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Swanson LM, de Sibour T, DuBuc K, Conroy DA, Raglan GB, Lorang K, Zollars J, Hershner S, Arnedt JT, Burgess HJ. Low-dose exogenous melatonin plus evening dim light and time in bed scheduling advances circadian phase irrespective of measured or estimated dim light melatonin onset time: preliminary findings. J Clin Sleep Med 2024; 20:1131-1140. [PMID: 38445651 PMCID: PMC11217625 DOI: 10.5664/jcsm.11076] [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: 10/24/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Abstract
STUDY OBJECTIVES The purpose of the present study was to preliminarily evaluate whether knowing the dim light melatonin onset (DLMO) time is advantageous when treating delayed sleep-wake phase disorder with low-dose melatonin treatment plus behavioral interventions (ie, evening dim light and time in bed scheduling). METHODS In this randomized, controlled, double-blind trial, 40 adults with delayed sleep-wake phase disorder were randomly assigned to 4 weeks of 0.5 mg timed to be administered either 3 hours before the DLMO (measured DLMO group, n = 20) or 5 hours before sleep-onset time per actigraphy (estimated DLMO group, n = 20), in conjunction with behavioral interventions. The primary outcome was change in the DLMO (measured in-home). Secondary outcomes included sleep parameters per diary and actigraphy (sleep-onset and -offset times and total sleep time), Morningness-Eveningness Questionnaire, Multidimensional Fatigue Inventory, PROMIS-Sleep Disturbance, PROMIS-Sleep Related Impairment, and Pittsburgh Sleep Quality Index. Mixed-effects models tested for group differences in these outcome. RESULTS After applying the Bonferroni correction for multiple comparisons (significant P value set at < .004), there were significant main effects for visit on all outcomes except for the Pittsburgh Sleep Quality Index and total sleep time per wrist actigraphy and diary. There were no group-by-visit interactions for any of the outcomes (P > .004). CONCLUSIONS Scheduled low-dose melatonin plus behavioral interventions may improve many circadian and sleep parameters regardless of whether melatonin administration is scheduled based on estimated or measured DLMO. A larger-scale trial is needed to confirm these preliminary findings. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The Clinical Utility of Measuring the Circadian Clock in Treatment of Delayed Sleep-Wake Phase Disorder; URL: https://clinicaltrials.gov/study/NCT03715465; Identifier: NCT03715465. CITATION Swanson LM, de Sibour T, DuBuc K, et al. Low-dose exogenous melatonin plus evening dim light and time in bed scheduling advances circadian phase irrespective of measured or estimated dim light melatonin onset time: preliminary findings. J Clin Sleep Med. 2024;20(7):1131-1140.
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Affiliation(s)
- Leslie M. Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Trevor de Sibour
- Medical School, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kelley DuBuc
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Deirdre A. Conroy
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Greta B. Raglan
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Kate Lorang
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Zollars
- Michigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, Michigan
| | - Shelley Hershner
- Department of Neurology, University of Michigan, Ann Arbor, Michigan
| | - J. Todd Arnedt
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Helen J. Burgess
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Li SX, Cheung FTW, Chan NY, Chan JWY, Zhang J, Li AM, Espie CA, Gradisar M, Wing YK. Effects of cognitive behavioural therapy and bright light therapy for insomnia in youths with eveningness: study protocol for a randomised controlled trial. Trials 2024; 25:246. [PMID: 38594725 PMCID: PMC11005158 DOI: 10.1186/s13063-024-08090-0] [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: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Insomnia and eveningness are common and often comorbid conditions in youths. While cognitive behavioural therapy for insomnia (CBT-I) has been suggested as a promising intervention, it remains unclear whether it is sufficient to also address circadian issues in youths. In addition, despite that light has been shown to be effective in phase-shifting one's circadian rhythm, there has been limited data on the effects of bright light therapy and its combination with CBT-I on sleep and circadian outcomes in youths. The current protocol outlines a randomised controlled trial that examines the efficacy of CBT-I and CBT-I plus bright light therapy (BLT) in reducing insomnia severity, improving mood symptoms and daytime functioning (e.g. sleepiness, fatigue, cognitive function), and improving subjective and objective sleep and circadian measures compared to a waitlist control group. METHODS We will carry out a randomised controlled trial (RCT) with 150 youths aged 12-24 who meet the criteria of insomnia and eveningness. Participants will be randomised into one of three groups: CBT-I with bright light therapy, CBT-I with placebo light, and waitlist control. Six sessions of CBT-I will be delivered in a group format, while participants will be currently asked to use a portable light device for 30 min daily immediately after awakening throughout the intervention period for bright light therapy. The CBT-I with light therapy group will receive bright constant green light (506 lx) while the CBT-I with placebo light group will receive the modified light device with the LEDs emitting less than 10 lx. All participants will be assessed at baseline and post-treatment, while the two active treatment groups will be additionally followed up at 1 month and 6 months post-intervention. The primary outcome will be insomnia severity, as measured by the Insomnia Severity Index. Secondary outcomes include self-reported mood, circadian, daytime functioning, and quality of life measures, as well as sleep parameters derived from actigraphy and sleep diary and neurocognitive assessments. Objective measures of the circadian phase using dim-light melatonin onset assessment and sleep parameters using polysomnography will also be included as the secondary outcomes. DISCUSSION This study will be the first RCT to directly compare the effects of CBT-I and BLT in youths with insomnia and eveningness. Findings from the study will provide evidence to inform the clinical management of insomnia problems and eveningness in youths. TRIAL REGISTRATION ClinicalTrials.gov NCT04256915. Registered on 5 February 2020.
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Affiliation(s)
- Shirley Xin Li
- Department of Psychology, Sleep Research Clinic and Laboratory, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.
| | - Forrest Tin Wai Cheung
- Department of Psychology, Sleep Research Clinic and Laboratory, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Joey Wing Yan Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medicine University, Guangzhou, Guangdong, China
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Colin A Espie
- Nuffield Department of Clinical Neurosciences and Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia
- Sleep Cycle AB, Gothenburg, Sweden
| | - Yun-Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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3
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Martin CV, Joyce-McCoach J, Peddle M, East CE. Sleep deprivation and medication administration errors in registered nurses-A scoping review. J Clin Nurs 2024; 33:859-873. [PMID: 37872866 DOI: 10.1111/jocn.16912] [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: 06/02/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
AIM To explore whether sleep deprivation contributes to medication errors in registered nurses (RNs). BACKGROUND Sleep deprivation is a potential issue for RNs, particularly those who work shifts. Sleep deprivation has been found to have a negative impact on numerous cognitive processes. Nurses administer several medications to patients a day, potentially while sleep deprived-anecdotal reports suggest that this could result in an increased risk of error occurring. DESIGN A scoping review was conducted using the Prisma-ScR extension framework to explore what is known about the effect of RNs' sleep deprivation on medication administration errors. METHODS A search of databases generated 171 results. When inclusion and exclusion criteria were applied, 18 empirical studies were analysed. Studies included retrospective analysis of errors, surveys of perceptions of causes and observational studies. RESULTS Data indicated that RNs consider fatigue, which may be caused by sleep deprivation, to be a contributing factor to medication errors. The search only identified three observer studies, which provided conflicting results as to whether lack of sleep contributes to the error rate. Of the numerous tools used to measure sleep, the Pittsburgh Sleep Quality Index was the most frequently used. CONCLUSION Although RNs anecdotally consider a lack of sleep potentially contributes to medication errors, there is insufficient research to provide robust evidence to confirm this assumption. NO PATIENT OR PUBLIC CONTRIBUTIONS Patient or public contributions were not required for this scoping review. RELEVANCE TO CLINICAL PRACTICE Sleep deprivation is a potential issue for nurses, especially those who work shifts. Poor sleep impacts cognitive processes that potentially could increase errors. Nurses should be aware of the impact sleep may have on patient safety.
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Affiliation(s)
- Christopher Vincent Martin
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Ballarat, Victoria, Australia
| | - Joanne Joyce-McCoach
- School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Monica Peddle
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Christine Elizabeth East
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
- Mercy Health, Melbourne, Victoria, Australia
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4
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Wang Y, Deboer T. Hypnotic effects of melatonin depend on the environmental lighting conditions in the rat. J Pineal Res 2024; 76:e12928. [PMID: 38031385 DOI: 10.1111/jpi.12928] [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: 08/21/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
Acute effects of exogenous melatonin have been widely reported to promote sleep or induce drowsiness in human. However, testing of the hypnotic effects of melatonin in nocturnal rodents has yielded contradictory results. The latter may be associated with differences in concentration, lighting conditions, time of administration of melatonin, and possibly the type of analysis. In this study, electroencephalogram (EEG) and electromyogram were recorded in pigmented male Brown Norway rats under both light-dark (LD) and constant dark (DD) conditions. Melatonin was administered intraperitoneally at a moderate dose of 3 mg/kg, at either 1 h after lights on under LD condition or 1 h after the activity offset under DD condition. The dosage is known to be able to entrain nocturnal rodents in DD conditions, but does not change sleep in rodents in LD. Only the rats under DD conditions showed a significant reduction in nonrapid eye movement (NREM) sleep latency, while the NREM sleep power spectrum remained unaffected. Under LD condition, melatonin did not alter NREM and rapid eye movement (REM) sleep latency, and had only minor effects on the NREM sleep EEG. Regardless of lighting conditions, melatonin administration resulted in less, but longer episodes for all vigilance states suggesting increased vigilance state consolidation. In the discussion, we compare our results with a summary of previously published data concerning the hypnotic effects of melatonin in polysomnographic/EEG-confirmed sleep in humans and nocturnal rodents. In conclusion, the hypnotic effect of exogenous melatonin in nocturnal rodents not only depends on the time of day, and concentration, but is also influenced by the lighting conditions. Regardless of inducing sleep or not, melatonin may consolidate sleep and through that enhance sleep quality.
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Affiliation(s)
- Yumeng Wang
- Laboratory for Neurophysiology, Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom Deboer
- Laboratory for Neurophysiology, Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
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Witt RM, Byars KC, Decker K, Dye TJ, Riley JM, Simmons D, Smith DF. Current Considerations in the Diagnosis and Treatment of Circadian Rhythm Sleep-Wake Disorders in Children. Semin Pediatr Neurol 2023; 48:101091. [PMID: 38065634 PMCID: PMC10710539 DOI: 10.1016/j.spen.2023.101091] [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: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 12/18/2023]
Abstract
Circadian Rhythm Sleep-Wake Disorders (CRSWDs) are important sleep disorders whose unifying feature is a mismatch between the preferred or required times for sleep and wakefulness and the endogenous circadian drives for these. Their etiology, presentation, and treatment can be different in pediatric patients as compared to adults. Evaluation of these disorders must be performed while viewed through the lens of a patient's comorbid conditions. Newer methods of assessment promise to provide greater diagnostic clarity and critical insights into how circadian physiology affects overall health and disease states. Effective clinical management of CRSWDs is multimodal, requiring an integrated approach across disciplines. Therapeutic success depends upon appropriately timed nonpharmacologic and pharmacologic interventions. A better understanding of the genetic predispositions for and causes of CRSWDs has led to novel clinical opportunities for diagnosis and improved therapeutics.
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Affiliation(s)
- Rochelle M Witt
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kelly C Byars
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kristina Decker
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Thomas J Dye
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Jessica M Riley
- Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Danielle Simmons
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - David F Smith
- Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology- Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
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6
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Pastor-Idoate S, Mateos-Olivares M, Sobas EM, Marcos M, Toribio A, Pastor JC, Usategui Martín R. Short-Wavelength Light-Blocking Filters and Oral Melatonin Administration in Patients With Retinitis Pigmentosa: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e49196. [PMID: 37971796 PMCID: PMC10690531 DOI: 10.2196/49196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/27/2023] [Accepted: 10/10/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The medical community is beginning to recognize that retinitis pigmentosa (RP), due to its disabling progression, eventually leads to a reduction in the patient´s quality of life, a direct economic impact, and an increase in the burden on the health care system. There is no curative treatment for the origin of the disease, and most of the current interventions fail in reducing the associated negative psychological states, such as anxiety and depression, which lead to increased variability of vision and pose a continuous threat to the patient's independence. OBJECTIVE The aim of this study is to assess the effect of oral melatonin (OM) administration alone and combined with short-wavelength light (SWL)-blocking filters on patients with RP and test their effectiveness in improving the level of stress and sleep problems in many of these patients. METHODS We have developed a low-cost therapy protocol for patients with RP with sleep disorders and negative psychological stress. Patients will be randomized to receive a combined intervention with SWL-blocking filters and OM, SWL-blocking filters alone, or OM alone. There will also be a nonintervention arm as a control group. This study will be conducted across 2 retinal units in patients with RP with sleep disorders and high perceived stress and anxiety score reports. Patients will be assessed in the preintervention period, weekly during the 4 weeks of intervention, and then at 6 months postintervention. The primary outcomes are the differences in changes from baseline to postintervention in hormone release (α-amylase, cortisol, and melatonin) and sleep quality, as measured with the visual analog scale. Secondary outcome measures include clinical macular changes, as measured with optical coherence tomography and optical coherence tomography angiography; retinal function, as measured using the visual field and best-corrected visual acuity; sleep data collected from personal wearables; and several patient-reported variables, such as self-recorded sleep diaries, quality of life, perceived stress, and functional status. RESULTS This project is still a study protocol and has not yet started. Bibliographic research for information for its justification began in 2020, and this working group is currently seeking start-up funding. As soon as we have the necessary means, we will proceed with the registration and organization prior to the preliminary phase. CONCLUSIONS In this feasibility randomized clinical controlled trial, we will compare the effects of SWL blocking alone, administration of OM alone, and a combined intervention with both in patients with RP. We present this study so that it may be replicated and incorporated into future studies at other institutions, as well as applied to additional inherited retinal dystrophies. The goal of presenting this protocol is to aid recent efforts in reducing the impact of sleeping disorders and other psychological disorders on the quality of life in patients with RP and recovering their self-autonomy. In addition, the results of this study will represent a significant step toward developing a novel low-cost therapy for patients with RP and validating a novel therapeutic target. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/49196.
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Affiliation(s)
- Salvador Pastor-Idoate
- Institute of Applied Ophthalmobiology, University of Valladolid, Valladolid, Spain
- Department of Ophthalmology, Clinical University Hospital of Valladolid, Valladolid, Spain
- Networks of Cooperative Research oriented to Health Results, National Institute of Health Carlos III, Madrid, Spain
- European Reference Network dedicated to Rare Eye Diseases, Valladolid, Spain
| | - Milagros Mateos-Olivares
- Department of Ophthalmology, Clinical University Hospital of Valladolid, Valladolid, Spain
- Department of Ophthalmology, Clinical University Hospital of Caceres, Caceres, Spain
| | - Eva María Sobas
- Institute of Applied Ophthalmobiology, University of Valladolid, Valladolid, Spain
- Nursing School, University of Valladolid, Valladolid, Spain
| | - Miguel Marcos
- Department of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain
- Institute of Biomedical Research of Salamanca, University of Salamanca, Salamanca, Spain
| | - Alfredo Toribio
- Federation of Associations of Hereditary Retinal Dystrophies in Spain, Valladolid, Spain
| | - José Carlos Pastor
- Institute of Applied Ophthalmobiology, University of Valladolid, Valladolid, Spain
- Networks of Cooperative Research oriented to Health Results, National Institute of Health Carlos III, Madrid, Spain
- European Reference Network dedicated to Rare Eye Diseases, Valladolid, Spain
| | - Ricardo Usategui Martín
- Institute of Applied Ophthalmobiology, University of Valladolid, Valladolid, Spain
- Department of Cellular Biology, Faculty of Medicine, University of Valladolid, Valladolid, Spain
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7
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Frontera JA, Guekht A, Allegri RF, Ashraf M, Baykan B, Crivelli L, Easton A, Garcia-Azorin D, Helbok R, Joshi J, Koehn J, Koralnik I, Netravathi M, Michael B, Nilo A, Özge A, Padda K, Pellitteri G, Prasad K, Romozzi M, Saylor D, Seed A, Thakur K, Uluduz D, Vogrig A, Welte TM, Westenberg E, Zhuravlev D, Zinchuk M, Winkler AS. Evaluation and treatment approaches for neurological post-acute sequelae of COVID-19: A consensus statement and scoping review from the global COVID-19 neuro research coalition. J Neurol Sci 2023; 454:120827. [PMID: 37856998 DOI: 10.1016/j.jns.2023.120827] [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: 06/20/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Post-acute neurological sequelae of COVID-19 affect millions of people worldwide, yet little data is available to guide treatment strategies for the most common symptoms. We conducted a scoping review of PubMed/Medline from 1/1/2020-4/1/2023 to identify studies addressing diagnosis and treatment of the most common post-acute neurological sequelae of COVID-19 including: cognitive impairment, sleep disorders, headache, dizziness/lightheadedness, fatigue, weakness, numbness/pain, anxiety, depression and post-traumatic stress disorder. Utilizing the available literature and international disease-specific society guidelines, we constructed symptom-based differential diagnoses, evaluation and management paradigms. This pragmatic, evidence-based consensus document may serve as a guide for a holistic approach to post-COVID neurological care and will complement future clinical trials by outlining best practices in the evaluation and treatment of post-acute neurological signs/symptoms.
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Affiliation(s)
- Jennifer A Frontera
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA.
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Mariam Ashraf
- Department of Anesthesiology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Betül Baykan
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, and EMAR Medical Center, Istanbul, Turkey
| | - Lucía Crivelli
- Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina
| | - Ava Easton
- The Encephalitis Society, Malton, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - David Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Raimund Helbok
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurology, Johannes Kepler University, Linz, Austria
| | - Jatin Joshi
- Department of Anesthesiology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Julia Koehn
- Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Igor Koralnik
- Departmentof Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Benedict Michael
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Annacarmen Nilo
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Aynur Özge
- Department of Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Karanbir Padda
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Gaia Pellitteri
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Kameshwar Prasad
- Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Marina Romozzi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Adam Seed
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Kiran Thakur
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Derya Uluduz
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, and EMAR Medical Center, Istanbul, Turkey
| | - Alberto Vogrig
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy; Department of Medicine, University of Udine Medical School, Udine, Italy
| | - Tamara M Welte
- Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany; Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Erica Westenberg
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dmitry Zhuravlev
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Mikhail Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Smieszek SP, Kaden AR, Johnson CE, Brzezynski JL, Xiao C, Polymeropoulos CM, Birznieks G, Emsellem HA, Polymeropoulos MH. Case report: A patient with Delayed Sleep-Wake Phase Disorder and Optic Nerve Hypoplasia treated with tasimelteon: a case study. Front Neurosci 2023; 17:1287514. [PMID: 38033548 PMCID: PMC10682171 DOI: 10.3389/fnins.2023.1287514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
We present a case of an adult female diagnosed with Delayed Sleep-Wake Phase Disorder (DSWPD) and Optic Nerve Hypoplasia (ONH), with a confirmed delayed Dim Light Melatonin Onset (DLMO), who reports the inability to fall asleep at their desired bedtime and obtain adequate sleep nightly, despite the ability to have a full night's sleep when not required to be up at a specific time for societal requirements. The participant was enrolled in an 11-month Open-Label Extension (OLE) following the randomized portion of a clinical study and was successfully treated with tasimelteon. DSWPD symptoms were resolved, and their previously delayed sleep-wake cycle was advanced. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04652882, identifier NCT04652882.
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Affiliation(s)
| | | | | | | | - Changfu Xiao
- Vanda Pharmaceuticals Inc., Washington, DC, United States
| | | | | | - Helene A. Emsellem
- The Center for Sleep & Wake Disorders, Chevy Chase, MD, United States
- Department of Neurology, George Washington University, Washington, DC, United States
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Butler M, D'Angelo S, Perrin A, Rodillas J, Miller D, Arader L, Chandereng T, Cheung YK, Shechter A, Davidson KW. A Series of Remote Melatonin Supplement Interventions for Poor Sleep: Protocol for a Feasibility Pilot Study for a Series of Personalized (N-of-1) Trials. JMIR Res Protoc 2023; 12:e45313. [PMID: 37535419 PMCID: PMC10436115 DOI: 10.2196/45313] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Poor sleep, defined as short-duration or poor-quality sleep, is a frequently reported condition with many deleterious effects including poorer cognitive functioning, increased accidents, and poorer health. Melatonin has been shown to be an efficacious treatment to manage symptoms of poor sleep. However, the treatment effects of melatonin on sleep can vary greatly between participants. Personalized, or N-of-1, trial designs represent a method for identifying the best treatment for individual participants. Although using N-of-1 trials of melatonin to treat poor sleep is possible, the feasibility, acceptability, and effectiveness of N-of-1 trials using melatonin are unknown. Using the National Institutes of Health Stage Model for Behavioral Intervention Development, a stage IB (intervention refinement, modification, and adaptation and pilot testing) design appeared to be needed to address these feasibility questions. OBJECTIVE This trial series evaluates the feasibility, acceptability, and effectiveness of a series of personalized interventions for remote delivery of melatonin dose (3 and 0.5 mg) versus placebo supplements for self-reported poor sleep among 60 participants. The goal of this study is to provide valuable information about implementing remote N-of-1 randomized controlled trials to improve poor sleep. METHODS Participants will complete a 2-week baseline followed by six 2-week alternating intervention periods of 3 mg of melatonin, 0.5 mg of melatonin, and placebo. Participants will be randomly assigned to 2 intervention orders. The feasibility and acceptability of the personalized trial approach will be determined with participants' ratings of usability and satisfaction with the remote, personalized intervention delivery system. The effectiveness of the intervention will be measured using participants' self-reported sleep quality and duration and Fitbit tracker-measured sleep duration and efficiency. Additional measures will include ecological momentary assessment measures of fatigue, stress, pain, mood, concentration, and confidence as well as measures of participant adherence to the intervention, use of the Fitbit tracker, and survey data collection. RESULTS As of the submission of this protocol, recruitment for this National Institutes of Health stage IB personalized trial series is approximately 78.3% complete (47/60). We expect recruitment and data collection to be finalized by June 2023. CONCLUSIONS Evaluating the feasibility, acceptability, and effectiveness of a series of personalized interventions of melatonin will address the longer term aim of this program of research-is integrating N-of-1 trials useful patient care? The personalized trial series results will be published in a peer-reviewed journal and will follow the CONSORT (Consolidated Standards of Reporting Trials) extension for N-of-1 trials (CENT 2015) reporting guidelines. This trial series was approved by the Northwell Health institutional review board. TRIAL REGISTRATION ClinicalTrials.gov NCT05349188; https://www.clinicaltrials.gov/study/NCT05349188. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45313.
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Affiliation(s)
- Mark Butler
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Stefani D'Angelo
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Alexandra Perrin
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Jordyn Rodillas
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Danielle Miller
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Lindsay Arader
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- St John's University, New York, NY, United States
| | - Thevaa Chandereng
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Ying Kuen Cheung
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Ari Shechter
- Columbia University Irving Medical Center, New York, NY, United States
| | - Karina W Davidson
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, United States
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10
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Wu A. Updates and confounding factors in delayed sleep-wake phase disorder. Sleep Biol Rhythms 2023; 21:279-287. [PMID: 37363638 PMCID: PMC9979143 DOI: 10.1007/s41105-023-00454-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023]
Abstract
Delayed sleep-wake phase disorder (DSWPD) is a circadian rhythm sleep disorder characterised by a delay in the main sleep period, with patients experiencing difficulty getting to sleep and waking up at socially appropriate times. This often causes insomnia and compromised sleep, results in impairment to daytime function and is associated with a range of comorbidities. Besides interventions aimed at ameliorating symptoms, there is good evidence supporting successful phase advancement with bright light therapy or melatonin administration. However, no treatment to date addresses the tendency to phase delay, which is a common factor amongst the various contributing causes of DSWPD. Circadian phase markers such as core body temperature and circulating melatonin typically correlate well with sleep timing in healthy patients, but numerous variations exist in DSWPD patients that can make these unpredictable for use in diagnostics. There is also increasing evidence that, on top of problems with the circadian cycle, sleep homeostatic processes actually differ in DSWPD patients compared to controls. This naturally has ramifications for management but also for the current approach to the pathogenesis itself in which DSWPD is considered a purely circadian disorder. This review collates what is known on the causes and treatments of DSWPD, addresses the pitfalls in diagnosis and discusses the implications of current data on modified sleep homeostasis, making clinical recommendations and directing future research.
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Affiliation(s)
- Alexandra Wu
- Division of Biosciences, University College London, Gower Street, London, WC1E 6BT UK
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11
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Dong C, Liu H, Yang B, Pan J, Tang L, Zeng H, Yang S. Circadian rhythm sleep-wake disorders and the risk of dyslipidemia among railway workers in southwest China: A cross-sectional study. Chronobiol Int 2023; 40:734-743. [PMID: 37096562 DOI: 10.1080/07420528.2023.2205933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/20/2023] [Accepted: 04/18/2023] [Indexed: 04/26/2023]
Abstract
Railway workers are more likely to have an irregular work schedule, which had an effect on their circadian rhythm of sleep, and may lead to circadian rhythm sleep-wake disorders (CRSWDs). The association between CRSWDs and dyslipidemia in railway workers is poorly understood. The objective of this research is to study the association between CRSWDs and the risk of dyslipidemia. This cross-sectional study was conducted among railway workers in Southwest China. CRSWDs were assessed by the morningness-eveningness questionnaire self-assessment version (MEQ-SA). The blood samples were collected in the morning and the lipids of participants were measured. Associations of CRSWDs with dyslipidemia and its components were analyzed. A total of 8079 participants were enrolled in this study, and the results revealed that shift work sleep disorder (SWD) and advanced sleep-wake phase disorder (ASWPD) were associated with a higher risk of dyslipidemia (OR 1.17, 95%CI 1.06-1.29, P < 0.01; OR 1.68, 95%CI 1.09-2.64, P < 0.05) after adjusting for sociodemographic characteristics and lifestyles, in comparison with the control group. As for its components, the SWD group was associated with a higher risk of elevated total cholesterol, triglycerides, and low-density lipoprotein than the control group, while the ASWPD group was associated with a higher risk of elevated total cholesterol, and low-density lipoprotein (P < 0.05). In summary, SWD and ASWPD participants were associated with a higher risk of dyslipidemia in railway workers in Southwest China.Abbreviation: TG: triglyceride; TC: Total cholesterol; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol; FPG: fasting plasma glucose. MEQ-SA: morningness-eveningness questionnaire self-assessment version; IPW: inverse-probability weighting; HDS: healthy diet scores; FFQ: food frequency; PA: physical activity; IQAP-SF: international physical activity questionnaire short form; MET-min/wk: metabolic equivalent task minutes per week; BMI: body mass index; SBP: systolic blood pressure; DBP: diastolic blood pressure; HBP: hypertension; DM: diabetes; CVD: cerebrovascular disease; OR: odds ratios; CI: confidence intervals.
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Affiliation(s)
- Chaohui Dong
- Department of Health Management Center, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu City, Sichuan Province, China
| | - Hongyun Liu
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Bo Yang
- Department of Health Management Center, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu City, Sichuan Province, China
| | - Jia Pan
- Department of Health Management Center, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu City, Sichuan Province, China
| | - Lei Tang
- Department of Health Management Center, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu City, Sichuan Province, China
| | - Honglian Zeng
- Department of Health Management Center, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu City, Sichuan Province, China
| | - Shujuan Yang
- Department of Health Management Center, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu City, Sichuan Province, China
- West China School of Public Health, Sichuan University, Chengdu, China
- International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan, China
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12
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Hu L, Wang EJH. Sleep as a Therapeutic Target for Pain Management. Curr Pain Headache Rep 2023; 27:131-141. [PMID: 37162641 DOI: 10.1007/s11916-023-01115-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a summary of the utilization of sleep as a therapeutic target for chronic pain and to evaluate the recent literature on current and proposed pharmacologic and non-pharmacologic sleep interventions used in the management of pain disorders. RECENT FINDINGS Sleep is a promising therapeutic target in the treatment of pain disorders with both non-pharmacologic and pharmacologic therapies. Non-pharmacologic therapies include cognitive behavioral therapy and sensory-based therapies such as pink noise, audio-visual stimulation, and morning bright light therapy. Pharmacologic therapies include melatonin, z-drugs, gabapentinoids, and the novel orexin antagonists. However, more research is needed to clarify if these therapies can improve pain specifically by improving sleep. There is a vast array of investigational opportunities in sleep-targeted therapies for pathologic pain, and larger controlled, prospective trials are needed to fully elucidate their efficacy.
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Affiliation(s)
- Lizbeth Hu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Eric Jyun-Han Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Blaustein Pain Treatment Center, 601 North Caroline Street, Suite 3062, Baltimore, MD, 21287, USA.
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13
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Al-Abri M, Al Asmi A, Rizvi S, Al-Mashaikhi T, Al Abri H, Al-Majrafi H, Gujjar AR. The Relationship Between Epilepsy Control and the Duration of Nighttime Sleep and Afternoon Siesta. Cureus 2023; 15:e39266. [PMID: 37342755 PMCID: PMC10278951 DOI: 10.7759/cureus.39266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/23/2023] Open
Abstract
CONTEXT The association between epilepsy control and the duration of sleep among people with epilepsy (PWE) is not well studied in Middle Eastern countries such as Oman. AIMS To describe the sleep habits of PWE in Oman and explore the association of their sleep habits at night and afternoon siesta with the level of seizure control achieved and antiseizure medications (ASMs) consumed. METHODS The subjects of this cross-sectional study were adult epilepsy patients attending a neurology clinic. Their sleep parameters were measured for one week using actigraphy. Home sleep apnea testing for one night was conducted to rule out obstructive sleep apnea (OSA). RESULTS A total of 129 PWE completed the study. Their mean age was 29.8 ± 9.2 years, and their mean body mass index (BMI) was 27.1 kg/m2. There was no significant difference between the people with controlled and uncontrolled epilepsy as regards the duration of night sleep or afternoon siesta (p = 0.24 and 0.37, respectively). There was also no significant correlation between their nighttime sleep duration, afternoon siesta, and the number of ASMs they consumed (p = 0.402 and 0.717, respectively). CONCLUSION The study revealed that the sleep habits of PWE with uncontrolled epilepsy who consumed more ASMs were not significantly different from those with controlled epilepsy who consumed fewer ASMs.
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Affiliation(s)
| | | | - Syed Rizvi
- Family Medicine and Public Health, Sultan Qaboos University, Muscat, OMN
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Bell A, Hewins B, Bishop C, Fortin A, Wang J, Creamer JL, Collen J, Werner JK. Traumatic Brain Injury, Sleep, and Melatonin-Intrinsic Changes with Therapeutic Potential. Clocks Sleep 2023; 5:177-203. [PMID: 37092428 PMCID: PMC10123665 DOI: 10.3390/clockssleep5020016] [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: 01/19/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Traumatic brain injury (TBI) is one of the most prevalent causes of morbidity in the United States and is associated with numerous chronic sequelae long after the point of injury. One of the most common long-term complaints in patients with TBI is sleep dysfunction. It is reported that alterations in melatonin follow TBI and may be linked with various sleep and circadian disorders directly (via cellular signaling) or indirectly (via free radicals and inflammatory signaling). Work over the past two decades has contributed to our understanding of the role of melatonin as a sleep regulator and neuroprotective anti-inflammatory agent. Although there is increasing interest in the treatment of insomnia following TBI, a lack of standardization and rigor in melatonin research has left behind a trail of non-generalizable data and ambiguous treatment recommendations. This narrative review describes the underlying biochemical properties of melatonin as they are relevant to TBI. We also discuss potential benefits and a path forward regarding the therapeutic management of TBI with melatonin treatment, including its role as a neuroprotectant, a somnogen, and a modulator of the circadian rhythm.
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Affiliation(s)
- Allen Bell
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Bryson Hewins
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
| | - Courtney Bishop
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
| | - Amanda Fortin
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
| | - Jonathan Wang
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
| | | | - Jacob Collen
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
| | - J. Kent Werner
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (B.H.)
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15
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YAZICI S, ÖNCÜ ÇETİNKAYA B. Sleep Disorders during Adolescence. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1105463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Sleep disorders during adolescence period increase each year and adversely affect the physical and mental health of adolescents. After-school social activities and various work outside the school may cause delays in bedtime. In addition, there can be shifts in the circadian rhythm due to a number of biological changes seen in the transition to adolescence, which can result in a wide range of sleep problems, such as not being able to fall asleep at night, difficulty waking up in the morning, daytime sleepiness, sleep deprivation and deterioration in sleep quality. It is important to know the causes of sleep disorders, possible effects on physical health and mental health, and protective and risk-forming factors seen in adolescent period; to intervene in these disorders and to develop preventive measures. Preventive measures, such as increasing awareness about sleep disorders in adolescents, informing families and adolescents about the issue, and organizing school start-up times for this age group, may contribute significantly to solving this important issue, which has increased year-to-year.
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16
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Conway-Jones R, Dunlop E, Kyle S, Ray D, Roberts N, Farmer A. A scoping review of the evidence for the impact of pharmacological and non-pharmacological interventions on shift work related sleep disturbance in an occupational setting. Wellcome Open Res 2023; 6:198. [PMID: 37346814 PMCID: PMC10280030 DOI: 10.12688/wellcomeopenres.17002.2] [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] [Accepted: 11/29/2022] [Indexed: 08/17/2023] Open
Abstract
Background: Shift work is essential in society but can be detrimental to health and quality of life and is associated with decreased productivity and increased risk of accidents. Interventions to reduce these consequences are needed, but the extent and range of trial evidence for interventions for those most affected by their shift-work schedules is unclear. We therefore carried out a scoping review to assess the availability of evidence to inform the development and evaluation of future interventions. Methods: We aimed to identify clinical trials of any intervention for shift work-related sleep disturbance that included a comparator group, where the intervention was delivered in an occupational setting. We searched Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Medline and Science Citation Index from inception to 30 th March 2020 for relevant citations. Citations were screened by two independent reviewers, a third reviewer resolved disagreements. Data were extracted by two independent reviewers. Results: From 1250 unique citations, 14 studies met inclusion criteria for comparative trials of treatment in an occupational setting. There were five trials of hypnotics, five trials of stimulants, and four trials of non-pharmacological therapies (cognitive behavioural therapy, light therapy, aromatherapy and herbal medicine). Outcomes included sleep parameters, day-time sleepiness, and quality of life. There were no consistently reported outcomes across trials. Conclusions: Interventions fell into three distinct groups investigated in distinct time periods without progression from efficacy trials to wider-scale interventions. The lack of consistent patient-reported outcome measures limits synthesising findings. Some trials focussed on optimising sleep, others on reducing wake-time sleepiness. Adequately powered trials of existing interventions are needed, with the development and testing of novel combination treatments in patients with well-defined shift work sleep disorder. A core set of clinically relevant outcomes will develop and standardise the evidence-base for shift work sleep disorder.
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Affiliation(s)
| | - Ella Dunlop
- Medical Science Division, University of Oxford, Oxford, UK
| | - Simon Kyle
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David Ray
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford, UK
| | - Nia Roberts
- The Bodleian Libraries, University of Oxford, Oxford, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Gohar AA, Knauert M, Kalot MA, Khan A, Sider D, Javed MA, Wooldridge D, Eck L, Buckhold F, Colaco B, Bhat A, Castillo DM, Newman R, Mustafa RA. Influence of medical trainee sleep pattern (chronotype) on burn-out and satisfaction with work schedules: a multicentre observational study. Postgrad Med J 2022; 98:936-941. [PMID: 37062998 PMCID: PMC10074556 DOI: 10.1136/postgradmedj-2021-140975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/25/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Medical trainees' work schedule is designed to cover duties without consideration of differences in circadian rhythms during a 24-hour period (chronotype). OBJECTIVE To explore chronotype variation among medical trainees and understand its association with burn-out and schedule satisfaction. METHODS In a multicentre observational study, we conducted two surveys between 1 October 2018 and 1 April 2019. Trainees from nine centres across the USA participated. We measured burn-out using Maslach Burnout Inventory (MBI), and trainee chronotype using the Morningness-Eveningness Questionnaire (MEQ). RESULTS 324 (32%) out of 1012 responded to our survey. Participants were 51% female and had a mean age of 30.8 years. Most participants had an intermediate MEQ type (65%). A large proportion of participants had burn-out on at least one of three tested MBI scales (62%); 5% of participants had burn-out on all three MBI scales. More participants with evening MEQ type had burn-out (66%) compared with morning MEQ type (55%), however, the results were not statically significant (p=0.294). Overall satisfaction with work shifts was 6.5 (95% CI 6.3 to 6.7), with higher satisfaction with day shift 7.7 (95% CI 7.5 to 7.9) and lowest satisfaction with overnight 24-hour call 3.5 (95% CI 3.2 to 3.9). Satisfaction was lower in trainees with burn-out 6.0 (95% CI 5.7 to 6.4), (p<0.001). In the follow-up survey, burn-out was present in at least one scale in 64% compared with 60% of respondents in the initial survey. CONCLUSION Burn-out is prevalent among medical trainees. Improving alignment between trainee preferences may improve performance, reduce human errors and burn-out.
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Affiliation(s)
- Ashraf A Gohar
- Department of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Melissa Knauert
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mohamad A Kalot
- Department of Medicine, State University of New York, Buffalo, New York, USA
| | - Akram Khan
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Darby Sider
- Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida, USA
| | - Muhammad Ali Javed
- Department of Critical Care Medicine, Mercy Hospital St Louis Area, Saint Louis, Missouri, USA
| | - David Wooldridge
- Department of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Leigh Eck
- Department of Medicine, University of Kansas Medical Center, Kansas City, Missouri, USA
| | - Fred Buckhold
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Brendon Colaco
- Department of pulmonary, Mayo Clinic, Jacksonville, Florida, USA
| | - Abid Bhat
- Department of Medicine, University of Missouri, Kansas City, Missouri, USA
| | - Dubier Matos Castillo
- Division of Pulmonary Critical Care, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Ross Newman
- Department of Pediatrics, Children's Mercy, Kansas City, Missouri, USA
| | - Reem A Mustafa
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Walsh SM, Forward CL, Flaherty GT. Parasomnias during trans-meridian and long-distance travel: Critical literature review and clinical practice recommendations. J Sleep Res 2022; 31:e13672. [PMID: 35726362 PMCID: PMC9786733 DOI: 10.1111/jsr.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/17/2022] [Accepted: 05/30/2022] [Indexed: 12/30/2022]
Abstract
Parasomnias are undesirable events that occur during sleep. They can be classified into rapid eye movement parasomnias and non-rapid eye movement parasomnias. Those who experience parasomnias may be anxious about travel for many reasons, including the occurrence of unwanted events during the trip, increased exposure to environmental trigger factors, and the propensity for harm to occur due to unfamiliar surroundings while travelling. There is a paucity of literature examining this area. This review summarizes the relevant literature and the clinical experience of the authors to compile clinical practice recommendations. The clinical features of parasomnias and how they relate to trans-meridian and long-distance travel are described. Triggers for non-rapid eye movement parasomnias, particularly the use of sedative hypnotic drugs, alcohol, drug withdrawal, sleep deprivation, emotional stress and environmental stimulations, are described. Management of parasomnias whilst travelling is reviewed, with a particular focus on trigger minimalization. The role for clonazepam and melatonin is outlined. At the pre-travel health consultation, the physician is strongly advised to screen the traveller for co-morbid sleep conditions, which exacerbate parasomnias. Areas for further research are explored, including the extent to which these sleep disorders impact on the travel experience.
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Affiliation(s)
- Sinead M. Walsh
- School of MedicineNational University of Ireland GalwayGalwayIreland,Department of Respiratory and Sleep MedicineGalway University HospitalsGalwayIreland
| | - Cameron L. Forward
- Department of Respiratory and Sleep MedicineGalway University HospitalsGalwayIreland
| | - Gerard T. Flaherty
- School of MedicineNational University of Ireland GalwayGalwayIreland,School of MedicineInternational Medical UniversityKuala LumpurMalaysia
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Negative Impacts of Sleep-Wake Rhythm Disturbances on Attention in Young Adults. Brain Sci 2022; 12:brainsci12121643. [PMID: 36552103 PMCID: PMC9776066 DOI: 10.3390/brainsci12121643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/02/2022] Open
Abstract
Sleep-wake rhythm disturbances have a negative impact on attention. However, how it affects attention and whether the restoration of regular rhythms can restore attention are unclear. This study aims to explore the effects of sleep-wake rhythm disturbances on three subfunctions of attention (alertness, orientation, and executive control) and the restoration of regular rhythms on these functions. Twenty-one participants in the experimental group (who experienced sleep-wake rhythm disturbances for at least one month; aged 18-26) were required to sleep regularly following a sleep schedule, whereas 20 participants in the control group (who maintained regular sleep for at least three months; aged 19-22) received no manipulation of their sleep. All participants were assessed using the attention network test three times in six days. All of them wore spectrum activity monitors and kept sleep diaries every day. The results showed that the effects of alertness and executive control in the experimental group were significantly lower than those in the control group. After five days of regular sleep, the difference in the alertness effect between the two groups significantly decreased. These results suggested that under natural conditions, sleep-wake rhythm disturbances could negatively influence alertness and executive control, and a short period of restoring a regular rhythm has a recovery effect on alertness.
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Iwamoto BK, Decker KM, Byars KC, Van Dyk TR. Impact of Exogenous Melatonin on Sleep and Daytime Functioning in Healthy, Typically Developing Adolescents. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Fan J, Wang L, Yang X, Zhang X, Song Z, Wu S, Zou L, Li X, Zhao X, Li C, Pan Y, Tie Y, Wang Y, Luo Z, Sun X. Night shifts in interns: Effects of daytime napping on autonomic activity and cognitive function. Front Public Health 2022; 10:922716. [PMID: 36299766 PMCID: PMC9589154 DOI: 10.3389/fpubh.2022.922716] [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] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/29/2022] [Indexed: 01/22/2023] Open
Abstract
Objective Night shifts have adverse cognitive outcomes that might be attenuated by daytime napping. The neurovisceral integration model suggests that resting vagally mediated heart rate variability (vmHRV) is linked with cognitive function. This study investigated the relationship between resting vmHRV and cognitive function after different nap durations in interns after shift work. Methods A total of 105 interns were randomly allocated to one of three groups (non-nap, n = 35; 15-min nap, n = 35; 45-min nap, n = 35) to perform cognitive tests and resting vmHRV at 12:00, 15:00 and 18:00. Information processing (digit symbol substitution test; DSST), motor speed (finger tapping test; FTT), response selection (choice reaction time; CRT), and attention shifts (shifting attention test; SAT) were assessed. Resting vmHRV was assessed at baseline and during each cognitive task across groups. Results Compared with the non-nap control, the 15-min and 45-min naps improved all outcome measures (including subjective sleepiness and cognitive performance) at 15:00, with some benefits maintained at 18:00. The 15-min nap produced significantly greater benefits on the FTT at 15:00 after napping than did the 45-min nap. Resting vmHRV was significantly correlated with DSST and SAT performance. In addition, FTT performance was the only significant predictor of DSST performance across different nap durations. Conclusion Our results demonstrate links between daytime napping (in particular, a 15-min nap) and improved cognitive control in relation to autonomic activity after shift work in interns. These results indicated that autonomic activity when awake plays a crucial role in DSST and SAT performance and facilitated the understanding of differences in neurocognitive mechanisms underlying information processing after different nap durations.
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Affiliation(s)
- Jieyi Fan
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China
| | - Liang Wang
- Department of Medical Genetics and Developmental Biology, Air Force Medical University, Xi'an, China
| | - Xiaotian Yang
- Department of Medical Genetics and Developmental Biology, Air Force Medical University, Xi'an, China
| | - Xiangbo Zhang
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China
| | - Ziyao Song
- Department of Medical Genetics and Developmental Biology, Air Force Medical University, Xi'an, China
| | - Sifan Wu
- Department of Medical Genetics and Developmental Biology, Air Force Medical University, Xi'an, China
| | - Linru Zou
- Department of Medical Genetics and Developmental Biology, Air Force Medical University, Xi'an, China
| | - Xi Li
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China
| | - Xingcheng Zhao
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China
| | - Chenfei Li
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China
| | - Yikai Pan
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China
| | - Yateng Tie
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China
| | - Yongchun Wang
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China,Yongchun Wang
| | - Zhengxue Luo
- General Hospital of PLA Air Force, Beijing, China,Zhengxue Luo
| | - Xiqing Sun
- Department of Aerospace Medicine, Air Force Medical University, Xi'an, China,*Correspondence: Xiqing Sun
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22
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Minich DM, Henning M, Darley C, Fahoum M, Schuler CB, Frame J. Is Melatonin the "Next Vitamin D"?: A Review of Emerging Science, Clinical Uses, Safety, and Dietary Supplements. Nutrients 2022; 14:3934. [PMID: 36235587 PMCID: PMC9571539 DOI: 10.3390/nu14193934] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Melatonin has become a popular dietary supplement, most known as a chronobiotic, and for establishing healthy sleep. Research over the last decade into cancer, Alzheimer's disease, multiple sclerosis, fertility, PCOS, and many other conditions, combined with the COVID-19 pandemic, has led to greater awareness of melatonin because of its ability to act as a potent antioxidant, immune-active agent, and mitochondrial regulator. There are distinct similarities between melatonin and vitamin D in the depth and breadth of their impact on health. Both act as hormones, affect multiple systems through their immune-modulating, anti-inflammatory functions, are found in the skin, and are responsive to sunlight and darkness. In fact, there may be similarities between the widespread concern about vitamin D deficiency as a "sunlight deficiency" and reduced melatonin secretion as a result of "darkness deficiency" from overexposure to artificial blue light. The trend toward greater use of melatonin supplements has resulted in concern about its safety, especially higher doses, long-term use, and application in certain populations (e.g., children). This review aims to evaluate the recent data on melatonin's mechanisms, its clinical uses beyond sleep, safety concerns, and a thorough summary of therapeutic considerations concerning dietary supplementation, including the different formats available (animal, synthetic, and phytomelatonin), dosing, timing, contraindications, and nutrient combinations.
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Affiliation(s)
- Deanna M. Minich
- Department of Human Nutrition and Functional Medicine, University of Western States, Portland, OR 97213, USA
| | - Melanie Henning
- Department of Sports and Performance Psychology, University of the Rockies, Denver, CO 80202, USA
| | - Catherine Darley
- College of Naturopathic Medicine, National University of Natural Medicine, Portland, OR 97201, USA
| | - Mona Fahoum
- School of Naturopathic Medicine, Bastyr University, Kenmore, WA 98028, USA
| | - Corey B. Schuler
- School of Nutrition, Sonoran University of Health Sciences, Tempe, AZ 85282, USA
- Department of Online Education, Northeast College of Health Sciences, Seneca Falls, NY 13148, USA
| | - James Frame
- Natural Health International Pty., Ltd., Sydney, NSW 2000, Australia
- Symphony Natural Health, Inc., West Valley City, UT 84119, USA
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Tighe CA, Buysse DJ, Weiner DK, Beehler GP, Forman DE. Prevalence, Impact, and Trajectories of Sleep Disturbance in Cardiac Rehabilitation: A NARRATIVE REVIEW AND SUGGESTIONS FOR EVALUATION AND TREATMENT. J Cardiopulm Rehabil Prev 2022; 42:316-323. [PMID: 35522949 PMCID: PMC9437109 DOI: 10.1097/hcr.0000000000000694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this review was to summarize literature examining the prevalence, impact, and trajectories of sleep disturbance in cardiac rehabilitation (CR) patients and discuss how CR programs may incorporate targeted evaluation and interventions to promote sleep health. REVIEW METHODS A narrative review of literature allowed for an examination of the prevalence of sleep disturbance in CR patients, the effects of sleep disturbance on CR outcomes, and trajectories of sleep disturbance in CR. SUMMARY Sleep disturbance is prevalent in CR patient populations and is related to clinical and functional outcomes. Sleep may be an important biobehavioral process to target in CR to improve important patient outcomes and achieve secondary prevention goals.
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Affiliation(s)
- Caitlan A. Tighe
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System
| | - Daniel J. Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Debra K. Weiner
- Department of Psychiatry, University of Pittsburgh School of Medicine
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
- Department of Anesthesiology, University of Pittsburgh School of Medicine
- Clinical and Translational Science Institute, University of Pittsburgh School of Medicine
| | - Gregory P. Beehler
- VA Center for Integrated Healthcare
- Community Health and Health Behavior, School of Public Health and Health Professions, University of Buffalo
| | - Daniel E. Forman
- Geriatric Research Education and Clinical Center, VA Pittsburgh Healthcare System
- Department of Medicine, University of Pittsburgh School of Medicine
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24
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Xiong X, Hu T, Yin Z, Zhang Y, Chen F, Lei P. Research advances in the study of sleep disorders, circadian rhythm disturbances and Alzheimer’s disease. Front Aging Neurosci 2022; 14:944283. [PMID: 36062143 PMCID: PMC9428322 DOI: 10.3389/fnagi.2022.944283] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Although there are still no satisfactory answers to the question of why we need to sleep, a better understanding of its function will help to improve societal attitudes toward sleep. Sleep disorders are very common in neurodegenerative diseases and are a key factor in the quality of life of patients and their families. Alzheimer’s disease (AD) is an insidious and irreversible neurodegenerative disease. Along with progressive cognitive impairment, sleep disorders and disturbances in circadian rhythms play a key role in the progression of AD. Sleep and circadian rhythm disturbances are more common in patients with AD than in the general population and can appear early in the course of the disease. Therefore, this review discusses the bidirectional relationships among circadian rhythm disturbances, sleep disorders, and AD. In addition, pharmacological and non-pharmacological treatment options for patients with AD and sleep disorders are outlined.
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Affiliation(s)
- Xiangyang Xiong
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Tianpeng Hu
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhenyu Yin
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Yaodan Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | | | - Ping Lei
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
- *Correspondence: Ping Lei,
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Gauld C, Lopez R, Philip P, Taillard J, Morin CM, Geoffroy PA, Micoulaud-Franchi JA. A Systematic Review of Sleep-Wake Disorder Diagnostic Criteria Reliability Studies. Biomedicines 2022; 10:1616. [PMID: 35884924 PMCID: PMC9313077 DOI: 10.3390/biomedicines10071616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 12/02/2022] Open
Abstract
The aim of this article is to provide a systematic review of reliability studies of the sleep-wake disorder diagnostic criteria of the international classifications used in sleep medicine. Electronic databases (ubMed (1946-2021) and Web of Science (-2021)) were searched up to December 2021 for studies computing the Cohen's kappa coefficient of diagnostic criteria for the main sleep-wake disorder categories described in the principal classifications. Cohen's kappa coefficients were extracted for each main sleep-wake disorder category, for each classification subtype, and for the different types of methods used to test the degree of agreement about a diagnosis. The database search identified 383 studies. Fifteen studies were analyzed in this systematic review. Insomnia disorder (10/15) and parasomnia disorder (7/15) diagnostic criteria were the most studied. The reliability of all sleep-wake disorders presented a Cohen's kappa with substantial agreement (Cohen's kappa mean = 0.66). The two main reliability methods identified were "test-retest reliability" (11/15), principally used for International Classification of Sleep Disorders (ICSD), and "joint interrater reliability" (4/15), principally used for Diagnostic and Statistical Manual of Mental Disorders (DSM) subtype diagnostic criteria, in particularl, the DSM-5. The implications in terms of the design of the methods used to test the degree of agreement about a diagnosis in sleep medicine are discussed.
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Affiliation(s)
- Christophe Gauld
- Department of Child Psychiatry, Hospices Civils de Lyon, 69000 Lyon, France;
- UMR CNRS 8590 IHPST, Sorbonne University, 75007 Paris, France
| | - Régis Lopez
- Institut des Neurosciences de Montpellier (INM), University Montpellier, 34000 Montpellier, France;
- Inserm, Unité des Troubles du Sommeil, Département de Neurologie, CHU Montpellier, 34000 Montpellier, France
| | - Pierre Philip
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33 076 Bordeaux, France;
- CNRS, SANPSY, Université de Bordeaux, UMR6033, 33000 Bordeaux, France;
| | - Jacques Taillard
- CNRS, SANPSY, Université de Bordeaux, UMR6033, 33000 Bordeaux, France;
| | - Charles M. Morin
- École de Psychologie, Université Laval, 2325 Rue des Bibliothèques, Québec City, QC G1V 0A6, Canada;
- Centre D’étude des Troubles du Sommeil, Université Laval, 2325 Rue des Bibliothèques, Québec City, QC G1V 0A6, Canada
| | - Pierre Alexis Geoffroy
- Département de Psychiatrie et d’addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hopital Bichat—Claude Bernard, 75018 Paris, France;
- GHU Paris—Psychiatry & Neurosciences, 1 Rue Cabanis, 75014 Paris, France
- NeuroDiderot, Inserm, Université de Paris, FHU I2-D2, 75019 Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, 67000 Strasbourg, France
| | - Jean-Arthur Micoulaud-Franchi
- University Sleep Clinic, Services of Functional Exploration of the Nervous System, University Hospital of Bordeaux, Place Amélie Raba-Léon, 33 076 Bordeaux, France;
- CNRS, SANPSY, Université de Bordeaux, UMR6033, 33000 Bordeaux, France;
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Circadian regulation of memory under stress: Endocannabinoids matter. Neurosci Biobehav Rev 2022; 138:104712. [PMID: 35643119 DOI: 10.1016/j.neubiorev.2022.104712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/27/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Abstract
Organisms ranging from plants to higher mammals have developed 24-hour oscillation rhythms to optimize physiology to environmental changes and regulate a plethora of neuroendocrine and behavioral processes, including neurotransmitter and hormone regulation, stress response and learning and memory function. Compelling evidence indicates that a wide array of memory processes is strongly influenced by stress- and emotional arousal-activated neurobiological systems, including the endocannabinoid system which has been extensively shown to play an integral role in mediating stress effects on memory. Here, we review findings showing how circadian rhythms and time-of-day influence stress systems and memory performance. We report evidence of circadian regulation of memory under stress, focusing on the role of the endocannabinoid system and highlighting its circadian rhythmicity. Our discussion illustrates how the endocannabinoid system mediates stress effects on memory in a circadian-dependent fashion. We suggest that endocannabinoids might regulate molecular mechanisms that control memory function under circadian and stress influence, with potential important clinical implications for both neurodevelopmental disorders and psychiatric conditions involving memory impairments.
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Abstract
With aging, there are normative changes to sleep physiology and circadian rhythmicity that may predispose older adults to sleep deficiency, whereas many health-related and psychosocial/behavioral factors may precipitate sleep deficiency. In this article, we describe age-related changes to sleep and describe how the health-related and psychosocial/behavioral factors typical of aging may converge in older adults to increase the risk for sleep deficiency. Next, we review the consequences of sleep deficiency in older adults, focusing specifically on important age-related outcomes, including mortality, cognition, depression, and physical function. Finally, we review treatments for sleep deficiency, highlighting safe and effective nonpharmacologic interventions.
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Affiliation(s)
- Jane Alexandra Pappas
- San Juan Bautista School of Medicine, Salida 21 Carr. 172 Urb. Turabo Gardens, Caguas 00726, Puerto Rico
| | - Brienne Miner
- Section of Geriatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
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Abstract
The timing, duration, and consolidation of sleep result from the interaction of the circadian timing system with a sleep-wake homeostatic process. When aligned and functioning optimally, this allows for wakefulness throughout the day and a long consolidated sleep episode at night. Changes to either the sleep regulatory process or how they interact can result in an inability to fall asleep at the desired time, difficulty remaining asleep, waking too early, and/or difficulty remaining awake throughout the day. This mismatch between the desired timing of sleep and the ability to fall asleep and remain asleep is a hallmark of a class of sleep disorders called the circadian rhythm sleep-wake disorders. In this updated article, we discuss typical changes in the circadian regulation of sleep with aging; how age influences the prevalence, diagnosis, and treatment of circadian rhythm sleep disorders; and how neurologic diseases in older patient impact circadian rhythms and sleep.
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Affiliation(s)
- Jee Hyun Kim
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Gonghangdae-ro 260, Gangseo-gu, Seoul, Republic of Korea
| | - Alexandria R Elkhadem
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital, 221 Longwood Avenue BLI438, Boston, MA 02115, USA
| | - Jeanne F Duffy
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
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29
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Castle-Kirszbaum M, Shi MDY, Goldschlager T. Quality of Life in Craniopharyngioma: A Systematic Review. World Neurosurg 2022; 164:424-435.e2. [PMID: 35580780 DOI: 10.1016/j.wneu.2022.05.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Craniopharyngiomas are morbid tumors that significantly reduce patients' quality of life (QoL). The lifelong burden of endocrine, visual, hypothalamic, and limbic dysfunction can have disastrous consequences for the physical and psychosocial health of patients. Elucidating the factors that influence QoL could guide therapeutic interventions to improve patient well-being. METHODS A systematic review was performed in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement using the PubMed and Medline databases. Studies that had reported patient QoL using validated metrics in both adult and pediatric populations were included. Bias and methodological rigor were assessed using the MINORS (methodological index for nonrandomized studies) criteria. RESULTS A total of 25 studies, including 2025 patients, were available for review. Most studies were small, retrospective, cohort studies with a high risk of bias. The QoL of the patients with craniopharyngioma was lower than that of the general population. Hypothalamic involvement was consistently the strongest predictor of QoL. Endocrinopathy contributed to morbidity but could be ameliorated by hormone replacement therapy. Social and emotional dysregulation and a poor memory are common complaints after surgery, and iatrogenic damage to the infundibulum, hypothalamus, limbic system, and frontal lobes might underlie these concerns. Sleep-wake cycle dysfunction and hypothalamic obesity are serious consequences of hypothalamic damage. CONCLUSIONS An experienced multidisciplinary team is necessary to optimally manage the complex cases of these patients. The poor QoL of patients with craniopharyngioma is multifactorial. However, the contribution of iatrogenesis is not insubstantial. Improved surgical techniques, focusing on hypothalamic preservation, and adjuvant treatment options are required to improve the well-being of these patients.
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Affiliation(s)
- Mendel Castle-Kirszbaum
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Victoria, Australia.
| | - Margaret D Y Shi
- Department of Surgery, Northern Hospital, Melbourne, Victoria, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Victoria, Australia; Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Zou C, Mei X, Li X, Hu J, Xu T, Zheng C. Effect of light therapy on delirium in older patients with Alzheimer's disease-related dementia. J Psychiatr Res 2022; 149:124-127. [PMID: 35272209 DOI: 10.1016/j.jpsychires.2022.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 12/25/2022]
Abstract
Light therapy has been used as a non-pharmacologic treatment to modulate biorhythms in patients with mental and psychological conditions. These conditions include affective disorders and depression. Delirium is a syndrome characterized by an acute change in a patient's mental status. We hypothesized that light therapy might suppress delirium in patients with Alzheimer's disease (AD). A 4-week randomized controlled trial was conducted in which AD participants were randomly assigned to a treatment group or a control group. Delirium, defined by the Confusion Assessment Method (CAM), was evaluated at baseline and after 4 weeks. The Neuropsychiatric Inventory (NPI) and Zarit Caregiver Burden Interview (ZBI) were also conducted to assess the behavior of patients and the burden of their caregivers. For this study, 61 participants were initially recruited. A total of 34 and 27 participants were included in the treatment and control groups, respectively. After treatment with light therapy, the CAM score decreased during the second and fourth week. The NPI score in the therapy group also decreased during the second and fourth week. From the caregiver's perspective, after light therapy, the ZBI score significantly decreased during the second and fourth week. Compared with the control group, patients who underwent CAM and NPI assessments showed a small but significant improvement after 4 weeks of light therapy. In conclusion, a course of 4-week light therapy significantly suppressed delirium in patients with AD. The combined effects of light therapy and conventional treatment were superior to that of conventional treatment alone.
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Affiliation(s)
- Chenjun Zou
- Department of Geriatric, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Zhenhai District, Ningbo City, Zhejiang Province, 315200, China.
| | - Xi Mei
- Key Lab of Sleep Medicine, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Zhenhai District, Ningbo City, Zhejiang Province, 315200, China.
| | - Xingxing Li
- Key Lab of Sleep Medicine, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Zhenhai District, Ningbo City, Zhejiang Province, 315200, China.
| | - Jun Hu
- Department of Geriatric, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Zhenhai District, Ningbo City, Zhejiang Province, 315200, China.
| | - Ting Xu
- Department of Geriatric, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Zhenhai District, Ningbo City, Zhejiang Province, 315200, China.
| | - Chengying Zheng
- Department of Geriatric, Ningbo Kangning Hospital, Zhuangyu South Road 1#, Zhenhai District, Ningbo City, Zhejiang Province, 315200, China.
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Sleep Disturbances Following Traumatic Brain Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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32
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Roh HW, Choi SJ, Jo H, Kim D, Choi JG, Son SJ, Joo EY. Associations of actigraphy derived rest activity patterns and circadian phase with clinical symptoms and polysomnographic parameters in chronic insomnia disorders. Sci Rep 2022; 12:4895. [PMID: 35318367 PMCID: PMC8941088 DOI: 10.1038/s41598-022-08899-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/04/2022] [Indexed: 12/13/2022] Open
Abstract
We explored the associations of actigraphy-derived rest-activity patterns and circadian phase parameters with clinical symptoms and level 1 polysomnography (PSG) results in patients with chronic insomnia to evaluate the clinical implications of actigraphy-derived parameters for PSG interpretation. Seventy-five participants underwent actigraphy assessments and level 1 PSG. Exploratory correlation analyses between parameters derived from actigraphy, PSG, and clinical assessments were performed. First, participants were classified into two groups based on rest-activity pattern variables; group differences were investigated following covariate adjustment. Participants with poorer rest-activity patterns on actigraphy (low inter-day stability and high intra-daily variability) exhibited higher insomnia severity index scores than participants with better rest-activity patterns. No between-group differences in PSG parameters were observed. Second, participants were classified into two groups based on circadian phase variables. Late-phase participants (least active 5-h and most active 10-h onset times) exhibited higher insomnia severity scores, longer sleep and rapid eye movement latency, and lower apnea-hypopnea index than early-phase participants. These associations remained significant even after adjusting for potential covariates. Some actigraphy-derived rest-activity patterns and circadian phase parameters were significantly associated with clinical symptoms and PSG results, suggesting their possible adjunctive role in deriving plans for PSG lights-off time and assessing the possible insomnia pathophysiology.
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Affiliation(s)
- Hyun Woong Roh
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Su Jung Choi
- Graduate School of Clinical Nursing Science, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hyunjin Jo
- Department of Neurology, Neuroscience Center, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Dongyeop Kim
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jung-Gu Choi
- Yonsei Graduate Program in Cognitive Science, Yonsei University, Seoul, Republic of Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Eun Yeon Joo
- Department of Neurology, Neuroscience Center, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Brown BWJ, Crowther ME, Appleton SL, Melaku YA, Adams RJ, Reynolds AC. Shift work disorder and the prevalence of help seeking behaviors for sleep concerns in Australia: A descriptive study. Chronobiol Int 2022; 39:714-724. [PMID: 35253569 DOI: 10.1080/07420528.2022.2032125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Shift work disorder (SWD) is a circadian rhythm sleep-wake disorder, defined by symptoms of insomnia and excessive levels of sleepiness resulting from work that occurs during non-standard hours. Sleep problems are common in shift workers, yet our understanding of help seeking behaviours for sleep in shift workers is limited. The primary aim of this study was to examine the help seeking behaviours of Australian workers who meet criteria for SWD. Of the 448 (46% of sample, n = 964 total) Australian workers reporting non-standard work hours, 10.5% (n = 41) met the criteria for probable shift work disorder (pSWD). Non-standard workers with pSWD did not seek help for sleep problems at higher rates than workers without SWD. Of the small proportion of workers with pSWD who sought help, general practitioners were the most common healthcare professionals for sleep problems. Self-management was common in workers with pSWD, with a high self-reported prevalence of alcohol use (31.7%) as a sleep management strategy, and caffeine consumption (76.9%) as a sleepiness management strategy. The majority of individuals with pSWD reported the mentality of 'accept it and keep going' as a sleepiness management strategy, highlighting a potential barrier to help seeking behaviour in workers with pSWD. These findings provide novel insight into the help seeking behaviours of those with pSWD. There is a need for further research to understand why individuals at risk for SWD are not actively seeking help, and to develop health promotion and intervention strategies to improve help seeking when needed.
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Affiliation(s)
- Brandon W J Brown
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | | | - Sarah L Appleton
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Yohannes Adama Melaku
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute of Sleep Health, Flinders University, Adelaide, Australia
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The Development, Implementation, and Feasibility of a Circadian, Light, and Sleep Skills Program for Shipboard Military Personnel (CLASS-SM). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053093. [PMID: 35270786 PMCID: PMC8910671 DOI: 10.3390/ijerph19053093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022]
Abstract
Service members face unique barriers to sufficient and high quality sleep. In the present study, a circadian, light, and sleep skills program for shipboard military personnel (CLASS-SM) was designed to encourage and inform strategies that support optimal sleep and circadian health in the context of those barriers. Phase 1 included program development and refinement via an iterative formative evaluation, including structured interviews with service members and feedback from veterans and experts, resulting in further tailoring to the population. In Phase 2, the highly tailored program was administered to shipboard personnel (n = 55), and acceptability indicators were measured. Sleep- and circadian-related knowledge (pre- and post-program) and the perceived relevance of, and satisfaction with, program content (post-program) were assessed. Before the intervention, most individuals were unaware that 7−9 h of sleep is recommended (72%) and had little understanding of the physiological effects of light; however, knowledge scores increased significantly post-program, from 51% to 88% correct (p < 0.0001). Reception was positive, with high reported satisfaction and relevance. Most individuals reported that they learned something new (89%), planned to use one or more learned strategies (100%), and intended to share learned information with others (85%); the physiological effects of light and circadian rhythms were the content areas most frequently reported as new and useful. The results demonstrate the need for, and feasibility of, the delivery of this program in operational environments.
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Abstract
Around 21% of workers reported working on shifts in 2017, and consequently, shift workers experience multiple sleep disturbances such as excessive sleepiness, insomnia, sleep deprivation, and social jet lag. These eventually lead to shift work disorder or exacerbation of other sleep disorders such as insomnia, obstructive sleep apnea, restless legs syndrome, and nonrapid eye movement parasomnia. Despite multiple interventions and guidelines, poor compliance to treatment is often encountered due to temporary relief of sleep disturbances provided by the treatment. Hence there is a need for comprehensive evaluation of those individuals who need to be awake during the night and asleep during the day.
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Affiliation(s)
- April Fatima J Hernandez
- Comprehensive Sleep Disorders Center, St. Luke's Medical Center - Quezon City, 279 E. Rodriguez Sr. Avenue, Quezon City 1112, Philippines; Comprehensive Sleep Disorders Center, St. Luke's Medical Center - Global City, Rizal Drive cor. 32nd St. and 5th Avenue, Taguig City 1634, Philippines; Department of Psychiatry, University of the East Ramon Magsaysay Memorial Medical Center, Aurora Boulevard, Quezon City 1105, Philippines.
| | - Reinzi Luz S Bautista
- Comprehensive Sleep Disorders Center, St. Luke's Medical Center - Global City, Rizal Drive cor. 32nd St. and 5th Avenue, Taguig City 1634, Philippines
| | - Cristine Celine Tan
- Comprehensive Sleep Disorders Center, St. Luke's Medical Center - Quezon City, 279 E. Rodriguez Sr. Avenue, Quezon City 1112, Philippines
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36
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Sleep during travel balances individual sleep needs. Nat Hum Behav 2022; 6:691-699. [PMID: 35210591 DOI: 10.1038/s41562-022-01291-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/06/2022] [Indexed: 11/08/2022]
Abstract
Travel is expected to have a deleterious effect on sleep, but an epidemiological-scale understanding of sleep changes associated with travel has been limited by a lack of large-scale data. Our global dataset of ~20,000 individuals and 3.17 million nights (~218,000 travel nights), while focused mainly on short, non-time-zone-crossing trips, reveals that travel has a balancing effect on sleep. Underslept individuals typically sleep more during travel than when at home, while individuals who average more than 7.5 hours of sleep at home typically sleep less when travelling. The difference in travel sleep quantity depends linearly on home sleep quantity and decreases as median sleep duration increases. On average, travel wake time advances to later hours on weekdays but earlier hours on weekends. Our study emphasizes the potential for consumer-grade wearable device data to explore how environment and behaviour affect sleep.
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Lehrer HM, Yao Z, Krafty RT, Evans MA, Buysse DJ, Kravitz HM, Matthews KA, Gold EB, Harlow SD, Samuelsson LB, Hall MH. Comparing polysomnography, actigraphy, and sleep diary in the home environment: The Study of Women's Health Across the Nation (SWAN) Sleep Study. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2022; 3:zpac001. [PMID: 35296109 PMCID: PMC8918428 DOI: 10.1093/sleepadvances/zpac001] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 12/04/2021] [Indexed: 01/28/2023]
Abstract
Study Objectives Polysomnography (PSG) is considered the "gold standard" for assessing sleep, but cost and burden limit its use. Although wrist actigraphy and self-report diaries are feasible alternatives to PSG, few studies have compared all three modalities concurrently across multiple nights in the home to assess their relative validity across multiple sleep outcomes. This study compared sleep duration and continuity measured by PSG, actigraphy, and sleep diaries and examined moderation by race/ethnicity. Methods Participants from the Study of Women's Health Across the Nation (SWAN) Sleep Study included 323 White (n = 147), African American (n = 120), and Chinese (n = 56) middle-aged community-dwelling women (mean age: 51 years, range: 48-57). PSG, wrist actigraphy (AW-64; Philips Respironics, McMurray, PA), and sleep diaries were collected concurrently in participants' homes over three consecutive nights. Multivariable repeated-measures linear models compared time in bed (TIB), total sleep time (TST), sleep efficiency (SE), sleep latency (SL), and wake after sleep onset (WASO) across modalities. Results Actigraphy and PSG produced similar estimates of sleep duration and efficiency. Diaries yielded higher estimates of TIB, TST, and SE versus PSG and actigraphy, and lower estimates of SL and WASO versus PSG. Diary SL was shorter than PSG SL only among White women, and diary WASO was lower than PSG and actigraphy WASO among African American versus White women. Conclusions Given concordance with PSG, actigraphy may be preferred as an alternative to PSG for measuring sleep in the home. Future research should consider racial/ethnic differences in diary-reported sleep continuity.
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Affiliation(s)
- H Matthew Lehrer
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zhigang Yao
- Department of Statistics and Applied Probability, National University of Singapore, Singapore, Singapore
| | - Robert T Krafty
- Deparment of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Marissa A Evans
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard M Kravitz
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA,Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Karen A Matthews
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ellen B Gold
- Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, CA, USA
| | - Sioban D Harlow
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Martica H Hall
- Corresponding author. Martica H. Hall, University of Pittsburgh, 3811 O’Hara Street, Room E-1131, Pittsburgh, PA 15213, USA.
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38
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Yang L, Jiang H, Ding X, Liao Z, Wei M, Li J, Wu T, Li C, Fang Y. Modulation of Sleep Architecture by Whole-Body Static Magnetic Exposure: A Study Based on EEG-Based Automatic Sleep Staging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:741. [PMID: 35055561 PMCID: PMC8775472 DOI: 10.3390/ijerph19020741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 12/10/2022]
Abstract
A steady increase in sleep problems has been observed along with the development of society. Overnight exposure to a static magnetic field has been found to improve sleep quality; however, such studies were mainly based on subjective evaluation. Thus, the presented data cannot be used to infer sleep architecture in detail. In this study, the subjects slept on a magneto-static mattress for four nights, and self-reported scales and electroencephalogram (EEG) were used to determine the effect of static magnetic field exposure (SMFE) on sleep. Machine learning operators, i.e., decision tree and supporting vector machine, were trained and optimized with the open access sleep EEG dataset to automatically discriminate the individual sleep stages, determined experimentally. SMEF was found to decrease light sleep duration (N2%) by 3.51%, and sleep onset latency (SOL) by 15.83%, while it increased deep sleep duration (N3%) by 8.43%, compared with the sham SMFE group. Further, the overall sleep efficiency (SE) was also enhanced by SMFE. It is the first study, to the best of our knowledge, where the change in sleep architecture was explored by SMFE. Our findings will be useful in developing a non-invasive sleep-facilitating instrument.
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Affiliation(s)
- Lei Yang
- China Academy of Information and Communications Technology, Beijing 100191, China; (L.Y.); (H.J.); (X.D.); (J.L.); (T.W.)
| | - Haoyu Jiang
- China Academy of Information and Communications Technology, Beijing 100191, China; (L.Y.); (H.J.); (X.D.); (J.L.); (T.W.)
| | - Xiaotong Ding
- China Academy of Information and Communications Technology, Beijing 100191, China; (L.Y.); (H.J.); (X.D.); (J.L.); (T.W.)
| | - Zhongcai Liao
- Zhejiang Heye Health Technology, Anji 313300, China; (Z.L.); (M.W.)
| | - Min Wei
- Zhejiang Heye Health Technology, Anji 313300, China; (Z.L.); (M.W.)
| | - Juan Li
- China Academy of Information and Communications Technology, Beijing 100191, China; (L.Y.); (H.J.); (X.D.); (J.L.); (T.W.)
| | - Tongning Wu
- China Academy of Information and Communications Technology, Beijing 100191, China; (L.Y.); (H.J.); (X.D.); (J.L.); (T.W.)
| | - Congsheng Li
- China Academy of Information and Communications Technology, Beijing 100191, China; (L.Y.); (H.J.); (X.D.); (J.L.); (T.W.)
| | - Yanwen Fang
- Zhejiang Heye Health Technology, Anji 313300, China; (Z.L.); (M.W.)
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Martin T, Duivon M, Bessot N, Grellard JM, Emile G, Polvent S, Raoul L, Viader F, Eustache F, Joly F, Giffard B, Perrier J. Rest activity rhythms characteristics of breast cancer women following endocrine therapy. Sleep 2021; 45:6384813. [PMID: 34624895 DOI: 10.1093/sleep/zsab248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/22/2021] [Indexed: 01/20/2023] Open
Abstract
Rest-activity rhythm (RAR) disruptions are frequently associated with chemotherapy in breast cancer (BC), but they are less known in BC with endocrine therapy. The aim of this ancillary study was to characterize the RAR and estimated sleep characteristics from actigraphy in BC patients either treated (ET+) or untreated with endocrine therapy (ET-), compared to healthy controls (HC) and using a cross-sectional design. Eighteen ET+, 18 ET- and 16 HC completed questionnaires and wore wrist actigraphs at home for 2 weeks. Parametric and non-parametric RAR, sleep parameters, and quality of life were compared between groups (p<0.05). BC groups presented lower daytime activity than HC according to RAR analysis (mesor and M10 parameters). Compared to HC, ET- had lower inter-daily stability and ET+ had greater sleep complaints. Compared to ET-, ET+ had lower sleep efficiency, more time awake and higher activity levels at night, as assessed with actigraphy. Our results suggest an effect of cancer independent of treatment on RAR in BC, highlighting the need for further investigation of this topic. In contrast, sleep as assessed with actigraphy seems modified only during ET which matches with patients' sleep complaints. Further longitudinal studies would aid in confirming the latter hypothesis.
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Affiliation(s)
- T Martin
- Le Mans University, Movement - Interactions, Performance, MIP, EA 4334, Faculty of Sciences and Technologies, Avenue Olivier Messiaen, Le Mans, France
| | - M Duivon
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - N Bessot
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University , Caen, France
| | - J M Grellard
- Departments of Clinical Research Unit and Medical Oncology, Caen, France.,Institut Normand du Sein, Centre François Baclesse, Caen, France
| | - G Emile
- Departments of Clinical Research Unit and Medical Oncology, Caen, France.,Institut Normand du Sein, Centre François Baclesse, Caen, France
| | - S Polvent
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - L Raoul
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - F Viader
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - F Eustache
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
| | - F Joly
- Departments of Clinical Research Unit and Medical Oncology, Caen, France.,Institut Normand du Sein, Centre François Baclesse, Caen, France.,CHU Côte de Nacre, Caen, France.,INSERM, Normandie Univ, UNICAEN, U1086 ANTICIPE, Caen, France.,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14076, Caen, France
| | - B Giffard
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France.,Cancer and Cognition Platform, Ligue Nationale Contre le Cancer, 14076, Caen, France
| | - J Perrier
- Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine, Caen, France
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Kimura S, Takaoka Y, Toyoura M, Kohira S, Ohta M. Core body temperature changes in school-age children with circadian rhythm sleep-wake disorder. Sleep Med 2021; 87:97-104. [PMID: 34547649 DOI: 10.1016/j.sleep.2021.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/21/2021] [Accepted: 08/26/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE/BACKGROUND Core body temperature (CBT) is considered a valuable marker for circadian rhythm. This study aimed to investigate the changes in CBT that are associated with the symptoms of circadian rhythm sleep-wake disorder (CRSWD) post-treatment in children. PATIENTS/METHODS Twenty-eight school-age children [10 boys and 18 girls; mean age (±standard deviation), 13.68 ± 0.93 years] who were admitted to our hospital with CRSWD underwent treatment for 6-8 weeks according to the following protocol: lights-out for sleep at 21:00; phototherapy for waking at 6:00 or 7:00; light exercise everyday (eg, a 20- to 30-min walk). CBT was continuously measured for 24 h on the first day of admission and on the first day after treatment. RESULTS The mean time of sleep onset/offset (±standard deviation; in hours:minutes) 1 week before admission and 1 week after treatment were 23:53 ± 2:26/9:58 ± 2:15 and 21:17 ± 0:19/6:46 ± 0:32, respectively. The mean times of sleep onset and offset measured post-treatment were significantly earlier than those measured pre-treatment (p < 0.001). The mean CBT and mean minimum CBT during sleep were significantly lower on the first day post-treatment than on the first day of admission (p = 0.011 and p < 0.001, respectively). CONCLUSIONS Symptom improvements in patients with CRSWD were associated with a decrease in CBT during sleep, suggesting that CBT may be a biomarker for improvements in CRSWD. These results help elucidate the cause of this sleep disorder.
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Affiliation(s)
- Shigemi Kimura
- Children's Rehabilitation, Sleep and Development Medical Center, Hyogo Prefectural Rehabilitation Central Hospital, 1070 Akebono-cho, Nishi-ku, Kobe, 651-2181, Japan; Division of Medical Informatics and Bioinformatics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yutaka Takaoka
- Division of Medical Informatics and Bioinformatics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan; Data Science Center for Medicine and Hospital Management, Toyama University Hospital, 2630, Sugitani, Toyama-shi, Toyama, 930-0194, Japan; Division of Medical Law and Ethics, Department of Medical Systems, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makiko Toyoura
- Children's Rehabilitation, Sleep and Development Medical Center, Hyogo Prefectural Rehabilitation Central Hospital, 1070 Akebono-cho, Nishi-ku, Kobe, 651-2181, Japan
| | - Shinji Kohira
- Children's Rehabilitation, Sleep and Development Medical Center, Hyogo Prefectural Rehabilitation Central Hospital, 1070 Akebono-cho, Nishi-ku, Kobe, 651-2181, Japan
| | - Mika Ohta
- Division of Medical Informatics and Bioinformatics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan; Data Science Center for Medicine and Hospital Management, Toyama University Hospital, 2630, Sugitani, Toyama-shi, Toyama, 930-0194, Japan; Division of Medical Law and Ethics, Department of Medical Systems, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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41
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An Efficient Approach for Detecting Driver Drowsiness Based on Deep Learning. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11188441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drowsy driving is one of the common causes of road accidents resulting in injuries, even death, and significant economic losses to drivers, road users, families, and society. There have been many studies carried out in an attempt to detect drowsiness for alert systems. However, a majority of the studies focused on determining eyelid and mouth movements, which have revealed many limitations for drowsiness detection. Besides, physiological measures-based studies may not be feasible in practice because the measuring devices are often not available on vehicles and often uncomfortable for drivers. In this research, we therefore propose two efficient methods with three scenarios for doze alert systems. The former applies facial landmarks to detect blinks and yawns based on appropriate thresholds for each driver. The latter uses deep learning techniques with two adaptive deep neural networks based on MobileNet-V2 and ResNet-50V2. The second method analyzes the videos and detects driver’s activities in every frame to learn all features automatically. We leverage the advantage of the transfer learning technique to train the proposed networks on our training dataset. This solves the problem of limited training datasets, provides fast training time, and keeps the advantage of the deep neural networks. Experiments were conducted to test the effectiveness of our methods compared with other methods. Empirical results demonstrate that the proposed method using deep learning techniques can achieve a high accuracy of 97%. This study provides meaningful solutions in practice to prevent unfortunate automobile accidents caused by drowsiness.
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42
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Conway-Jones R, Dunlop E, Kyle S, Ray D, Roberts N, Farmer A. A scoping review of the evidence for the impact of pharmacological and non-pharmacological interventions on shift work related sleep disturbance in an occupational setting. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.17002.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Shift work is essential in society but can be detrimental to health and quality of life and is associated with decreased productivity and increased risk of accidents. Interventions to reduce these consequences are needed, but the extent and range of trial evidence for interventions for those most affected by their shift-work schedules is unclear. We therefore carried out a scoping review to assess the availability of evidence to inform the development and evaluation of future interventions. Methods: We aimed to identify clinical trials of any intervention for shift work-related sleep disturbance that included a comparator group, where the intervention was delivered in an occupational setting. We searched Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, EMBASE, Medline and Science Citation Index from inception to 30th March 2020 for relevant citations. Citations were screened by two independent reviewers, a third reviewer resolved disagreements. Data were extracted by two independent reviewers. Results: From 1250 unique citations, 14 studies met inclusion criteria for comparative trials of treatment in an occupational setting. There were five trials of hypnotics, five trials of stimulants, and four trials of non-pharmacological therapies (cognitive behavioural therapy, light therapy, aromatherapy and herbal medicine). Outcomes included sleep parameters, day-time sleepiness, and quality of life. There were no consistently reported outcomes across trials. Conclusions: Interventions fell into three distinct groups investigated in distinct time periods without progression from efficacy trials to wider-scale interventions. The lack of consistent patient-reported outcome measures limits synthesising findings. Some trials focussed on optimising sleep, others on reducing wake-time sleepiness. Adequately powered trials of existing interventions are needed, with the development and testing of novel combination treatments in patients with well-defined shift work sleep disorder. A core set of clinically relevant outcomes will develop and standardise the evidence-base for shift work sleep disorder.
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Martinez-Nicolas A, Guaita M, Santamaría J, Montserrat JM, Madrid JA, Rol MA. Ambulatory circadian monitoring in sleep disordered breathing patients and CPAP treatment. Sci Rep 2021; 11:14711. [PMID: 34282278 PMCID: PMC8290024 DOI: 10.1038/s41598-021-94315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022] Open
Abstract
Our aim was to evaluate the circadian rhythm of motor activity, body position and integrated variable TAP (composed by wrist Temperature, motor Activity and body Position) in Sleep Disordered Breathing (SDB), its relation to SDB severity and the effect of continuous positive airway pressure (CPAP) on these circadian rhythms. To do this, we monitored motor activity and body position rhythms of 78 SDB patients (53.3 ± 1.2 years old, 26.9% women) and 32 healthy subjects (51.4 ± 3.2 years old, 43.8% women) for 1 week. On the last day of that week, SDB patients underwent a polysomnography followed by a Maintenance of Wakefulness Test, Multiple Sleep Latency Test and Sustained Attention to Response Task protocol. A subgroup of 18 moderate to severe SDB patients was treated with CPAP and monitored again after 3 months under treatment. A non-parametrical analysis was performed to characterize the circadian patterns to assess differences between groups and associations between sleep and circadian parameters. Circadian variables were altered in SDB, exhibiting a direct relationship to SDB severity. The motor activity pattern showed a clear improvement with CPAP treatment. Thus, circadian ambulatory monitoring, including the integrated variable TAP, could be used to evaluate the circadian alterations caused by SDB and activity pattern to monitor the effect of CPAP treatment.
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Affiliation(s)
- Antonio Martinez-Nicolas
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus. IUIE. IMIB - Arrixaca, 30100, Espinardo, Murcia, Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - Marc Guaita
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Santamaría
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Neurology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep M Montserrat
- Multidisciplinary Sleep Disorders Unit, Hospital Clinic of Barcelona, Barcelona, Spain.,Pneumology Department, Hospital Clinic of Barcelona, Barcelona, Spain.,Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Juan Antonio Madrid
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus. IUIE. IMIB - Arrixaca, 30100, Espinardo, Murcia, Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - María Angeles Rol
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus. IUIE. IMIB - Arrixaca, 30100, Espinardo, Murcia, Spain. .,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
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44
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Kim M, Liotta EM, Maas MB, Braun RI, Garcia-Canga B, Ganger DR, Ladner DP, Reid KJ, Zee PC. Rest-activity rhythm disturbance in liver cirrhosis and association with cognitive impairment. Sleep 2021; 44:6047598. [PMID: 33367862 DOI: 10.1093/sleep/zsaa288] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/20/2020] [Indexed: 11/12/2022] Open
Abstract
Cognitive impairment and disturbed sleep-wake rhythms are disabling complications of liver cirrhosis, yet there is limited understanding of how they are related. We tested the hypothesis that alterations of sleep, rest-activity, and light exposure patterns are associated with worse cognition in cirrhosis. A total of 54 ambulatory adult patients with cirrhosis and 41 age-/gender-matched healthy controls wore wrist actigraphy for rest-activity and light measurements and completed Patient-Reported Outcomes Measurement Information System sleep instruments for self-reported sleep quality. We used standard nonparametric descriptors to characterize rest-activity and light patterns, and wake after sleep onset and sleep efficiency to assess objective sleep quality. The NIH Toolbox cognition battery was used for objective cognitive evaluation using T-scores from a demographically adjusted population reference. Spearman's correlation and multivariable models were used to explore associations between measures of cognition, sleep, rest-activity, and light. Cognition was significantly impaired in cirrhosis patients. Sleep quality was worse in cirrhosis patients by subjective and objective measures compared with controls. Cirrhosis patients exhibited fragmented and dampened rest-activity rhythms, lower daytime and higher nighttime light exposure compared with controls. Worse working memory and processing speed was associated with lower daytime activity level, higher rest-activity fragmentation, lower day-to-day stability, and greater nocturnal light exposure. No association was found between cognition and sleep quality. Rest-activity fragmentation and abnormal light exposure patterns are common in patients with liver disease and are associated with the severity of cognitive impairment. Further research is needed to investigate the effects of timed bright light and exercise intervention on cognitive function in patients with liver disease.
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Affiliation(s)
- Minjee Kim
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Chicago, IL
| | - Eric M Liotta
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Chicago, IL
- Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, IL
| | - Matthew B Maas
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rosemary I Braun
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Biostatistics Division, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Engineering Sciences and Applied Mathematics, Northwestern University, Evanston, IL
| | - Blas Garcia-Canga
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Daniel R Ganger
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Chicago, IL
- Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, IL
- Department of Medicine, Northwestern Medicine, Chicago, IL
| | - Daniela P Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center (CTC), Feinberg School of Medicine, Chicago, IL
- Division of Transplant, Department of Surgery, Northwestern Medicine, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathryn J Reid
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Phyllis C Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Hubbard J, Kobayashi Frisk M, Ruppert E, Tsai JW, Fuchs F, Robin-Choteau L, Husse J, Calvel L, Eichele G, Franken P, Bourgin P. Dissecting and modeling photic and melanopsin effects to predict sleep disturbances induced by irregular light exposure in mice. Proc Natl Acad Sci U S A 2021; 118:e2017364118. [PMID: 34155139 PMCID: PMC8237663 DOI: 10.1073/pnas.2017364118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Artificial lighting, day-length changes, shift work, and transmeridian travel all lead to sleep-wake disturbances. The nychthemeral sleep-wake cycle (SWc) is known to be controlled by output from the central circadian clock in the suprachiasmatic nuclei (SCN), which is entrained to the light-dark cycle. Additionally, via intrinsically photosensitive retinal ganglion cells containing the photopigment melanopsin (Opn4), short-term light-dark alternations exert direct and acute influences on sleep and waking. However, the extent to which longer exposures typically experienced across the 24-h day exert such an effect has never been clarified or quantified, as disentangling sustained direct light effects (SDLE) from circadian effects is difficult. Recording sleep in mice lacking a circadian pacemaker, either through transgenesis (Syt10cre/creBmal1fl/- ) or SCN lesioning and/or melanopsin-based phototransduction (Opn4-/- ), we uncovered, contrary to prevailing assumptions, that the contribution of SDLE is as important as circadian-driven input in determining SWc amplitude. Specifically, SDLE were primarily mediated (>80%) through melanopsin, of which half were then relayed through the SCN, revealing an ancillary purpose for this structure, independent of its clock function in organizing SWc. Based on these findings, we designed a model to estimate the effect of atypical light-dark cycles on SWc. This model predicted SWc amplitude in mice exposed to simulated transequatorial or transmeridian paradigms. Taken together, we demonstrate this SDLE is a crucial mechanism influencing behavior on par with the circadian system. In a broader context, these findings mandate considering SDLE, in addition to circadian drive, for coping with health consequences of atypical light exposure in our society.
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Affiliation(s)
- Jeffrey Hubbard
- CNRS-Unité Propre de Recherche (UPR) 3212, Institute of Cellular and Integrative Neurosciences, 67084 Strasbourg, France
- International Research Center for ChronoSomnology, Translational Medicine Federation Strasbourg, Sleep Disorders Center, Strasbourg University Hospital, University of Strasbourg, 67000 Strasbourg, France
| | - Mio Kobayashi Frisk
- CNRS-Unité Propre de Recherche (UPR) 3212, Institute of Cellular and Integrative Neurosciences, 67084 Strasbourg, France
- International Research Center for ChronoSomnology, Translational Medicine Federation Strasbourg, Sleep Disorders Center, Strasbourg University Hospital, University of Strasbourg, 67000 Strasbourg, France
| | - Elisabeth Ruppert
- CNRS-Unité Propre de Recherche (UPR) 3212, Institute of Cellular and Integrative Neurosciences, 67084 Strasbourg, France
- International Research Center for ChronoSomnology, Translational Medicine Federation Strasbourg, Sleep Disorders Center, Strasbourg University Hospital, University of Strasbourg, 67000 Strasbourg, France
| | - Jessica W Tsai
- Department of Biology, Stanford University, Stanford, CA 94305
| | - Fanny Fuchs
- CNRS-Unité Propre de Recherche (UPR) 3212, Institute of Cellular and Integrative Neurosciences, 67084 Strasbourg, France
- International Research Center for ChronoSomnology, Translational Medicine Federation Strasbourg, Sleep Disorders Center, Strasbourg University Hospital, University of Strasbourg, 67000 Strasbourg, France
| | - Ludivine Robin-Choteau
- CNRS-Unité Propre de Recherche (UPR) 3212, Institute of Cellular and Integrative Neurosciences, 67084 Strasbourg, France
- European Center for Diabetes Studies, 67200 Strasbourg, France
| | - Jana Husse
- Department of Genes and Behavior, Max Planck Institute for Biophysical Chemistry, 37077 Goettingen, Germany
| | - Laurent Calvel
- CNRS-Unité Propre de Recherche (UPR) 3212, Institute of Cellular and Integrative Neurosciences, 67084 Strasbourg, France
- International Research Center for ChronoSomnology, Translational Medicine Federation Strasbourg, Sleep Disorders Center, Strasbourg University Hospital, University of Strasbourg, 67000 Strasbourg, France
| | - Gregor Eichele
- Department of Genes and Behavior, Max Planck Institute for Biophysical Chemistry, 37077 Goettingen, Germany
| | - Paul Franken
- Center for Integrative Genomics, University of Lausanne, 1015 Lausanne, Switzerland
| | - Patrice Bourgin
- CNRS-Unité Propre de Recherche (UPR) 3212, Institute of Cellular and Integrative Neurosciences, 67084 Strasbourg, France;
- International Research Center for ChronoSomnology, Translational Medicine Federation Strasbourg, Sleep Disorders Center, Strasbourg University Hospital, University of Strasbourg, 67000 Strasbourg, France
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Zhang F, Yang Z, Qin K, Sweeney JA, Roberts N, Jia Z, Gong Q. Effect of jet lag on brain white matter functional connectivity. PSYCHORADIOLOGY 2021; 1:55-65. [PMID: 38665361 PMCID: PMC10917196 DOI: 10.1093/psyrad/kkaa003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 02/05/2023]
Abstract
Background A long-haul flight across more than five time zones may produce a circadian rhythm sleep disorder known as jet lag. Little is known about the effect of jet lag on white matter (WM) functional connectivity (FC). Objective The present study is to investigate changes in WM FC in subjects due to recovery from jet lag after flying across six time zones. Methods Here, resting-state functional magnetic resonance imaging was performed in 23 participants within 24 hours of flying and again 50 days later. Gray matter (GM) and WM networks were identified by k-means clustering. WM FC and functional covariance connectivity (FCC) were analyzed. Next, a sliding window method was used to establish dynamic WM FC. WM static and dynamic FC and FCC were compared between when participants had initially completed their journey and 50 days later. Emotion was assessed using the Positive and Negative Affect Schedule and the State Anxiety Inventory. Results All participants were confirmed to have jet lag symptoms by the Columbian Jet Lag Scale. The static FC strengthes of cingulate network (WM7)- sensorimotor network and ventral frontal network- visual network were lower after the long-haul flight compared with recovery. Corresponding results were obtained for the dynamic FC analysis. The analysis of FCC revealed weakened connections between the WM7 and several other brain networks, especially the precentral/postcentral network. Moreover, a negative correlation was found between emotion scores and the FC between the WM7 and sensorimotor related regions. Conclusions The results of this study provide further evidence for the existence of WM networks and show that jet lag is associated with alterations in static and dynamic WM FC and FCC, especially in sensorimotor networks. Jet lag is a complex problem that not only is related to sleep rhythm but also influences emotion.
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Affiliation(s)
- Feifei Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
| | - Zhipeng Yang
- College of Electronic Engineering, Chengdu University of Information Technology, Chengdu 610225, China
| | - Kun Qin
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
| | - John A Sweeney
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH, USA
| | - Neil Roberts
- School of Clinical Sciences, University of Edinburgh, EH16 4TJ, UK
| | - Zhiyun Jia
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
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Thakral M, Von Korff M, McCurry SM, Morin CM, Vitiello MV. ISI-3: evaluation of a brief screening tool for insomnia. Sleep Med 2021; 82:104-109. [PMID: 33910159 PMCID: PMC8141095 DOI: 10.1016/j.sleep.2020.08.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/04/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVES We evaluated the performance of the Insomnia Severity Index-3 (ISI-3) as a short screening tool to identify clinically significant insomnia derived from the 7-item ISI in an older primary care population. METHODS We used results from two surveys including the 7-item ISI: Sample 1 (n = 3197) and Sample 2 (n = 247) individuals aged ≥60 years with a diagnosis of osteoarthritis from electronic health records. The 7 items were: difficulty falling asleep, difficulty staying asleep, waking too early, sleep satisfaction, sleep interference with daytime functioning, noticeability of sleep problems by others, and worry about sleep. The ISI-3 included items with highest item-total correlations to the 7-item ISI from Sample 1. A 7-item ISI score ≥15 was defined as clinically significant insomnia and served as the primary criterion for the ISI-3. We derived operating characteristics to determine the diagnostic accuracy and cut-points to maximize sensitivity and specificity for both samples. RESULTS The items with the highest item-total correlations were: sleep dissatisfaction, sleep interference with daily functioning, and worry about sleep problems (r = 0.78-0.81); while difficulty falling asleep, difficulty staying asleep, waking too early and noticeability of sleep problems by others showed lower correlations (r = 0.60-0.74). The ISI-3 achieved high discriminant validity in identifying insomnia (AUC = 0.97-0.98). An ISI-3 score of ≥7 maximized sensitivity (0.94-0.97) and specificity (0.88-0.91) with kappa = 0.68-0.71, 89.1-91.5% agreement. CONCLUSIONS The ISI-3 can effectively screen for insomnia to trigger a more thorough diagnostic evaluation including the 7-item ISI for research or clinical purposes. Future validation studies are needed in other community and clinical populations. CLINICAL TRIAL This manuscript describes secondary analyses of data two National Institutes on Aging-funded clinical trials (ClinicalTrials.gov identifier: NCT01142349, NCT02946957).
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Affiliation(s)
- Manu Thakral
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, USA.
| | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Susan M McCurry
- Department of Child, Family, and Population Health Nursing, University of Washington School of Nursing, Seattle, WA, USA
| | - Charles M Morin
- School of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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Kakar E, Venema E, Jeekel J, Klimek M, van der Jagt M. Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis. BMJ Open 2021; 11:e042510. [PMID: 33972331 PMCID: PMC8112429 DOI: 10.1136/bmjopen-2020-042510] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Sleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect of recorded music interventions on sleep quality and quantity in the adult critical care and surgical populations. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, MEDLINE Ovid, Cochrane Central, Web of Science and Google Scholar. ELIGIBILITY CRITERIA FOR STUDIES Randomised controlled trials assessing the effect of music on sleep quality in critically ill and surgical patients. METHODS The electronic databases were systematically searched from 1 January 1981 to 27 January 2020. Data were screened, extracted and appraised by two independent reviewers. Primary outcomes were sleep quality and quantity, assessed with validated tools. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random effects meta-analysis was performed, and pooled standardised mean differences (SMDs) with 95% CIs were reported. RESULTS Five studies (259 patients) were included in qualitative (risk of bias) and quantitative analysis (meta-analysis). Pooled data showed a significant effect of recorded music on subjective sleep quality in the critical care and surgical population (SMD=1.21 (95% CI 0.50 to 1.91), p<0.01, excluding one non-English study; SMD=0.87 (95% CI 0.45 to 1.29), p<0.01). The SMD of 1.21 corresponded to a 27.1% (95% CI 11.2 to 42.8) increase in subjective sleep quality using validated questionnaires. A significant increase in subjective sleep quantity of 36 min was found in one study. Objective measurements of sleep assessed in one study using polysomnography showed significant increase in deeper sleep stage in the music group. CONCLUSIONS Recorded music showed a significant improvement in subjective sleep quality in some critical care and surgical populations. Therefore, its use may be relevant to improve sleep, but given the moderate potential for bias, further research is needed. PROSPERO REGISTRATION NUMBER CRD42020167783.
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Affiliation(s)
- Ellaha Kakar
- Department of Surgery and Intensive Care Unit, Erasmus MC, Rotterdam, The Netherlands
| | - Esmée Venema
- Maastricht University, Maastricht, The Netherlands
| | - Johannes Jeekel
- Department of Surgery and Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Markus Klimek
- Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
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Tonon AC, Pilz LK, Markus RP, Hidalgo MP, Elisabetsky E. Melatonin and Depression: A Translational Perspective From Animal Models to Clinical Studies. Front Psychiatry 2021; 12:638981. [PMID: 33897495 PMCID: PMC8060443 DOI: 10.3389/fpsyt.2021.638981] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Daily rhythm of melatonin synchronizes the body to the light/dark environmental cycle. Several hypotheses have been raised to understand the intersections between melatonin and depression, in which changes in rest-activity and sleep patterns are prominent. This review describes key experimental and clinical evidence that link melatonin with the etiopathology and symptomatology of depressive states, its role in the follow up of therapeutic response to antidepressants, as well as the clinical evidence of melatonin as MDD treatment. Melatonin, as an internal temporal cue contributing to circadian organization and best studied in the context of circadian misalignment, is also implicated in neuroplasticity. The monoaminergic systems that underly MDD and melatonin production overlap. In addition, the urinary metabolite 6-sulfatoxymelatonin (aMT6) has been proposed as biomarker for antidepressant responders, by revealing whether the blockage of noradrenaline uptake has taken place within 24 h from the first antidepressant dose. Even though animal models show benefits from melatonin supplementation on depressive-like behavior, clinical evidence is inconsistent vis-à-vis prophylactic or therapeutic benefits of melatonin or melatonin agonists in depression. We argue that the study of melatonin in MDD or other psychiatric disorders must take into account the specificities of melatonin as an integrating molecule, inextricably linked to entrainment, metabolism, immunity, neurotransmission, and cell homeostasis.
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Affiliation(s)
- André C. Tonon
- Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luísa K. Pilz
- Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Regina P. Markus
- Laboratório de Cronofarmacologia, Departamento de Fisiologia, Instituto de Biociência, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Paz Hidalgo
- Laboratório de Cronobiologia e Sono, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Elaine Elisabetsky
- Programa de Pós-Graduação em Ciências Biológicas-Bioquímica, Departamento de Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Martin T, Twomey R, Medysky ME, Temesi J, Culos-Reed SN, Millet GY. The Relationship between Fatigue and Actigraphy-Derived Sleep and Rest-Activity Patterns in Cancer Survivors. ACTA ACUST UNITED AC 2021; 28:1170-1182. [PMID: 33802111 PMCID: PMC8025824 DOI: 10.3390/curroncol28020113] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 01/15/2023]
Abstract
Cancer-related fatigue can continue long after curative cancer treatment. The aim of this study was to investigate sleep and rest–activity cycles in fatigued and non-fatigued cancer survivors. We hypothesized that sleep and rest–activity cycles would be more disturbed in people experiencing clinically-relevant fatigue, and that objective measures of sleep would be associated with the severity of fatigue in cancer survivors. Cancer survivors (n = 87) completed a 14-day wrist actigraphy measurement to estimate their sleep and rest–activity cycles. Fatigue was measured using the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F). Participants were dichotomised into two groups using a previously validated score (fatigued n = 51 and non-fatigued n = 36). The participant’s perception of sleep was measured using the Insomnia Severity Index (ISI). FACIT-F score was correlated with wake after sleep onset (r = −0.28; p = 0.010), sleep efficiency (r = 0.26; p = 0.016), sleep onset latency (r = −0.31; p = 0.044) and Insomnia Severity Index (ISI) score (r = −0.56; p < 0.001). The relative amplitude of the rest–activity cycles was lower in the fatigued vs. the non-fatigued group (p = 0.017; d = 0.58). After treatment for cancer, the severity of cancer-related fatigue is correlated with specific objective measures of sleep, and there is evidence of rest–activity cycle disruption in people experiencing clinically-relevant fatigue.
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Affiliation(s)
- Tristan Martin
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (R.T.); (M.E.M.); (J.T.); (S.N.C.-R.)
- UMR-S 1075 COMETE: MOBILITES “Vieillissement, Pathologies, Santé”, INSERM, Normandy University, 14032 Caen, France
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (R.T.); (M.E.M.); (J.T.); (S.N.C.-R.)
- Ohlson Research Initiative, Arnie Charbonneau Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Mary E. Medysky
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (R.T.); (M.E.M.); (J.T.); (S.N.C.-R.)
- School of Nursing, Oregon Health and Science University, Portland, OR 97239, USA
| | - John Temesi
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (R.T.); (M.E.M.); (J.T.); (S.N.C.-R.)
- Faculty of Health & Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (R.T.); (M.E.M.); (J.T.); (S.N.C.-R.)
- Department of Oncology, Cumming School of Medicine, Calgary, T2N 4N1, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB T2N 4N2, Canada
| | - Guillaume Y. Millet
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (T.M.); (R.T.); (M.E.M.); (J.T.); (S.N.C.-R.)
- Univ Lyon, UJM Saint-Etienne, Inter-University Laboratory of Human Movement Biology, EA 7424, 42023 Saint-Etienne, France
- Correspondence: ; Tel.: +33-4-7742-1894
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