (p = 0.001), and overestimated light sleep (p = 0.045) and total sleep time (TST) (p = 0.001) (paired t-test). Sleep onset and sleep end differed insignificantly from PSG values. Our results suggest that GV4 is not able to reliably describe sleep architecture but may allow for detection of changes in sleep onset, sleep end, and TST (ICC ≥ 0.825) in longitudinally followed groups. Still, generalizations are difficult due to our sample limitations.
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Affiliation(s)
- Nanna J. Mouritzen
- Department of Neurology, Center of Neurophysiology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Lisbeth H. Larsen
- Department of Neurology, Center of Neurophysiology, Zealand University Hospital, Roskilde, Denmark
| | - Maja H. Lauritzen
- Department of Neurology, Center of Neurophysiology, Zealand University Hospital, Roskilde, Denmark
| | - Troels W. Kjær
- Department of Neurology, Center of Neurophysiology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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28
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Sridhar N, Shoeb A, Stephens P, Kharbouch A, Shimol DB, Burkart J, Ghoreyshi A, Myers L. Deep learning for automated sleep staging using instantaneous heart rate. NPJ Digit Med 2020; 3:106. [PMID: 32885052 PMCID: PMC7441407 DOI: 10.1038/s41746-020-0291-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Clinical sleep evaluations currently require multimodal data collection and manual review by human experts, making them expensive and unsuitable for longer term studies. Sleep staging using cardiac rhythm is an active area of research because it can be measured much more easily using a wide variety of both medical and consumer-grade devices. In this study, we applied deep learning methods to create an algorithm for automated sleep stage scoring using the instantaneous heart rate (IHR) time series extracted from the electrocardiogram (ECG). We trained and validated an algorithm on over 10,000 nights of data from the Sleep Heart Health Study (SHHS) and Multi-Ethnic Study of Atherosclerosis (MESA). The algorithm has an overall performance of 0.77 accuracy and 0.66 kappa against the reference stages on a held-out portion of the SHHS dataset for classifying every 30 s of sleep into four classes: wake, light sleep, deep sleep, and rapid eye movement (REM). Moreover, we demonstrate that the algorithm generalizes well to an independent dataset of 993 subjects labeled by American Academy of Sleep Medicine (AASM) licensed clinical staff at Massachusetts General Hospital that was not used for training or validation. Finally, we demonstrate that the stages predicted by our algorithm can reproduce previous clinical studies correlating sleep stages with comorbidities such as sleep apnea and hypertension as well as demographics such as age and gender.
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Affiliation(s)
| | - Ali Shoeb
- Verily Life Sciences, Mountain View, CA USA
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29
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Van Someren EJW. Brain mechanisms of insomnia: new perspectives on causes and consequences. Physiol Rev 2020; 101:995-1046. [PMID: 32790576 DOI: 10.1152/physrev.00046.2019] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
While insomnia is the second most common mental disorder, progress in our understanding of underlying neurobiological mechanisms has been limited. The present review addresses the definition and prevalence of insomnia and explores its subjective and objective characteristics across the 24-hour day. Subsequently, the review extensively addresses how the vulnerability to develop insomnia is affected by genetic variants, early life stress, major life events, and brain structure and function. Further supported by the clear mental health risks conveyed by insomnia, the integrated findings suggest that the vulnerability to develop insomnia could rather be found in brain circuits regulating emotion and arousal than in circuits involved in circadian and homeostatic sleep regulation. Finally, a testable model is presented. The model proposes that in people with a vulnerability to develop insomnia, the locus coeruleus is more sensitive to-or receives more input from-the salience network and related circuits, even during rapid eye movement sleep, when it should normally be sound asleep. This vulnerability may ignite a downward spiral of insufficient overnight adaptation to distress, resulting in accumulating hyperarousal, which, in turn, impedes restful sleep and moreover increases the risk of other mental health adversity. Sensitized brain circuits are likely to be subjectively experienced as "sleeping with one eye open". The proposed model opens up the possibility for novel intervention studies and animal studies, thus accelerating the ignition of a neuroscience of insomnia, which is direly needed for better treatment.
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Affiliation(s)
- Eus J W Van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands; Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit University Amsterdam, Amsterdam, The Netherlands; and Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands
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30
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Kuula L, Halonen R, Kajanto K, Lipsanen J, Makkonen T, Peltonen M, Pesonen AK. The Effects of Presleep Slow Breathing and Music Listening on Polysomnographic Sleep Measures - a pilot trial. Sci Rep 2020; 10:7427. [PMID: 32366866 PMCID: PMC7198497 DOI: 10.1038/s41598-020-64218-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 04/08/2020] [Indexed: 02/04/2023] Open
Abstract
Knowledge on efficient ways to reduce presleep arousal and, therefore, improve sleep, is scanty. We explored the effects of presleep slow breathing and music listening conditions on sleep quality and EEG power spectral density in young adults in a randomized, controlled trial with a crossover design. Participants’ (N = 20, 50% females) sleep was measured on two consecutive nights with polysomnography (40 nights), the other night serving as the control condition. The intervention condition was either a 30-minute slow breathing exercise or music listening (music by Max Richter: Sleep). The intervention and control conditions were placed in a random order. We measured heart rate variability prior to, during and after the intervention condition, and found that both interventions increased immediate heart rate variability. Music listening resulted in decreased N2 sleep, increased frontal beta1 power spectral density, and a trend towards increased N3 sleep was detected. In the slow breathing condition higher central delta power during N3 was observed. While some indices pointed to improved sleep quality in both intervention groups, neither condition had robust effects on sleep quality. These explorative findings warrant further replication in different populations.
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Affiliation(s)
- Liisa Kuula
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Risto Halonen
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kristiina Kajanto
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lipsanen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tommi Makkonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Miina Peltonen
- Department of oral and maxillofacial diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anu-Katriina Pesonen
- SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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31
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Hu S, Chen J, Li Y, Shao Y, Zhao X, Lou S, Pan W, Yao P, Sun W, Lu L, Tang X, Sun H. The influence of placebo administration on the first- night effect in patients with insomnia disorder. Sleep Med 2020; 72:138-143. [PMID: 32619848 DOI: 10.1016/j.sleep.2020.03.002] [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: 11/07/2019] [Revised: 01/24/2020] [Accepted: 03/02/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We aimed to investigate the effects of placebo on the first-night effect (FNE) in insomniacs. METHODS In sum, 36 patients with insomnia disorder who met the DSM-5 criteria were enrolled in this study. Sixteen patients with insomnia disorder were given two days of placebo intervention (placebo-administration group, PL). Twenty patients with insomnia disorder (drug-free group, DF) were not given any interventions. All participants underwent two consecutive nights of polysomnographic (PSG) testing in the sleep laboratory. Sleep diaries were recorded during one week at home before the PSG nights and on two subsequent nights. RESULTS The results demonstrated that compared with the DF group, sleep onset latency (SOL), time in bed (TIB) and wake after sleep onset (WASO) significantly increased and sleep efficiency (SE) significantly decreased in the first sleep lab night in the PL group (all p < 0.05). Moreover, compared with the second night, significant differences were observed in lower self-reported total sleep time (TST) and more subjective WASO during the first night in the PL group (all p < 0.05). However, no significant difference was found in the duration and percentage of N1, N2, N3 and REM between the two groups. CONCLUSION In patients with insomnia disorder, placebo administration may increase the occurrence of worse sleep without causing a change in the duration and percentage of N1, N2, N3 and REM on the first sleep lab night. In some cases, a placebo may not serve as treatment but may result in a nocebo effect.
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Affiliation(s)
- Sifan Hu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Jie Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Yuezhen Li
- Department of Neuropsychiatry, Behavioral Neurology and Sleep Center, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yan Shao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Xiaoxia Zhao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Sijia Lou
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Wen Pan
- Sleep Medicine Center, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Ping Yao
- Department of Physiology, College of Basic Medicine, Inner Mongolia Medical University, Hohhot, China
| | - Wei Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Translational Neuroscience Center, State Key Laboratory, West China Hospital, Sichuan University, Chengdu, China.
| | - Hongqiang Sun
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University, Beijing, China.
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32
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About the Accuracy and Problems of Consumer Devices in the Assessment of Sleep. SENSORS 2019; 19:s19194160. [PMID: 31557952 PMCID: PMC6806072 DOI: 10.3390/s19194160] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 11/17/2022]
Abstract
Commercial sleep devices and mobile-phone applications for scoring sleep are gaining ground. In order to provide reliable information about the quantity and/or quality of sleep, their performance needs to be assessed against the current gold standard, i.e., polysomnography (PSG; measuring brain, eye, and muscle activity). Here, we assessed some commercially available sleep trackers, namely an activity tracker; Mi band (Xiaomi, Beijing, China), a scientific actigraph: Motionwatch 8 (CamNTech, Cambridge, UK), and a much-used mobile phone application: Sleep Cycle (Northcube, Gothenburg, Sweden). We recorded 27 nights in healthy sleepers using PSG and these devices and compared the results. Surprisingly, all devices had poor agreement with the PSG gold standard. Sleep parameter comparisons revealed that, specifically, the Mi band and the Sleep Cycle application had difficulties in detecting wake periods which negatively affected their total sleep time and sleep-efficiency estimations. However, all 3 devices were good in detecting the most basic parameter, the actual time in bed. In summary, our results suggest that, to date, the available sleep trackers do not provide meaningful sleep analysis but may be interesting for simply tracking time in bed. A much closer interaction with the scientific field seems necessary if reliable information shall be derived from such devices in the future.
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Reducing bedtime physiological arousal levels using immersive audio-visual respiratory bio-feedback: a pilot study in women with insomnia symptoms. J Behav Med 2019; 42:973-983. [PMID: 30790211 DOI: 10.1007/s10865-019-00020-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 02/14/2019] [Indexed: 02/02/2023]
Abstract
Hyperarousal is a critical component of insomnia, particularly at bedtime when individuals are trying to fall asleep. The current study evaluated the effect of a novel, acute behavioral experimental manipulation (combined immersive audio-visual relaxation and biofeedback) in reducing bedtime physiological hyperarousal in women with insomnia symptoms. After a clinical/adaptation polysomnographic (PSG) night, sixteen women with insomnia symptoms had two random-order PSG nights: immersive audio-visual respiratory bio-feedback across the falling asleep period (manipulation night), and no pre-sleep arousal manipulation (control night). While using immersive audio-visual respiratory bio-feedback, overall heart rate variability was increased and heart rate (HR) was reduced (by ~ 5 bpm; p < 0.01), reflecting downregulation of autonomic pre-sleep arousal, relative to no-manipulation. HR continued to be lower during sleep, and participants had fewer awakenings and sleep stage transitions on the manipulation night relative to the control night (p < 0.05). The manipulation did not affect sleep onset latency or other PSG parameters. Overall, this novel behavioral approach targeting the falling asleep process emphasizes the importance of pre-sleep hyperarousal as a potential target for improving sleep and nocturnal autonomic function during sleep in insomnia.
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Castelnovo A, Ferri R, Punjabi NM, Castronovo V, Garbazza C, Zucconi M, Ferini-Strambi L, Manconi M. The paradox of paradoxical insomnia: A theoretical review towards a unifying evidence-based definition. Sleep Med Rev 2018; 44:70-82. [PMID: 30731262 DOI: 10.1016/j.smrv.2018.12.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 01/23/2023]
Abstract
Paradoxical insomnia is one of the most intriguing yet challenging subtypes of insomnia. Despite being recognized for a long time by the international community, it is still unclear whether this entity really exists, which are its features and boundaries. Much of the debate is fuelled by the lack of a consensus on its precise definition. To help filling some of the existing gaps, a systematic review of the literature was conducted, through which 19 different quantitative definitions were obtained. These definitions were then applied to two distinct datasets. The first consisted of 200 chronic primary insomnia patients, diagnosed according to the DSM-IV-TR criteria. The second consisted of 200 age- and sex-matched healthy persons without insomnia. For each dataset, available data from the objective sleep parameters and their subjective estimation were imported and analysed in MATLAB. Depending on the definition used, the prevalence of paradoxical insomnia ranged from 8 to 66%, while agreement between different definitions ranged from -0.19 to 0.9 (using Cohen's kappa coefficient). Based on the results garnered, necessary features for a quantitative definition of paradoxical insomnia were identified. Several open questions remain, such as whether there is a minimum number of hours a patient should sleep to fulfill the criteria for a diagnosis of paradoxical insomnia, and whether sleep latency can be used in the definition along with total sleep time. We conclude by advocating continued study of paradoxical insomnia and sleep state misperception and by providing specific directions for future research. STATEMENT OF SIGNIFICANCE: The current understanding of paradoxical insomnia and, more broadly, of sleep state misperception, is greatly hampered by the lack of agreement on a quantitative and evidence-base measure of the discrepancy between subjective and objective sleep evaluation. The current study provides a critical analysis about the strength and the limitations of the available definitions, using both a data-driven and a theory-driven approach. The overarching goal is to motivate a rigorous discussion involving the main experts of the field, to build a consensus, and develop an evidence-based measure of sleep state misperception and/or of paradoxical insomnia.
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Affiliation(s)
- Anna Castelnovo
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland.
| | | | - Naresh M Punjabi
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Vincenza Castronovo
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Corrado Garbazza
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland
| | - Marco Zucconi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Lugano, Switzerland; Sleep Disorders Center, Department of Neurology, Scientific Institute Ospedale San Raffaele, Vita-Salute University, Milan, Italy.
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Chung KF, Poon YPYP, Ng TK, Kan CK. Correlates of sleep irregularity in schizophrenia. Psychiatry Res 2018; 270:705-714. [PMID: 30551313 DOI: 10.1016/j.psychres.2018.10.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 09/14/2018] [Accepted: 10/23/2018] [Indexed: 12/24/2022]
Abstract
Circadian rhythm disruption, manifested as circadian misalignment, difficulty initiating sleep, and sleep-wake irregularity, is often left unrecognized in patients with schizophrenia. Studies have shown multiple adverse consequences of sleep irregularity, but limited data is available on schizophrenia. This is a secondary analysis of a case-control study of 66 schizophrenia patients with delayed sleep-wake phase (with or without meeting criteria for the disorder) and normal sleep-wake phase (mean age = 44.08 years; 45.45% males). Potential correlates included sleep quality, daytime sleepiness, social rhythms, chronotype, psychiatric symptoms, psychosocial functioning, metabolic index, cognitive function, and sociodemographic, lifestyle and pharmacological factors. Square successive difference (SSD) scores, derived from 1-week sleep diary and actigraphy, were indexes of sleep irregularity. Multilevel modeling analysis, with SSD scores as level-1 measures and the hypothesized correlates as level-2 measures, was performed. Statistical significance was Bonferroni-adjusted. Higher SSD scores of sleep diary and actigraphy variables were significantly associated with positive and depressive symptoms, poor sleep quality, daytime sleepiness, irregular social rhythm, evening chronotype, delayed sleep-wake phase disorder, later caffeine use and dinner time, greater cigarette use, and lower dosages of hypnotics and antipsychotics. Our findings highlight the implications of sleep irregularity in schizophrenia and the need for a multimodal intervention.
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Affiliation(s)
- Ka-Fai Chung
- Department of Psychiatry and Center on Behavioral Health, University of Hong Kong, Hong Kong SAR, China.
| | | | - Ting-Kin Ng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong SAR, China
| | - Chui-Kwan Kan
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
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Sterr A, Ebajemito JK, Mikkelsen KB, Bonmati-Carrion MA, Santhi N, Della Monica C, Grainger L, Atzori G, Revell V, Debener S, Dijk DJ, DeVos M. Sleep EEG Derived From Behind-the-Ear Electrodes (cEEGrid) Compared to Standard Polysomnography: A Proof of Concept Study. Front Hum Neurosci 2018; 12:452. [PMID: 30534063 PMCID: PMC6276915 DOI: 10.3389/fnhum.2018.00452] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 10/24/2018] [Indexed: 11/20/2022] Open
Abstract
Electroencephalography (EEG) recordings represent a vital component of the assessment of sleep physiology, but the methodology presently used is costly, intrusive to participants, and laborious in application. There is a recognized need to develop more easily applicable yet reliable EEG systems that allow unobtrusive long-term recording of sleep-wake EEG ideally away from the laboratory setting. cEEGrid is a recently developed flex-printed around-the-ear electrode array, which holds great potential for sleep-wake monitoring research. It is comfortable to wear, simple to apply, and minimally intrusive during sleep. Moreover, it can be combined with a smartphone-controlled miniaturized amplifier and is fully portable. Evaluation of cEEGrid as a motion-tolerant device is ongoing, but initial findings clearly indicate that it is very well suited for cognitive research. The present study aimed to explore the suitability of cEEGrid for sleep research, by testing whether cEEGrid data affords the signal quality and characteristics necessary for sleep stage scoring. In an accredited sleep laboratory, sleep data from cEEGrid and a standard PSG system were acquired simultaneously. Twenty participants were recorded for one extended nocturnal sleep opportunity. Fifteen data sets were scored manually. Sleep parameters relating to sleep maintenance and sleep architecture were then extracted and statistically assessed for signal quality and concordance. The findings suggest that the cEEGrid system is a viable and robust recording tool to capture sleep and wake EEG. Further research is needed to fully determine the suitability of cEEGrid for basic and applied research as well as sleep medicine.
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Affiliation(s)
- Annette Sterr
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guilford, United Kingdom
| | - James K Ebajemito
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guilford, United Kingdom
| | - Kaare B Mikkelsen
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | | | - Nayantara Santhi
- Surrey Sleep Research Centre, University of Surrey, Guildford, United Kingdom
| | - Ciro Della Monica
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Lucinda Grainger
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Giuseppe Atzori
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Victoria Revell
- Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Stefan Debener
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany.,Cluster of Excellence Hearing, University of Oldenburg, Oldenburg, Germany
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, United Kingdom.,Surrey Clinical Research Centre, Department of Psychology, University of Surrey, Guildford, Germany
| | - Maarten DeVos
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
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Miettinen T, Myllymaa K, Hukkanen T, Töyräs J, Sipilä K, Myllymaa S. Home Polysomnography Reveals a First-Night Effect in Patients With Low Sleep Bruxism Activity. J Clin Sleep Med 2018; 14:1377-1386. [PMID: 30092900 PMCID: PMC6086957 DOI: 10.5664/jcsm.7278] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/20/2018] [Accepted: 05/18/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To examine the presence of a first-night effect (FNE) and the level of internight variability in sleep bruxism (SB) activity when a self-applicable electrode set is used in home polysomnography (PSG) in a sample of subjects with possible SB. METHODS Fourteen females and two males aged 38.3 ± 9.1 years (mean ± standard deviation) with self-reported SB underwent home-PSG on three consecutive nights. The subjects applied PSG sensors themselves, including self-applicable electrode sets used to record sleep and masseter muscle activity. Repeated-measures analysis of variance was used to compare SB and sleep variables between the nights. RESULTS Surprisingly, there were statistically significant elevations in the rhythmic masticatory muscle activity (RMMA) episode index (P = .009), burst index (P = .016), and bruxism time index (P = .049) throughout the course of 3 nights. More bruxers were diagnosed on the second (6 bruxers, ≥ 2 episodes/h) and third night (7 bruxers) compared to the first night (2 bruxers). Most subjects (14/16) had their highest RMMA index on the second or third night. The mean coefficient of variation for RMMA episode index was 50.7%. No statistically significant differences were detected in other sleep variables. CONCLUSIONS The results indicate that a FNE may be present in SB activity, possibly lasting several nights in some subjects. Furthermore, FNE appears to be combined with high internight variability of SB activity without indications of internight changes in sleep macrostructure. To confirm the level of ongoing SB activity, several nights of PSG may be required, especially in subjects with low first-night SB activity. COMMENTARY A commentary on this article appears in this issue on page 1281.
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Affiliation(s)
- Tomi Miettinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Katja Myllymaa
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Taina Hukkanen
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Kirsi Sipilä
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
- Oral and Maxillofacial Department, Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
- Research Unit of Oral Health Sciences, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Sami Myllymaa
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Lundetræ RS, Saxvig IW, Pallesen S, Aurlien H, Lehmann S, Bjorvatn B. Prevalence of Parasomnias in Patients With Obstructive Sleep Apnea. A Registry-Based Cross-Sectional Study. Front Psychol 2018; 9:1140. [PMID: 30026716 PMCID: PMC6042013 DOI: 10.3389/fpsyg.2018.01140] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/14/2018] [Indexed: 12/05/2022] Open
Abstract
Objective: To assess the prevalence of parasomnias in relation to presence and severity of obstructive sleep apnea (OSA). We hypothesized higher parasomnia prevalence with higher OSA severity. Methods: The sample comprised 4,372 patients referred to a Norwegian university hospital with suspicion of OSA (mean age 49.1 years, 69.8% males). OSA was diagnosed and categorized by standard respiratory polygraphy (type 3 portable monitor). The patients completed a comprehensive questionnaire prior to the sleep study, including questions about different parasomnias during the last 3 months. Pearson chi-square tests explored differences according to the presence and severity of OSA. Furthermore, logistic regression analyses with the parasomnias as dependent variables and OSA severity as predictor were conducted (adjusted for sex, age, marital status, smoking, and alcohol consumption). Results: In all, 34.7% had apnea-hypopnea index (AHI) <5 (no OSA), 32.5% had AHI 5-14.9 (mild OSA), 17.4% had AHI 15-29.9 (moderate OSA), and 15.3% had AHI ≥30 (severe OSA). The overall prevalence of parasomnias was 3.3% (sleepwalking), 2.5% (sleep-related violence), 3.1% (sexual acts during sleep), 1.7% (sleep-related eating), and 43.8% (nightmares). The overall parasomnia prevalence was highest in the no OSA group. In the chi-square analyses, including all OSA groups, the prevalence of sleep-related violence and nightmares were inversely associated with OSA severity, whereas none of the other parasomnias were significantly associated with OSA severity. In adjusted logistic regression analyses the odds of sleepwalking was significantly higher in severe compared to mild OSA (OR = 2.0, 95% CI = 1.12–3.55). The other parasomnias, including sleep-related violence and nightmares, were not associated with OSA presence or severity when adjusting for sex and age. Conclusions: We found no increase in parasomnias in patients with OSA compared to those not having OSA. With the exception of sleepwalking, the parasomnias were not associated with OSA severity.
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Affiliation(s)
- Ragnhild S Lundetræ
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ingvild W Saxvig
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Harald Aurlien
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Sverre Lehmann
- Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn Bjorvatn
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
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Bertisch SM, Pollock BD, Mittleman MA, Buysse DJ, Bazzano LA, Gottlieb DJ, Redline S. Insomnia with objective short sleep duration and risk of incident cardiovascular disease and all-cause mortality: Sleep Heart Health Study. Sleep 2018; 41:4924334. [PMID: 29522193 PMCID: PMC5995202 DOI: 10.1093/sleep/zsy047] [Citation(s) in RCA: 217] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/29/2017] [Indexed: 01/22/2023] Open
Abstract
Study Objectives To quantify the association between insomnia or poor sleep with objective short sleep duration and incident cardiovascular disease (CVD) and mortality in the general population. Methods We conducted a time-to-event analysis of Sleep Heart Health Study data. Questionnaires and at-home polysomnography (PSG) were performed between 1994 and 1998. Participants were followed for a median of 11.4 years (Q1-Q3, 8.8-12.4 years) until death or last contact. The primary exposure was insomnia or poor sleep with short sleep defined as follows: difficulty falling asleep, difficulty returning to sleep, early morning awakenings, or sleeping pill use, 16-30 nights per month; and total sleep of <6 hr on PSG. We used proportional hazard models to estimate the association between insomnia or poor sleep with short sleep and CVD, as well as all-cause mortality. Results Among 4994 participants (mean age: 64.0 ± 11.1 years), 14.1 per cent reported insomnia or poor sleep, of which 50.3 per cent slept <6 hr. Among 4437 CVD-free participants at baseline, we observed 818 incident CVD events. After propensity adjustment, there was a 29 per cent higher risk of incident CVD in the insomnia or poor sleep with short sleep group compared with the reference group (HR: 1.29, 95% CI: 1.00, 1.66), but neither the insomnia or poor sleep only nor short sleep only groups were associated with higher incident CVD. Insomnia or poor sleep with objective short sleep was not associated with all-cause mortality (HR: 1.07, 95% CI: 0.86, 1.33). Conclusions Insomnia or poor sleep with PSG-short sleep was associated with higher risk of incident CVD. Future studies should evaluate the impact of interventions to improve insomnia with PSG-short sleep on CVD.
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Affiliation(s)
- Suzanne M Bertisch
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Benjamin D Pollock
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
- Department of Epidemiology, Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX
- Robbins Institute for Health Policy and Leadership, Baylor University, Waco, TX
| | - Murray A Mittleman
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA
| | - Daniel J Gottlieb
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
- VA Boston Healthcare System, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Susan Redline
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA
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Maich KHG, Lachowski AM, Carney CE. Psychometric Properties of the Consensus Sleep Diary in Those With Insomnia Disorder. Behav Sleep Med 2018; 16:117-134. [PMID: 27231885 DOI: 10.1080/15402002.2016.1173556] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Consensus Sleep Diary (CSD) is a standardized, prospective tool for tracking nightly subjective sleep. The current study evaluated the validity and utility of the CSD, with consideration for challenges inherent to psychometric evaluation of diary measures. Results showed that the CSD indices differentiated good sleepers from those with insomnia and were associated with similar objective indices and a subjective insomnia severity measure. The ability to detect treatment improvements after cognitive behavior therapy for insomnia (CBT-I) was tested by comparing pre- and post-CBT-I CSD indices with a subjective rating of insomnia symptom severity. Improvement in insomnia symptom severity was significantly related to improvement on the CSD indices. Completion rate of the CSD amongst participants across all 14 days was 99.8%. These findings provide support for the validity, clinical utility, and usability of the CSD.
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Affiliation(s)
| | | | - Colleen E Carney
- a Department of Psychology , Ryerson University , Toronto , Canada
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Chapman JL, Comas M, Hoyos CM, Bartlett DJ, Grunstein RR, Gordon CJ. Is Metabolic Rate Increased in Insomnia Disorder? A Systematic Review. Front Endocrinol (Lausanne) 2018; 9:374. [PMID: 30061861 PMCID: PMC6054926 DOI: 10.3389/fendo.2018.00374] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Insomnia disorder is a highly prevalent health condition, affecting ~10-15% of the adult population worldwide. A central feature of insomnia is hyperarousal characterized as persistent and increased somatic, cognitive and cortical stimulation. Hyperarousal leads to a state of conditioned arousal that disrupts both sleep and daytime function. Research studies have shown increases in body temperature, heart rate, electroencephalographic activity, catecholamines, and oxygen consumption as a measure of metabolic rate. These findings provide evidence of increased physiological activation in insomnia however results are not consistent. The aim of the systematic review was to determine if metabolic rate in patients with insomnia is increased in keeping with the hyperarousal hypothesis. Methods: We searched Pubmed, Web of Science, CINAHL, PsycINFO, EMBASE, and Scopus databases for observational and interventional studies that have measured metabolic rate in insomnia. Study characteristics were extracted and summarized and a risk of bias was performed for each of the studies. Results: Two reviewers screened 963 abstracts with 35 articles of interest for full-text review. Four articles evaluating 75 participants were included in this systematic review. Two studies showed increased oxygen consumption across 24 h in insomnia patients compared with good-sleeping controls. One study which measured oxygen consumption at only a single timepoint showed no difference between insomnia patients and good-sleeping controls. A further study evaluating the effect of lorazepam on oxygen consumption in patients with chronic insomnia showed that lorazepam reduced metabolic rate during the night time only. Conclusions: These findings show that metabolic rate appears to be increased across 24 h in line with the hyperarousal model of insomnia. However, these increases in metabolic rate in insomnia were minor compared to good-sleeping controls and the clinical significance is unclear. Larger, methodologically robust studies are required to confirm these findings and the effect of any increase in metabolic rate on sleep-wake disturbances or pathophysiology.
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Affiliation(s)
- Julia L. Chapman
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Maria Comas
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Camilla M. Hoyos
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Delwyn J. Bartlett
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Ronald R. Grunstein
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Christopher J. Gordon
- CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
- *Correspondence: Christopher J. Gordon
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Veauthier C, Piper SK, Gaede G, Penzel T, Paul F. The first night effect in multiple sclerosis patients undergoing home-based polysomnography. Nat Sci Sleep 2018; 10:337-344. [PMID: 30498381 PMCID: PMC6207396 DOI: 10.2147/nss.s176201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The first night effect (FNE) is a polysomnography (PSG) habituation effect in the first of several consecutive in-laboratory PSGs (I-PSGs). The FNE is caused by the discomfort provoked by electrodes and cables and the exposure to an unfamiliar environment. A reverse FNE (RFNE) with an improved sleep in the first night is characteristic of insomnia, presumably because the video PSG in the sleep laboratory leads to a decrease in the negatively toned cognitive activity. Therefore, two or more I-PSGs are required for an accurate diagnosis. Although the FNE is well documented in I-PSG, little is known about the FNE and the RFNE in home-based PSGs (H-PSGs). METHODS This is a retrospective analysis of a recently published cross-sectional study using H-PSG. Sixty-three consecutive patients suffering from multiple sclerosis (MS) were investigated by two consecutive H-PSGs without video. The differences between the first and second H-PSGs were analyzed. The patients were classified into four subgroups: no sleep disorder, insomnia, sleep-related breathing disorders (SRBDs), and periodic limb movement disorder or restless legs syndrome (PLMD/RLS). RESULTS MS patients suffering from insomnia showed no RFNE. MS patients with SRBD or PLMD/RLS showed no reduced sleep efficiency but significantly less slow wave sleep. Furthermore, SRBD patients showed significantly less non-rapid eye movement (NREM) sleep, and PLMD/RLS patients were significantly awake longer in the first night after sleep onset (increased wake-after-sleep-onset time) and showed a higher rapid eye movement (REM) latency. CONCLUSION SRBD and PLMD/RLS patients showed a significant FNE. Two consecutive H-PSGs are required in these patients to obtain a precise hypnogram even in the ambulatory field. In MS patients suffering from insomnia, no RFNE was found, and in insomnia patients one H-PSG seems to be sufficient.
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Affiliation(s)
- Christian Veauthier
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
| | - Sophie K Piper
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Gunnar Gaede
- Department of Neurology, St. Joseph Krankenhaus Berlin-Weissensee, Berlin, Germany
| | - Thomas Penzel
- Interdisciplinary Center of Sleep Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany, .,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Smith FRH, Gaskell MG, Weighall AR, Warmington M, Reid AM, Henderson LM. Consolidation of vocabulary is associated with sleep in typically developing children, but not in children with dyslexia. Dev Sci 2017; 21:e12639. [PMID: 29226513 DOI: 10.1111/desc.12639] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 10/13/2017] [Indexed: 11/27/2022]
Abstract
Sleep is known to play an active role in consolidating new vocabulary in adults; however, the mechanisms by which sleep promotes vocabulary consolidation in childhood are less well understood. Furthermore, there has been no investigation into whether previously reported differences in sleep architecture might account for variability in vocabulary consolidation in children with dyslexia. Twenty-three children with dyslexia and 29 age-matched typically developing peers were exposed to 16 novel spoken words. Typically developing children showed overnight improvements in novel word recall; the size of the improvement correlated positively with slow wave activity, similar to previous findings with adults. Children with dyslexia showed poorer recall of the novel words overall, but nevertheless showed overnight improvements similar to age-matched peers. However, comparisons with younger children matched on initial levels of novel word recall pointed to reduced consolidation in dyslexics after 1 week. Crucially, there were no significant correlations between overnight consolidation and sleep parameters in the dyslexic group. This suggests a reduced role of sleep in vocabulary consolidation in dyslexia, possibly as a consequence of lower levels of learning prior to sleep, and highlights how models of sleep-associated memory consolidation can be usefully informed by data from typical and atypical development.
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Affiliation(s)
- Faye R H Smith
- School of Education, Communication and Language Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | | | - Anna R Weighall
- Institute of Psychological Sciences, University of Leeds, Leeds, UK
| | - Meesha Warmington
- Department of Human Communication Sciences, University of Sheffield, Sheffield, UK
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Bjorvatn B, Rajakulendren N, Lehmann S, Pallesen S. Increased severity of obstructive sleep apnea is associated with less anxiety and depression. J Sleep Res 2017; 27:e12647. [DOI: 10.1111/jsr.12647] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/06/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Bjørn Bjorvatn
- Norwegian Competence Center for Sleep Disorders; Haukeland University Hospital; Bergen Norway
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
| | - Narvini Rajakulendren
- Department of Global Public Health and Primary Care; University of Bergen; Bergen Norway
| | - Sverre Lehmann
- Norwegian Competence Center for Sleep Disorders; Haukeland University Hospital; Bergen Norway
- Section of Thoracic Medicine; Department of Clinical Science; University of Bergen; Bergen Norway
| | - Ståle Pallesen
- Norwegian Competence Center for Sleep Disorders; Haukeland University Hospital; Bergen Norway
- Department of Psychosocial Science; University of Bergen; Bergen Norway
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45
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Blackwell T, Paudel M, Redline S, Ancoli-Israel S, Stone KL. A novel approach using actigraphy to quantify the level of disruption of sleep by in-home polysomnography: the MrOS Sleep Study: Sleep disruption by polysomnography. Sleep Med 2017; 32:97-104. [PMID: 28366349 PMCID: PMC5380148 DOI: 10.1016/j.sleep.2016.11.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The "first-night effect" of polysomnography (PSG) has been previously studied; however, the ability to quantify the sleep disruption level has been confounded with the use of PSG on all nights. We used actigraphy to quantify disruption level and examined characteristics associated with disruption. METHODS Totally, 778 older men (76.2 ± 5.4 years) from a population-based study at six US centers underwent one night of in-home PSG. Actigraphy was performed on the PSG night and three subsequent nights. Actigraphically measured total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep onset latency (SOL) from the PSG night and subsequent nights were compared. Linear regression models were used to examine the association of characteristics and sleep disruption. RESULTS On average, sleep on the PSG night was worse than the following night (p < 0.05, TST 21 ± 85 min less, SE 2.3 ± 11.3% less, WASO 4.9 ± 51.8 min more, SOL 6.6 ± 56.2 min more). Sleep on the PSG night was significantly worse than that two and three nights later. Characteristics associated with greater sleep disruption on the PSG night included older age, higher apnea-hypopnea index, worse neuromuscular function, and more depressive symptoms. Minorities and men with excessive daytime sleepiness slept somewhat better on the PSG night. CONCLUSIONS Among older men, there was sleep disruption on the PSG night, which may lead to sleep time underestimation. The increase of sleep on the night after the PSG suggests that data from the second monitoring may overestimate sleep.
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Affiliation(s)
- Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA, United States.
| | - Misti Paudel
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, United States
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Sonia Ancoli-Israel
- Department of Psychiatry and Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, United States
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Abstract
Accelerometry can be a practical replacement for polysomnography in large observational studies. This review discusses the need for sleep characterization in large observational studies, exemplified by the practices of the ongoing German National Cohort study. After brief descriptions of the physical principles and state-of-the-art accelerometer devices and an overview of public data analysis algorithms for sleep-wake differentiation, we demonstrate that the spectral properties of acceleration data provide additional features that can be exploited. This leads to a periodogram-based sleep detection algorithm. Finally, we address issues of data handling and quality assurance in large cohort studies.
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Driller M, McQuillan J, O’Donnell S. Inter-device reliability of an automatic-scoring actigraph for measuring sleep in healthy adults. ACTA ACUST UNITED AC 2016; 9:198-201. [PMID: 28123660 PMCID: PMC5241607 DOI: 10.1016/j.slsci.2016.08.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 11/19/2022]
Abstract
Actigraphy has become a common method of measuring sleep due to its non-invasive, cost-effective nature. An actigraph (Readiband™) that utilizes automatic scoring algorithms has been used in the research, but is yet to be evaluated for its inter-device reliability. A total of 77 nights of sleep data from 11 healthy adult participants was collected while participants were concomitantly wearing two Readiband™ actigraphs attached together (ACT1 and ACT2). Sleep indices including total sleep time (TST), sleep latency (SL), sleep efficiency (SE%), wake after sleep onset (WASO), total time in bed (TTB), wake episodes per night (WE), sleep onset variance (SOV) and wake variance (WV) were assessed between the two devices using mean differences, 95% levels of agreement, intraclass correlation coefficients (ICC), typical error of measurement (TEM) and coefficient of variation (CV%) analysis. There were no significant differences between devices for any of the measured sleep variables (p>0.05). TST, SE, SL, TTB, SOV and WV all resulted in very high ICC's (>0.90), with WASO and WE resulting in high ICC's between devices (0.85 and 0.80, respectively). Mean differences of −2.1 and 0.2 min for TST and SL were associated with a low TEM between devices (9.5 and 3.8 min, respectively). SE resulted in a 0.3% mean difference between devices. The Readiband™ is a reliable tool for researchers using multiple devices of this brand in sleep studies to assess basic measures of sleep quality and quantity in healthy adult populations.
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Correlates and prognostic relevance of sleep irregularity in inter-episode bipolar disorder. Compr Psychiatry 2016; 69:155-62. [PMID: 27423356 DOI: 10.1016/j.comppsych.2016.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/05/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Sleep-wake disturbances, such as sleep irregularity, are common in bipolar disorder. Early studies suggest that sleep irregularity is associated with mood symptoms in bipolar disorder, but little research has been conducted to identify other correlates of sleep irregularity. We investigated the relationship between sleep irregularity and sleep quality, social rhythms, eveningness, sleep-related cognitions and behaviors, and past and future mood episodes in 84 patients with inter-episode bipolar I or II disorder. METHODS This is a retrospective and prospective, naturalistic follow-up study. The Expanded Consensus Sleep Diary, Pittsburgh Sleep Quality Index (PSQI), Social Rhythm Metric (SRM-II-5), Composite Scale of Morningness (CSM), Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS-16), and Sleep Hygiene Practice Scale (SHPS) were administered. The Square Successive Difference (SSD), derived from a week-long sleep diary, was used as an index of sleep irregularity. Multilevel modeling analysis, which adjusts for biases in parameter estimates, was used to minimize the impact of missing data. Bonferroni correction was performed to account for multiple testing. RESULTS Higher SSD scores of sleep diary variables were significantly associated with higher PSQI, SRM-II-5, DBAS-16, and SHPS scores. Irregularity in total sleep time was related to more depressive episodes in the past 5years (p=.002), while irregularity in wake after sleep onset predicted the onset of depressive episodes over the next 2years (p=.002). CONCLUSION Sleep irregularity was associated with poor sleep quality, irregular social rhythms, dysfunctional sleep-related cognitions and behaviors, and greater number of depressive episodes in bipolar disorder.
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Cheek RE, Shaver JL, Lentz MJ. Lifestyle Practices and Nocturnal Sleep in Midlife Women with and without Insomnia. Biol Res Nurs 2016; 6:46-58. [PMID: 15186707 DOI: 10.1177/1099800404263763] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Relationships between common lifestyle practices important to sleep hygiene (e.g., smoking cigarettes, drinking alcohol, ingesting caffeine, exercising, bedtimes, getting-up times) and nocturnal sleep have not been documented for women with insomnia in their home environments. This community-based sample of 121 women, ages 40 to 55 years, included 92 women who had experienced insomnia for at least 3 months and 29womenwith good-quality sleep. Women recorded lifestyle practices and sleep perceptions (time to fall asleep, awakenings during sleep, feeling rested after sleeping, and overall sleep quality) in diaries while undergoing 6 nights of somnographic sleep monitoring at home. Compared to women with good-quality sleep, women with insomnia reported greater nightto-night variation in perceived sleep variables, poorer overall sleep quality (M = 2.8,SD = 0.7 vs.M = 1.9,SD = 0.5,P < 0.05), and longer times to fall asleep (M = 25 min,SD = 14.2 vs.M = 12.9 min,SD = 5.8,P < 0.05). Correlations between mean individual lifestyle practice scores and mean perceived or somnographic sleep variables were low, ranging from 0 to 0.20. An aggregated sleep hygiene practice score was not associated with either perceived or somnographic sleep variables. Regression analysis using dummy variables showed that combinations of alcohol, caffeine, exercise, smoking, and history of physical disease explained 9% to 19% of variance in perceived or somnographic sleep variables. Lifestyle practices, and combinations thereof, do warrant consideration when assessing or treating insomnia, but these data fail to support a dominant relationship between lifestyle practices and either perceived or somnographic sleep variables.
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Affiliation(s)
- Rita E Cheek
- Montana State University-Bozeman, College of Nursing, Missoula Campus, 32 Campus Drive 7416, Missoula, MT 59812-7416, USA.
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50
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Westerlund A, Lagerros YT, Kecklund G, Axelsson J, Åkerstedt T. Relationships Between Questionnaire Ratings of Sleep Quality and Polysomnography in Healthy Adults. Behav Sleep Med 2016; 14:185-99. [PMID: 25384098 DOI: 10.1080/15402002.2014.974181] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to examine the association between polysomnographic sleep and subjective habitual sleep quality and restoration from sleep. Thirty-one normal sleepers completed the Karolinska Sleep Questionnaire and multiple home polysomnography recordings (n = 2-5). Using linear regression, sleep quality and restoration were separately analyzed as functions of standard polysomnography parameters: sleep efficiency, total sleep time, sleep latency, stage 1 and 2 sleep, slow-wave sleep, rapid eye movement sleep, wake time after sleep onset, and awakenings (n), averaged across recordings. Stage 2 and slow-wave sleep predicted worse and better sleep quality, respectively. Also, slow-wave sleep predicted less subjective restoration, although adjustment for age attenuated this relation. Our findings lend some physiological validity to ratings of habitual sleep quality in normal sleepers. Data were less supportive of a physiological correlate of ratings of restoration from sleep.
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Affiliation(s)
- Anna Westerlund
- a Clinical Epidemiology Unit, Department of Medicine Karolinska Institutet
| | | | - Göran Kecklund
- b Stress Research Institute, Stockholm University.,c Behavioural Science Institute, Radboud University.,d Division of Psychology, Department of Clinical Neuroscience Karolinska Institutet
| | - John Axelsson
- d Division of Psychology, Department of Clinical Neuroscience Karolinska Institutet
| | - Torbjörn Åkerstedt
- b Stress Research Institute, Stockholm University.,d Division of Psychology, Department of Clinical Neuroscience Karolinska Institutet
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