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Clegg I, Notebaert L, Richardson C. Negative attention bias and attentional control as mechanisms in the association between insomnia and depression in young people. Behav Res Ther 2024; 179:104569. [PMID: 38761556 DOI: 10.1016/j.brat.2024.104569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/30/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
Evidence supports a causal role of insomnia in the development and maintenance of depression, yet mechanisms underlying this association in young people are not well established. Attention biases have been implicated separately in the sleep and depression fields and represents an important candidate mechanism. Poor sleep may lead to a negative attention bias (characteristic of depression) by impacting attentional control. This study assessed the hypothesis that attentional control and negative attention bias would sequentially mediate the relationship between insomnia and depressive symptoms in an unselected sample of young people (17-24 years). Concerns have been raised regarding the psychometric properties of tasks used to measure attention bias, and a Dual-Probe Task is emerging as a more reliable measure. Participants (N = 275, Male = 59, Mage = 19.40) completed the Dual-Probe Task, a behavioural measure of attentional control, and self-report measures of insomnia and depression. Participants completed a one-week sleep diary. Results were consistent with negative attention bias, but not attentional control, as a mechanism which partially accounts for the relationship between sleep (i.e., insomnia severity, sleep duration, sleep efficiency, sleep latency) and depression. This study highlights sleep and negative attention bias as potentially modifiable risk factors to reduce depressive symptoms in young people.
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Affiliation(s)
- Isabel Clegg
- Center for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia; Center for Sleep Science, School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia.
| | - Lies Notebaert
- Center for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia.
| | - Cele Richardson
- Center for Sleep Science, School of Psychological Science, University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia.
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Musich M, Beversdorf DQ, McCrae CS, Curtis AF. Subjective-Objective Sleep Discrepancy in a Predominately White and Educated Older Adult Population: Examining the Associations With Cognition and Insomnia. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae074. [PMID: 38679960 DOI: 10.1093/geronb/gbae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVES This study examined associations between various cognitive domains and sleep discrepancy (self-reported vs objectively measured sleep), and evaluated interactive associations with insomnia status (non-insomnia vs insomnia). METHODS Older adults (N = 65, Mage = 68.72, SD = 5.06, 43 insomnia/22 non-insomnia) aged 60+ reported subjective sleep (7 days of sleep diaries), objective sleep assessment (one-night polysomnography, PSG, via Sleep Profiler during the 7-day period), and completed cognitive tasks (National Institutes of Health Toolbox-Cognition Battery) measuring attention and processing speed, working memory, inhibitory control, cognitive flexibility, and episodic memory. The sleep diary variable corresponding to the same one night of PSG was used to calculate the sleep discrepancy (diary minus PSG parameter) variables for total sleep time (TST), sleep onset latency, wake after sleep onset, and sleep efficiency. Regression analyses determined independent and interactive (with insomnia status) associations between cognition and sleep discrepancy, controlling for age, sex, apnea-hypopnea index, and sleep medication usage. RESULTS Working memory interacted with insomnia status in associations with sleep discrepancy related to TST and sleep efficiency. In those with insomnia, worse working memory was associated with shorter self-reported TST (p = .008) and lower sleep efficiency (p = .04) than PSG measured. DISCUSSION In older adults with insomnia, worse working memory may be a contributing factor to sleep discrepancy. Future investigations of underlying neurophysiological factors and consideration of other objective sleep measures (actigraphy) are warranted. Prospective findings may help determine whether sleep discrepancy is a potential marker of future cognitive decline.
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Affiliation(s)
- Madison Musich
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
| | - David Q Beversdorf
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri, USA
- Departments of Radiology and Neurology, University of Missouri-Columbia, Columbia, Missouri, USA
| | | | - Ashley F Curtis
- College of Nursing, University of South Florida, Tampa, Florida, USA
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3
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Pchelina P, Poluektov M, Krieger T, Duss SB, Berger T. Clinical effectiveness of internet-based cognitive behavioral therapy for insomnia in routine secondary care: results of a randomized controlled trial. Front Psychiatry 2024; 15:1301489. [PMID: 38800061 PMCID: PMC11116772 DOI: 10.3389/fpsyt.2024.1301489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 04/08/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Delivering cognitive behavioral therapy for insomnia over the internet bears the advantage of accessibility and uptake to many patients suffering from chronic insomnia. In the current study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy for insomnia (iCBT-I) in routine care. Materials and methods We conducted a two-arm non-blinded randomized controlled trial with care as usual (CAU) as a control condition. Participants were recruited in a specialized outpatient sleep medicine department. Both arms had access to other healthcare resources, and the intervention group had access to the iCBT-I program for 2 months. The primary outcome was insomnia severity, measured by the Insomnia Severity Index (ISI). Secondary outcomes were fatigue severity, daytime sleepiness, affective symptoms, dysfunctional beliefs and attitudes about sleep, sleep locus of control, sleep hygiene, sleep efficiency (SE), sleep onset latency, wake time after sleep onset (WASO), and total sleep time (TST). Linear mixed models for repeated measures were used to analyze the longitudinal data at baseline, post-treatment, and after 3 months of follow-up. The trial was registered at www.clinicaltrials.gov (NCT04300218 21.04.2020). Results The results showed a significant time*group interaction effect (p = 0.001) at post-treatment with between-group effect size (d = 0.51), indicating that the ISI decreased by a score of 3.8-fold in the iCBT-I group than in the CAU group. There was no significant difference in ISI between groups at follow-up. Regarding secondary outcomes, dysfunctional beliefs about sleep, SE, and WASO decreased significantly during treatment in the intervention group with between-group effect sizes d = 0.35, d = -0.51, and d = 0.47, respectively. At the follow-up, between-group effects on DBAS and SE remained significant: d = 0.36 and d = -0.63, respectively. For TST, we observed a significant time*group effect of d = -0.38 only after follow-up. Conclusion Our findings suggest that iCBT-I has a significant effect on insomnia severity at post-treatment compared to CAU. iCBT-I further improved dysfunctional beliefs about sleep and improved subjective sleep characteristics, such as SE, WASO, and TST during 3 months after treatment. Clinical trial registration www.clinicaltrials.gov, identifier (NCT04300218).
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Affiliation(s)
- Polina Pchelina
- Department of Neurology and Neurosurgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Mikhail Poluektov
- Department of Neurology and Neurosurgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Simone B. Duss
- Interdisciplinary Sleep-Wake-Epilepsy-Center and Swiss Sleep House Bern, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
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Phillips-Beyer A, Kawata AK, Kleinman L, Seboek Kinter D, Flamion B. Meaningful Within-Patient Change in Subjective Total Sleep Time in Patients with Insomnia Disorder: An Analysis of the Sleep Diary Questionnaire Using Data from Open-Label and Phase III Clinical Trials. Pharmaceut Med 2024; 38:133-144. [PMID: 38302765 PMCID: PMC10948516 DOI: 10.1007/s40290-023-00512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND The Sleep Diary Questionnaire (SDQ), a modified version of the Consensus Sleep Diary, is a 17-item sleep diary for assessing subjective total sleep time (sTST: total time spent asleep at night) and other sleep parameters in insomnia trials. sTST is a key parameter of efficacy in insomnia trials; however, the magnitude of improvement in this parameter that people with insomnia disorder consider clinically meaningful is unclear. OBJECTIVE The aim of this study was to estimate meaningful within-patient change for sTST using clinical trial data. METHODS Data were from an open-label trial of zolpidem and pooled data from a phase III placebo-controlled trial of daridorexant. In both trials, adults with moderate to severe insomnia completed the SDQ daily. Meaningful change in sTST was estimated in an anchor-based analysis using outcome measures that were correlated with change in weekly average sTST (Spearman correlation coefficient ≥ 0.30): the Insomnia Severity Index, patient global assessments and impressions of severity and change in daytime and night-time symptoms (PGA-S, PGI-S, PGI-C), and clinician global impressions of severity and change in patients' daytime symptoms (CGI-S, CGI-C). Meaningful within-patient change estimates were 'triangulated' to identify a value where they converged. RESULTS In the open-label trial (N = 114), subjects with a 1-point or 1-step improvement on the anchors had mean increases in sTST of 60.1-83.2 min at day 8 and 55.5-68.2 min at day 15. For subjects with a 2-point or 2-step improvement on the anchors, mean increases in sTST were 79.6-81.4 min at day 8 and 80.1-93.5 min at day 15. In the phase III trial (N = 930), weekly average increases in sTST for subjects with a 1-point or 1-step improvement on the anchors were 39.3-46.7 min at month 1 and 47.3-58.3 min at month 3. For subjects with a 2-point or 2-step improvement on the anchors, mean increases in sTST were 60.7-76.2 min at month 1 and 70.1-87.7 min at month 3. Triangulation of these values supported a meaningful within-patient change threshold starting at 55 min. CONCLUSION Increasing sTST is an important treatment outcome for people with insomnia. An increase in sleep time of approximately 55 min is meaningful to patients. CLINICAL TRIALS REGISTRATION NCT03056053 (17 February 2017) and NCT03545191 (4 June 2018).
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Affiliation(s)
- Andrea Phillips-Beyer
- Innovus Consulting Ltd, 8a Wingbury Courtyard, Business Village, Wingrave, Buckinghamshire, HP22 4LW, UK.
| | | | | | | | - Bruno Flamion
- Clinical Development, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
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Bini C, Hjelm C, Hellström A, Årestedt K, Broström A, Sandlund C. How patients with insomnia interpret and respond to the consensus sleep diary: a cognitive interview study. J Patient Rep Outcomes 2024; 8:19. [PMID: 38376583 PMCID: PMC10879077 DOI: 10.1186/s41687-024-00695-y] [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: 04/26/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE/BACKGROUND The Consensus Sleep Diary (CSD) is widely used to assess subjective sleep. Psychometric evaluations and focus-groups support its validity and clinical usefulness, but further research into its validity is needed. The aim of the study was to evaluate a Swedish translation of the CSD regarding test content and response processes in patients with insomnia. PATIENTS/METHODS In connection with translating the CSD into Swedish, we used cognitive interviewing to evaluate test content and the response process, that is, how people make decisions when responding to survey items. Cognitive interviews were conducted with 13 primary health care patients with insomnia disorder (mean age, 49 years; SD 15.5). Iterative, reparative analysis was used to investigate test content. Descriptive deductive analysis was used to investigate interview transcripts for the themes of the cognitive model: comprehension, retrieval, decision process, and judgement. Together, the themes explain the response process when responding to a patient-reported outcome measure. RESULTS The overall comprehension of the CSD could be affected by poor adherence to the instructions (comprehension). Patients had difficulty with recall if they did not complete the diary immediately in the morning and just before bedtime (retrieval). They could have problems deciding how to respond to certain items because they imbued sleep-related concepts with extra meaning (decision process), and had trouble finding response alternatives nuanced enough to describe their experience of sleep and tiredness (judgement). CONCLUSIONS This study contributes knowledge on how the instrument is perceived and used by care-seeking patients with insomnia. In this context, the CSD exhibits known flaws such as memory lapses if the diary is not filled in directly in the morning. To increase the accuracy of patients' responses, therapists should support patients in reading the instructions.
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Affiliation(s)
- Christina Bini
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Alfred Nobels allé 23, Huddinge, SE-141 83, Sweden.
- Academic Primary Health Care Centre, Region Stockholm, Solnavägen 1E, Stockholm, 113 65, Sweden.
| | - Carina Hjelm
- Department of Health, Medicine and Care, Nursing and Reproductive Health, Linköping University, Linköping, 581 83, Sweden
| | - Amanda Hellström
- Faculty of Health and Life Sciences, Linnaeus University, Universitetskajen 1, Kalmar, SE-392 31, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Universitetskajen 1, Kalmar, SE-392 31, Sweden
- Department of Research, Region Kalmar, Lasarettsvägen 8, Kalmar, SE-39185, Sweden
| | - Anders Broström
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, 551 11, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, 581 85, Sweden
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Vestlandet, 5020, Norway
| | - Christina Sandlund
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Alfred Nobels allé 23, Huddinge, SE-141 83, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Solnavägen 1E, Stockholm, 113 65, Sweden
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Rauwerda NL, Kuut TA, Braamse AMJ, Csorba I, Nieuwkerk P, van Straten A, Knoop H. Insomnia and sleep characteristics in post COVID-19 fatigue: A cross-sectional case-controlled study. J Psychosom Res 2024; 177:111522. [PMID: 38113796 DOI: 10.1016/j.jpsychores.2023.111522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Following COVID-19 many patients report persistent fatigue and insomnia. Given the overlapping features, insomnia can be underdiagnosed in post-COVID-19 fatigue patients. This study aimed to determine insomnia severity, prevalence of clinical insomnia and sleep characteristics of post-COVID-19 fatigue patients. Data of post-COVID-19 fatigue patients were compared with those of patients with chronic fatigue syndrome (ME/CFS), a condition resembling post-COVID-19 fatigue. METHODS In this cross-sectional case-controlled study, insomnia severity, assessed with the Insomnia Severity Index (ISI), and prevalence of clinical insomnia (ISI score ≥ 10), were determined in patients with post-COVID-19 fatigue (n = 114) and compared with ME/CFS (n = 59) using ANCOVA and logistic regression, respectively. Linear regression analyses were used to evaluate whether mood, concentration problems, pain, fatigue (assessed with questionnaires) and diagnosis were associated with insomnia. Sleep characteristics were determined with a sleep diary and accelerometer in post-COVID-19 fatigue and compared with ME/CFS using ANCOVA. RESULTS In patients with post-COVID-19 fatigue mean (SD) insomnia severity was 11.46 (5.7) and 64% reported clinical insomnia. Insomnia severity was significantly associated with depressive symptoms (ß = 0.49, p = 0.006) and age (ß = 0.08, p = 0.04). The mean (SD) subjective sleep duration was 7.4 (1.0) hours with a sleep efficiency of 82 (11)%. Several subjective sleep characteristics of the post-COVID-19 fatigue patients differed from ME/CFS patients; only sleep duration, being significantly shorter in post-COVID-19 fatigue patients (p = 0.003), seemed clinically relevant (d = 0.58). CONCLUSION Insomnia severity and prevalence of clinical insomnia are high in patients with post-COVID-19 fatigue. Insomnia should be assessed and if present treated with insomnia focused therapy.
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Affiliation(s)
- Nynke L Rauwerda
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, Hospital Gelderse Vallei, Ede, the Netherlands.
| | - Tanja A Kuut
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Annemarie M J Braamse
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Irene Csorba
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Institute for Infection and Immunity, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro and Developmental Psychology & Amsterdam Public Health Research Institute, VU University, Amsterdam, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
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Chen Y, Zhou E, Wang Y, Wu Y, Xu G, Chen L. The past, present, and future of sleep quality assessment and monitoring. Brain Res 2023; 1810:148333. [PMID: 36931581 DOI: 10.1016/j.brainres.2023.148333] [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: 01/05/2023] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023]
Abstract
Sleep quality is considered to be an individual's self-satisfaction with all aspects of the sleep experience. Good sleep not only improves a person's physical, mental and daily functional health, but also improves the quality-of-life level to some extent. In contrast, chronic sleep deprivation can increase the risk of diseases such as cardiovascular diseases, metabolic dysfunction and cognitive and emotional dysfunction, and can even lead to increased mortality. The scientific evaluation and monitoring of sleep quality is an important prerequisite for safeguarding and promoting the physiological health of the body. Therefore, we have compiled and reviewed the existing methods and emerging technologies commonly used for subjective and objective evaluation and monitoring of sleep quality, and found that subjective sleep evaluation is suitable for clinical screening and large-scale studies, while objective evaluation results are more intuitive and scientific, and in the comprehensive evaluation of sleep, if we want to get more scientific monitoring results, we should combine subjective and objective monitoring and dynamic monitoring.
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Affiliation(s)
- Yanyan Chen
- School of Physical Education, Jianghan University, Wuhan Hubei, 430056, China
| | - Enyuan Zhou
- School of Physical Education, Jianghan University, Wuhan Hubei, 430056, China
| | - Yu Wang
- School of Physical Education, Jianghan University, Wuhan Hubei, 430056, China
| | - Yuxiang Wu
- School of Physical Education, Jianghan University, Wuhan Hubei, 430056, China
| | - Guodong Xu
- School of Physical Education, Jianghan University, Wuhan Hubei, 430056, China
| | - Lin Chen
- School of Physical Education, Jianghan University, Wuhan Hubei, 430056, China.
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8
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Schenker MT, Ince S, Ney LJ, Hsu CMK, Zuj DV, Jordan AS, Nicholas CL, Felmingham KL. Sex differences in the effect of subjective sleep on fear conditioning, extinction learning, and extinction recall in individuals with a range of PTSD symptom severity. Behav Res Ther 2022; 159:104222. [PMID: 36327524 DOI: 10.1016/j.brat.2022.104222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022]
Abstract
Sleep has been found to play a key role in fear conditioning, extinction learning and extinction recall, and sleep disturbances are linked to many mental disorders including post-traumatic stress disorder (PTSD). Previous studies examining associations between sleep and fear or extinction processes primarily focused on objectively measured sleep architecture. Little research has so far focused on subjective sleep measures and particularly in clinical populations, which often experience subjectively poor sleep, including PTSD. Here we investigated whether subjective sleep disturbance, sleep onset latency, wake after sleep onset or sleep efficiency were related to fear conditioning, extinction learning or extinction recall in a large sample of individuals with a range of PTSD symptom severity (n = 248). Overall, we did not find that subjective sleep was associated with fear conditioning or extinction processes. However, exploratory analyses examining the moderating effect of sex found that shorter sleep onset latency and greater sleep efficiency were associated with improved extinction recall in women with higher PTSD symptom severity. This suggests that less time falling asleep and longer time asleep while in bed may be protective in highly symptomatic women against the commonly observed impaired extinction recall in PTSD. More studies are needed to explore sex-specific effects further.
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Affiliation(s)
- Maya T Schenker
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Sevil Ince
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Luke J Ney
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia; School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Chia-Ming K Hsu
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia.
| | - Daniel V Zuj
- School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia.
| | - Amy S Jordan
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Christian L Nicholas
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia.
| | - Kim L Felmingham
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia; School of Psychological Sciences, University of Tasmania, Hobart, TAS, Australia.
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9
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Bjella TD, Collier Høegh M, Holmstul Olsen S, Aminoff SR, Barrett E, Ueland T, Icick R, Andreassen OA, Nerhus M, Myhre Ihler H, Hagen M, Busch-Christensen C, Melle I, Lagerberg TV. Developing “MinDag” – an app to capture symptom variation and illness mechanisms in bipolar disorder. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:910533. [PMID: 35935144 PMCID: PMC9354925 DOI: 10.3389/fmedt.2022.910533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe illness course of bipolar disorder (BD) is highly heterogeneous with substantial variation between individuals with the same BD subtype and within individuals over time. This heterogeneity is not well-delineated and hampers the development of more targeted treatment. Furthermore, although lifestyle-related behaviors are believed to play a role in the illness course, such mechanisms are poorly understood. To address some of these knowledge gaps, we aimed to develop an app for collection of multi-dimensional longitudinal data on BD-relevant symptoms and lifestyle-related behaviors.MethodsAn app named MinDag was developed at the Norwegian Center for Mental Disorders Research in Oslo, Norway. The app was designed to tap into selected areas: mood, sleep, functioning/activities (social, occupational, physical exercise, leisure), substance use, emotional reactivity, and psychotic experiences. Ethical, security and usability issues were highly prioritized throughout the development and for the final app solution. We conducted beta- and pilot testing to eliminate technical problems and enhance usability and acceptability.ResultsThe final version of MinDag comprises six modules; three which are presented for the user once daily (the Sleep module in the morning and the Mood and Functoning/Activities modules in the evening) and three which are presented once weekly (Substance Use, Emotional Reactivity, and Psychotic Experiences modules). In general, MinDag was well received in both in the beta-testing and the pilot study, and the participants provided valuable feedback that was taken into account in the final development. MinDag is now in use as part of the research protocol at the NORMENT center and in a specialized treatment unit for BD at Oslo University Hospital in Norway.DiscussionWe believe that MinDag will generate unique longitudinal data well suited for capturing the heterogeneity of BD and clarifying important unresolved issues such as how life-style related behavior may influence BD symptoms. Also, the experiences and knowledge derived from the development of MinDag may contribute to improving the security, acceptability, and benefit of digital tools in mental health.
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Affiliation(s)
- Thomas D. Bjella
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- *Correspondence: Thomas D. Bjella
| | - Margrethe Collier Høegh
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stine Holmstul Olsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sofie R. Aminoff
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elizabeth Barrett
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torill Ueland
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Romain Icick
- INSERM, UMR_S1144, Paris University, Paris, France
- FondaMental Foundation, Créteil, France
| | - Ole A. Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mari Nerhus
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Special Psychiatry, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Henrik Myhre Ihler
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marthe Hagen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cecilie Busch-Christensen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trine Vik Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Oltmanns JR, Schwartz HA, Ruggero C, Son Y, Miao J, Waszczuk M, Clouston SAP, Bromet EJ, Luft BJ, Kotov R. Artificial intelligence language predictors of two-year trauma-related outcomes. J Psychiatr Res 2021; 143:239-245. [PMID: 34509091 PMCID: PMC8935804 DOI: 10.1016/j.jpsychires.2021.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/29/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent research on artificial intelligence has demonstrated that natural language can be used to provide valid indicators of psychopathology. The present study examined artificial intelligence-based language predictors (ALPs) of seven trauma-related mental and physical health outcomes in responders to the World Trade Center disaster. METHODS The responders (N = 174, Mage = 55.4 years) provided daily voicemail updates over 14 days. Algorithms developed using machine learning in large social media discovery samples were applied to the voicemail transcriptions to derive ALP scores for several risk factors (depressivity, anxiousness, anger proneness, stress, and personality). Responders also completed self-report assessments of these risk factors at baseline and trauma-related mental and physical health outcomes at two-year follow-up (including symptoms of depression, posttraumatic stress disorder, sleep disturbance, respiratory problems, and GERD). RESULTS Voicemail ALPs were significantly associated with a majority of the trauma-related outcomes at two-year follow-up, over and above corresponding baseline self-reports. ALPs showed significant convergence with corresponding self-report scales, but also considerable uniqueness from each other and from self-report scales. LIMITATIONS The study has a relatively short follow-up period relative to trauma occurrence and a limited sample size. CONCLUSIONS This study shows evidence that ALPs may provide a novel, objective, and clinically useful approach to forecasting, and may in the future help to identify individuals at risk for negative health outcomes.
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11
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Alshehri MM, Alenazi AM, Alothman SA, Rucker JL, Phadnis MA, Miles JM, Siengsukon CF, Kluding PM. Using Cognitive Behavioral Therapy for Insomnia in People with Type 2 Diabetes, Pilot RCT Part I: Sleep and Concomitant Symptom. Behav Sleep Med 2021; 19:652-671. [PMID: 33108932 DOI: 10.1080/15402002.2020.1831501] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE/BACKGROUND The primary aim of this study was to examine the effect of Cognitive Behavioral Therapy for Insomnia (CBT-I) on the severity of insomnia in people with Type 2 diabetes (T2D) compared to a health education (HE) control group. The secondary aim was to explore the effect of CBT-I on other sleep outcomes and concomitant symptoms. PARTICIPANTS Twenty-eight participants with T2D were randomly assigned to CBT-I (n = 14) or HE (n = 14). METHODS Validated assessments were used at baseline and post intervention to assess sleep outcomes and concomitant symptoms. In addition, actigraph and sleep diaries were used to measure sleep parameters. Independent sample t tests and Mann-Whitney U tests were utilized to measure between-group differences in the mean change scores. RESULTS Participants in the CBT-I group showed higher improvements in the following mean change scores compared to the HE group: insomnia symptoms (d = 1.78; p < .001), sleep quality (d = 1.53; p =.001), sleep self-efficacy (d = 1.67; p < .001). Both actigraph and sleep diary showed improvements in sleep latency and sleep efficiency in the CBT-I group as compared to the HE group. In addition, participants in the CBT-I group showed greater improvement in the mean change scores of depression symptoms (d = 1.49; p = .002) and anxiety symptoms (d = 0.88; p = .04) compared to the HE group. CONCLUSION This study identified a clinically meaningful effect of CBT-I on sleep outcomes and concomitant symptoms in people with T2D and insomnia symptoms. Further work is needed to investigate the long-term effects of CBT-I in people with T2D and insomnia symptoms.
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Affiliation(s)
- Mohammed M Alshehri
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas.,Physical Therapy Department, Jazan University, Jazan, Saudi Arabia
| | - Aqeel M Alenazi
- Physical Therapy Department, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Shaima A Alothman
- Lifestyle and Health Research Center, Princess Nora Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Jason L Rucker
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas
| | - John M Miles
- Endocrinology Department, University of Kansas Medical Center, Kansas City, Kansas
| | - Catherine F Siengsukon
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas
| | - Patricia M Kluding
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas
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12
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A Pilot Study of 24-h Motor Activity Patterns in Multiple Sclerosis: Pre-Planned Follow-Up at 2 Years. Clocks Sleep 2021; 3:366-376. [PMID: 34203507 PMCID: PMC8293228 DOI: 10.3390/clockssleep3030023] [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: 05/21/2021] [Revised: 06/16/2021] [Accepted: 06/16/2021] [Indexed: 11/23/2022] Open
Abstract
Early multiple sclerosis (MS) predictive markers of disease activity/prognosis have been proposed but are not universally accepted. Aim of this pilot prospective study is to verify whether a peculiar hyperactivity, observed at baseline (T0) in early relapsing-remitting (RR) MS patients, could represent a further prognostic marker. Here we report results collected at T0 and at a 24-month follow-up (T1). Eighteen RRMS patients (11 females, median Expanded Disability Status Scale-EDSS score 1.25, range EDSS score 0–2) were monitored at T0 (mean age 32.33 ± 7.51) and T1 (median EDSS score 1.5, range EDSS score 0–2.5). Patients were grouped into two groups: responders (R, 14 patients) and non-responders (NR, 4 patients) to treatment at T1. Each patient wore an actigraph for one week to record the 24-h motor activity pattern. At T0, NR presented significantly lower motor activity than R between around 9:00 and 13:00. At T1, NR were characterized by significantly lower motor activity than R between around 12:00 and 17:00. Overall, these data suggest that through the 24-h motor activity pattern, we can fairly segregate at T0 patients who will show a therapeutic failure, possibly related to a more active disease, at T1. These patients are characterized by a reduced morning level of motor activation. Further studies on larger populations are needed to confirm these preliminary findings.
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13
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Sipilä RM, Kalso EA. Sleep Well and Recover Faster with Less Pain-A Narrative Review on Sleep in the Perioperative Period. J Clin Med 2021; 10:jcm10092000. [PMID: 34066965 PMCID: PMC8124518 DOI: 10.3390/jcm10092000] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 01/02/2023] Open
Abstract
Sleep disturbance, pain, and having a surgical procedure of some kind are all very likely to occur during the average lifespan. Postoperative pain continues to be a prevalent problem and growing evidence supports the association between pain and sleep disturbances. The bidirectional nature of sleep and pain is widely acknowledged. A decline in sleep quality adds a risk for the onset of pain and also exacerbates existing pain. The risk factors for developing insomnia and experiencing severe pain after surgery are quite similar. The main aim of this narrative review is to discuss why it is important to be aware of sleep disturbances both before and after surgery, to know how sleep disturbances should be assessed and monitored, and to understand how better sleep can be supported by both pharmacological and non-pharmacological interventions.
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Affiliation(s)
- Reetta M. Sipilä
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland;
- Sleep Well Research Programme, University of Helsinki, 00016 Helsinki, Finland
- Correspondence:
| | - Eija A. Kalso
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, 00029 Helsinki, Finland;
- Sleep Well Research Programme, University of Helsinki, 00016 Helsinki, Finland
- Department of Pharmacology, University of Helsinki, 00016 Helsinki, Finland
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14
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Abstract
Sleep inertia (SI) refers to a complex psychophysiological phenomenon, observed after awakening, that can be described as the gradual recovery of waking-like status. The time course of cognitive performance dissipation in an everyday life condition is still unclear, especially in terms of the sleep stage at awakening (REM or NREM-stage 2) and the relative effects on performance. The present study aimed to investigate the SI dissipation in different memory performances upon spontaneous morning awakening after uninterrupted nighttime sleep. Eighteen young adults (7 females; mean age 24.9 ± 3.14 years) spent seven non-consecutive nights (one baseline, three REM awakenings and three St2 awakenings) in the laboratory under standard polysomnographic (PSG) control. Participants were tested after three REM awakenings and three St2 awakenings, and three times at 11:00 a.m. as a control condition. In each testing session, participants filled in the Global Vigor and Affect Scale and carried out one memory task (episodic, semantic, or procedural task). For each condition, participants were tested every 10 min within a time window of 80 min. In accordance with previous studies, SI affected subjective alertness throughout the entire time window assessed. Moreover, SI significantly affected performance speed but not accuracy in the semantic task. With reference to this task, the SI effect dissipated within 30 min of awakening from REM, and within 20 min of awakening from St2. No significant SI effect was observed on episodic or procedural memory tasks.
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15
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Hruska B, Barduhn MS. Dynamic psychosocial risk and protective factors associated with mental health in Emergency Medical Service (EMS) personnel. J Affect Disord 2021; 282:9-17. [PMID: 33387746 DOI: 10.1016/j.jad.2020.12.130] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/31/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND EMS personnel have a heightened risk of developing posttraumatic stress disorder (PTSD) and major depression relative to other occupational populations necessitating a greater understanding of the risk and protective factors that operate each day in relation to this risk. This study examined dynamic psychosocial factors and their relationship with daily mental health symptoms among EMS workers. The psychosocial factors examined consisted of occupational stressors, sleep disturbance, social conflict, meaning made from the day's challenges, recovery activities, social support, and perceived prosocial impact. METHOD Seventy-nine EMS workers recruited from an emergency medical service provider in Central New York completed a daily assessment for 8 days asking questions about occupational stressors encountered, sleep efficiency, social conflicts, meaning made from the day's challenges, recovery activities engaged in, social support received, and perceived prosocial impact. RESULTS Daily occupational stressors were associated with elevated daily PTSD symptom severity (b = 0.13, SE = 0.06, p = .023). Social conflicts were associated with greater depression symptom severity (b = 0.75, SE = 0.14, p < .001); the meaning made from day's stressors (b = -0.17, SE = 0.05, p = .002) and the recovery activities engaged in (b = -0.30, SE = 0.07, p < .001) were associated with lower daily depression symptom severity. LIMITATIONS A relatively modest sample size and small sampling window may constrain the generalizations made from this study. CONCLUSIONS Occupational stressors and social conflicts are key risk factors related to the daily expression of PTSD and depression symptom severity in EMS workers. The meaning made from the day's challenges and the recovery activities engaged in may protect against depression. These results reveal several dynamic psychosocial factors that aid in understanding features of the work day that contribute to the mental health burden observed among EMS personnel.
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Affiliation(s)
- Bryce Hruska
- Department of Public Health, Syracuse University, Syracuse, NY, USA.
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16
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Birling Y, Li G, Jia M, Zhu X, Sarris J, Bensoussan A, Wang J, Fahey P. Is insomnia disorder associated with time in bed extension? SLEEP SCIENCE (SAO PAULO, BRAZIL) 2021; 13:215-219. [PMID: 33564366 PMCID: PMC7856667 DOI: 10.5935/1984-0063.20200089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective There is a lack of evidence for extension of time in bed behaviors (i.e., getting to bed earlier, going out of bed later, staying in bed while awake and napping) as perpetuating factors of insomnia. The aim of this study is to assess if insomnia disorder is associated with extension of time in bed behaviors. Methods 150 good sleepers and 173 insomniacs were recruited between December 2017 and June 2018. A cross-sectional survey was performed using the Wang Insomnia Integrated Questionnaire. Results Bedtime, rising time and time in bed were not different between good sleepers and insomniacs (Cohen’s d, <0.01, 0.07, 0.07, respectively; all p>0.05) and were not correlated with insomnia severity (all p>0.05). Staying in bed while awake during the night and in the morning where both different between good sleepers and insomniacs (Cohen’s d, 1.33 and 0.85, respectively; all p<0.001) and were positively correlated with insomnia severity (all p<0.001). Napping was more frequent (p<0.01) among good sleepers (63.3%) than insomniacs (48.6%) and a predictor of good sleep (p<0.01). Conclusion Going to bed earlier and getting out of bed later do not seem to be associated with insomnia. Staying in bed while awake during the night and in the morning are associated with insomnia but could be only signs of insomnia symptoms. Limiting time in bed to prevent insomnia might and suppressing insomniacs’ napping behavior to treat insomnia might not be effective.
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Affiliation(s)
- Yoann Birling
- Western Sydney University, NICM Health Research Institute - Penrith - NSW - Australia.,Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Psychology and Sleep Department - Beijing - Beijing - China
| | - Guixia Li
- Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Psychology and Sleep Department - Beijing - Beijing - China
| | - Mingxian Jia
- Beijing University of Chinese Medicine, Chinese Medicine - Beijing - Beijing - China
| | - Xiaoshu Zhu
- Western Sydney University, NICM Health Research Institute - Penrith - NSW - Australia.,Western Sydney University, School of Science and Health - Penrith - NSW - Australia
| | - Jerome Sarris
- Western Sydney University, NICM Health Research Institute - Penrith - NSW - Australia.,University of Melbourne, Professional Unit, The Melbourne Clinic, Department of Psychiatry - Melbourne - VIC - Australia
| | - Alan Bensoussan
- Western Sydney University, NICM Health Research Institute - Penrith - NSW - Australia
| | - Jian Wang
- Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Psychology and Sleep Department - Beijing - Beijing - China
| | - Paul Fahey
- Western Sydney University, School of Science and Health - Penrith - NSW - Australia
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17
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Measuring Subjective Sleep Quality: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031082. [PMID: 33530453 PMCID: PMC7908437 DOI: 10.3390/ijerph18031082] [Citation(s) in RCA: 178] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/07/2021] [Accepted: 01/16/2021] [Indexed: 01/31/2023]
Abstract
Sleep quality is an important clinical construct since it is increasingly common for people to complain about poor sleep quality and its impact on daytime functioning. Moreover, poor sleep quality can be an important symptom of many sleep and medical disorders. However, objective measures of sleep quality, such as polysomnography, are not readily available to most clinicians in their daily routine, and are expensive, time-consuming, and impractical for epidemiological and research studies., Several self-report questionnaires have, however, been developed. The present review aims to address their psychometric properties, construct validity, and factorial structure while presenting, comparing, and discussing the measurement properties of these sleep quality questionnaires. A systematic literature search, from 2008 to 2020, was performed using the electronic databases PubMed and Scopus, with predefined search terms. In total, 49 articles were analyzed from the 5734 articles found. The psychometric properties and factor structure of the following are reported: Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Insomnia Severity Index (ISI), Mini-Sleep Questionnaire (MSQ), Jenkins Sleep Scale (JSS), Leeds Sleep Evaluation Questionnaire (LSEQ), SLEEP-50 Questionnaire, and Epworth Sleepiness Scale (ESS). As the most frequently used subjective measurement of sleep quality, the PSQI reported good internal reliability and validity; however, different factorial structures were found in a variety of samples, casting doubt on the usefulness of total score in detecting poor and good sleepers. The sleep disorder scales (AIS, ISI, MSQ, JSS, LSEQ and SLEEP-50) reported good psychometric properties; nevertheless, AIS and ISI reported a variety of factorial models whereas LSEQ and SLEEP-50 appeared to be less useful for epidemiological and research settings due to the length of the questionnaires and their scoring. The MSQ and JSS seemed to be inexpensive and easy to administer, complete, and score, but further validation studies are needed. Finally, the ESS had good internal consistency and construct validity, while the main challenges were in its factorial structure, known-group difference and estimation of reliable cut-offs. Overall, the self-report questionnaires assessing sleep quality from different perspectives have good psychometric properties, with high internal consistency and test-retest reliability, as well as convergent/divergent validity with sleep, psychological, and socio-demographic variables. However, a clear definition of the factor model underlying the tools is recommended and reliable cut-off values should be indicated in order for clinicians to discriminate poor and good sleepers.
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18
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Anvekar AP, Nathan EA, Doherty DA, Patole SK. Effect of shift work on fatigue and sleep in neonatal registrars. PLoS One 2021; 16:e0245428. [PMID: 33444333 PMCID: PMC7808639 DOI: 10.1371/journal.pone.0245428] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/03/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We aimed to study fatigue and sleep in registrars working 12-hour rotating shifts in our tertiary neonatal intensive unit. METHODS AND PARTICIPANTS This study involved neonatal registrar's working day (08:00-21:00) and night (20:30-08:30) shifts. Participants maintained a sleep diary, answered a self-reported sleepiness questionnaire assessing subjective sleepiness, and performed a 10-minute psychomotor vigilance task (PVT) at the start and end of each shift. Primary outcomes: (1) Fatigue at the (i) "start vs end" of day and night shifts, (ii) end of the "day vs night" shifts, and (iii) end of "first vs last shift" in block of day and night shifts. (2) Duration and quality of sleep before the "day vs night" shifts. Mean reaction time (RTM), relative coefficient of variation (RTCV), and lapses (reaction time > 500ms) were used as measures of fatigue on PVT. Secondary outcome: Subjective sleepiness (self-reported sleepiness questionnaire) at the 'start vs end" of day and night shifts. RESULTS Fifteen registrars completed the study. Acuity was comparable for all shifts. (1) Psychomotor responses were impaired at the end vs start of day shifts [RTM (p = 0.014), lapses (p = 0.001)], end vs start of night shifts [RTM (p = 0.007), RTCV (p = 0.003), lapses (p<0.001)] and end of night vs day shifts [RTM (p = 0.007), RTCV (p = 0.046), lapses (p = 0.001)]. Only lapses were significantly increased at the end of the last (p = 0.013) vs first shift (p = 0.009) in a block of day and night shifts. (2) Duration of sleep before the night (p = 0.019) and consecutive night shifts was decreased significantly (p = 0.034). Subjective sleepiness worsened after day (p = 0.014) and night shifts (p<0.001). CONCLUSION Fatigue worsened after the 12-hour day and night shifts with a greater change after night shifts. Lapses increased after block of day and night shifts. Sleep was decreased before night shifts. Our findings need to be confirmed in larger studies.
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Affiliation(s)
- Ajay P. Anvekar
- Department of Neonatal Paediatrics, Perth Children Hospital, Perth, Australia
| | - Elizabeth A. Nathan
- Women and Infants Research Foundation, KEM Hospital for Women, Perth, Australia
- Division of Obstetrics and Gynaecology, School of Medicine, University of Western Australia, Perth, Australia
| | - Dorota A. Doherty
- Women and Infants Research Foundation, KEM Hospital for Women, Perth, Australia
- Division of Obstetrics and Gynaecology, School of Medicine, University of Western Australia, Perth, Australia
| | - Sanjay K. Patole
- Department of Neonatal Paediatrics, King Edward Memorial Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
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19
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Biggers A, Henkins J, Barton I, Hubbard C, Perez R, Sharp LK, Gerber BS. Feasibility of text message sleep assessment in African American and Latino patients with type 2 diabetes. J Clin Sleep Med 2021; 17:69-78. [PMID: 32964830 DOI: 10.5664/jcsm.8828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Text messaging (TM) may provide an inexpensive and convenient method for self-reported sleep assessment. This pilot study evaluated the feasibility of a TM sleep diary among a racial/ethnic minority population with uncontrolled type 2 diabetes. METHODS A convenience sample of 40 participants with uncontrolled type 2 diabetes was recruited. Participants wore an Actiwatch (Philips Spectrum Plus, Philips Respironics, Murrysville, Pennsylvania) for 7 consecutive days during both wake and sleep intervals and completed a daily TM sleep diary including 10 questions adapted from the Consensus Sleep Diary. The relationships between sleep measures from TMs and actigraphy were explored through Bland-Altman plots and correlations. RESULTS Of the 40 participants enrolled, 34 were African American and 6 were Latino. The mean age was 52.2 years (standard deviation = 8.2), and the mean hemoglobin A1c was 9.0% (standard deviation = 1.5). All but 1 participant attempted to complete the TM sleep diary. With a maximum of 70 TM replies possible, the median number of responses per participant was 66 (interquartile range = 59.5-69). Actigraphy and TM measures were related for total sleep time (median = 382 vs 393 min, respectively [r = .71; P < .01]), sleep onset latency (median = 31.4 vs 27.5 min [r = .61; P < .01]), time in bed (433.3 vs 489.3 min [r = .74; P < .01]), and sleep efficiency (77% vs 86% [r = .45; P = .005]). The measure of wake after sleep onset was higher from actigraphy than from TM, with a weak relationship between the 2 measures (median 47.9 vs 6.0 min [r = .31; P = .05]). CONCLUSIONS TM is a novel and feasible method for sleep assessment in racial/ethnic minority adults with uncontrolled type 2 diabetes.
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Affiliation(s)
- Alana Biggers
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Julia Henkins
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Isaye Barton
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Colin Hubbard
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Rose Perez
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Lisa K Sharp
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Ben S Gerber
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
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20
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Napping and weekend catchup sleep do not fully compensate for high rates of sleep debt and short sleep at a population level (in a representative nationwide sample of 12,637 adults). Sleep Med 2020; 74:278-288. [DOI: 10.1016/j.sleep.2020.05.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022]
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21
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Galbiati A, Sforza M, Poletti M, Verga L, Zucconi M, Ferini-Strambi L, Castronovo V. Insomnia Patients With Subjective Short Total Sleep Time Have a Boosted Response to Cognitive Behavioral Therapy for Insomnia Despite Residual Symptoms. Behav Sleep Med 2020; 18:58-67. [PMID: 30468399 DOI: 10.1080/15402002.2018.1545650] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Two distinct insomnia disorder (ID) phenotypes have been proposed, distinguished on the basis of an objective total sleep time less or more than 6 hr. In particular, it has been recently reported that patients with objective short sleep duration have a blunted response to cognitive behavioral therapy for insomnia (CBT-I). The aim of this study was to investigate the differences of CBT-I response in two groups of ID patients subdivided according to total sleep time. Methods: Two hundred forty-six ID patients were subdivided into two groups, depending on their reported total sleep time (TST) assessed by sleep diaries. Patients with a TST greater than 6 hr were classified as "normal sleepers" (NS), while those with a total sleep time less than 6 hr were classified as "short sleepers" (SS). Results: The delta between Insomnia Severity Index scores and sleep efficiency at the beginning as compared to the end of the treatment was significantly higher for SS in comparison to NS, even if they still exhibit more insomnia symptoms. No difference was found between groups in terms of remitters; however, more responders were observed in the SS group in comparison to the NS group. Conclusions: Our results demonstrate that ID patients with reported short total sleep time had a beneficial response to CBT-I of greater magnitude in comparison to NS. However, these patients may still experience the presence of residual insomnia symptoms after treatment.
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Affiliation(s)
- Andrea Galbiati
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Sforza
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mattia Poletti
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Verga
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Faculty of Psychology and Neuroscience, Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Marco Zucconi
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini-Strambi
- Faculty of Psychology, "Vita-Salute" San Raffaele University, Milan, Italy.,Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenza Castronovo
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
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22
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Ravyts SG, Dzierzewski JM, Grah SC, Buman MP, Aiken-Morgan AT, Giacobb PR, Roberts BL, Marsiske M, McCrae CS. Pain inconsistency and sleep in mid to late-life: the role of depression. Aging Ment Health 2019; 23:1174-1179. [PMID: 30215277 PMCID: PMC6417978 DOI: 10.1080/13607863.2018.1481929] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/24/2018] [Indexed: 12/20/2022]
Abstract
Objectives: Inconsistency in pain may lead to depression, which may then influence sleep. Thus, the purpose of this study was to examine whether depression mediates the relationship between day-to-day inconsistency in pain and sleep in middle aged to older adults. Methods: Baseline measures from the Active Adult Mentoring Project were used for secondary data analysis. Participants included 82 adults in mid- to late-life. Pain was assessed for seven consecutive days on an 11-point Likert-scale, with pain inconsistency defined as the seven-day individual standard deviation. A self-report daily diary was used to assess sleep efficiency (SE), total wake time (TWT), total sleep time (TST), and sleep quality (SQ), and depression was assessed using the BDI-II. Results: Mediation analyses revealed that depression partially mediated the relationship between pain inconsistency and SE, TWT, and SQ but not TST. Conclusions: Results indicate that depression may be an important factor through which pain inconsistency influences sleep. Although further research is warranted, these preliminary findings suggest that intervening on both pain inconsistency and depression may be one way to improve sleep in older adults.
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Affiliation(s)
- Scott G Ravyts
- a Department of Clinical Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Joseph M Dzierzewski
- a Department of Clinical Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Stephanie C Grah
- a Department of Clinical Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Matthew P Buman
- b Exercise Science and Health Promotion , Arizona State University , Phoenix , AZ , USA
| | | | - Peter R Giacobb
- d College of Physical Activity and Sport Sciences , West Virginia University , Morgantown , WV , USA
| | - Beverly L Roberts
- e College of Nursing , University of Florida , Gainesville , FL , USA
| | - Michael Marsiske
- f Department of Clinical and Health Psychology , University of Florida , Gainesville , FL , USA
| | - Christina S McCrae
- g Department of Health Psychology , University of Missouri , Columbia , MO , USA
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Waszczuk MA, Ruggero C, Li K, Luft BJ, Kotov R. The role of modifiable health-related behaviors in the association between PTSD and respiratory illness. Behav Res Ther 2019; 115:64-72. [PMID: 30401484 PMCID: PMC6622464 DOI: 10.1016/j.brat.2018.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/26/2018] [Accepted: 10/31/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) increases risk of future respiratory illness. However, mechanisms that underpin the association between these common and debilitating conditions remain unknown. The aim of this study was to identify modifiable, health-related behaviors they may explain the link between PTSD and respiratory problems. METHODS World Trade Center responders (N = 452, 89% male, mean age = 55 years) completed baseline PTSD and sleep questionnaires, followed by 2-weeks of daily diaries, actigraphy and ambulatory spirometry to monitor lower respiratory symptoms, pulmonary function, activity levels, stressors, and sleep. Lipid levels were obtained from electronic medical records. RESULTS Cross-sectional mediation analyses revealed that the association between PTSD and self-reported respiratory symptoms was explained by poor sleep, low activity, and daily stressors. The association between PTSD symptoms and pulmonary function was explained by insomnia and low activity. CONCLUSIONS A range of health-related daily behaviors and experiences, especially sleep disturbances and inactivity, may explain excess respiratory illness morbidity in PTSD. The findings were generally consistent across daily self-report and spirometry measures of respiratory problems. Targeting these behaviors might enhance prevention of and intervention in respiratory problems in traumatized populations.
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Affiliation(s)
- Monika A Waszczuk
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA.
| | - Camilo Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Kaiqiao Li
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Benjamin J Luft
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
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Tonetti L, Natale V. Effects of a single short exposure to blue light on cognitive performance. Chronobiol Int 2019; 36:725-732. [PMID: 30897969 DOI: 10.1080/07420528.2019.1593191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of the present study is to explore the effects of a single short one-minute exposure to blue light on cognitive performance. For this purpose, 32 young adults (16 females, mean age 24.06 ± 1.88 years) took part in a within-subjects research design, under two conditions: blue light and no light. Under both conditions, they performed the lexical decision task (LDT) in order to assess the degree of automatic activation of semantic memory through an embedded semantic priming (reaction times to prime - reaction times to target), together with the Attention Network Test (ANT) to assess the efficiency of the alerting, executive and orienting networks. During the LDT, a significantly stronger semantic priming under the blue light condition compared to no light was observed, while during the ANT a significant difference in orienting network efficiency between conditions was observed. The present data appear to highlight that even a single short exposure to blue light has an effect on cognitive performance in young adults.
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Affiliation(s)
- Lorenzo Tonetti
- a Department of Psychology , University of Bologna , Bologna , Italy
| | - Vincenzo Natale
- a Department of Psychology , University of Bologna , Bologna , Italy
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The association between physical and mental chronic conditions and napping. Sci Rep 2019; 9:1795. [PMID: 30741949 PMCID: PMC6370873 DOI: 10.1038/s41598-018-37355-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022] Open
Abstract
The objectives of this study were to assess the associations among various physical and mental chronic conditions and napping. A cross-sectional epidemiological survey was proposed within the NutriNet-Santé population-based e-cohort launched in France in 2009. Participants were 43,060 French volunteers aged 18 y and over with Internet access. A self-report questionnaire assessing sleep characteristics was administered in 2014. The main outcome (dependent) variable was weekday or weekend napping (yes/no). The main exposure (independent) variables were overweight/obesity, hypertension, diabetes, anxiety and depressive disorders, incident major cardiovascular diseases (myocardial infarction, stroke, unstable angina), and incident cancer (breast and prostate). The associations of interest were investigated with multivariable logistic regression analysis. No significant associations were found between major cardiovascular diseases or breast or prostate cancer and napping. Instead, we found that napping was more common among males (46.1%) than among females 36.9% (p < 0.0001). Individuals who were overweight or obese or had hypertension, diabetes, depression or anxiety disorders had an increased likelihood of napping compared with their healthy peers. The adjusted ORs ranged from 1.14 to 1.28″. In conclusion, most chronic conditions were independently associated with napping. Future longitudinal analyses are needed to elucidate causality.
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Molzof HE, Emert SE, Tutek J, Mulla MM, Lichstein KL, Taylor DJ, Riedel BW. Intraindividual sleep variability and its association with insomnia identity and poor sleep. Sleep Med 2018; 52:58-66. [PMID: 30286381 DOI: 10.1016/j.sleep.2018.08.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/01/2018] [Accepted: 08/27/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Insomnia identity refers to the conviction that one has insomnia, which can occur independently of poor sleep. Night-to-night variability in sleep (termed intraindividual variability [IIV]) may contribute to insomnia identity yet remain undetected via conventional mean analyses. This study compared sleep IIV across four subgroups: noncomplaining good sleepers (NG), complaining poor sleepers (CP), complaining good sleepers (CG), and noncomplaining poor sleepers (NP). METHODS This study analyzed 14 days of sleep diary data from 723 adults. Participants were classified according to presence/absence of a sleep complaint and presence/absence of poor sleep. A 2 × 2 multivariate analysis of covariance (MANCOVA) was performed to explore differences on five measures of sleep IIV: intraindividual standard deviation in total sleep time (iSD TST), sleep onset latency (iSD SOL), wake after sleep onset (iSD WASO), number of nightly awakenings (iSD NWAK), and sleep efficiency (iSD SE). RESULTS MANCOVA revealed significant main effects of poor sleep, sleep complaint, and their interaction on sleep IIV. Poor sleepers exhibited greater IIV across all sleep parameters compared to good sleepers. Similarly, individuals with a sleep complaint exhibited greater IIV compared to individuals with no complaint. The interaction revealed that iSD SOL was significantly greater among CP than NP, and iSD NWAK was significantly greater among CG than NG. CONCLUSIONS Greater night-to-night variability in specific sleep parameters was present among complaining versus noncomplaining sleepers in good and poor sleep subgroups. These findings suggest certain aspects of sleep consistency may be salient for treatment-seeking individuals based on their quantitative sleep status.
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Affiliation(s)
- Hylton E Molzof
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA.
| | - Sarah E Emert
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Joshua Tutek
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | | | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX, USA
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Exelmans L, Gradisar M, Van den Bulck J. Sleep latency versus shuteye latency: Prevalence, predictors and relation to insomnia symptoms in a representative sample of adults. J Sleep Res 2018; 27:e12737. [DOI: 10.1111/jsr.12737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 01/02/2023]
Affiliation(s)
| | | | - Jan Van den Bulck
- Department of Communication Studies; University of Michigan; Ann Arbor Michigan
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Farajtabar M, Kıcıman E, Nathan G, White RW. Modeling behaviors and lifestyle with online and social data for predicting and analyzing sleep and exercise quality. INTERNATIONAL JOURNAL OF DATA SCIENCE AND ANALYTICS 2018. [DOI: 10.1007/s41060-018-0136-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Steel JL, Terhorst L, Collins KP, Geller DA, Vodovotz Y, Kim J, Krane A, Antoni M, Marsh JW, Burke LE, Butterfield LH, Penedo FJ, Buysse DJ, Tsung A. Prospective Analyses of Cytokine Mediation of Sleep and Survival in the Context of Advanced Cancer. Psychosom Med 2018; 80:483-491. [PMID: 29621045 PMCID: PMC5976532 DOI: 10.1097/psy.0000000000000579] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aims of this study were to examine the potential association between sleep problems, symptom burden, and survival in patients with advanced cancer. METHODS A prospective study of 294 patients with gastrointestinal cancer administered questionnaires assessing sleep, depression, anxiety, stress, pain, fatigue, and health-related quality of life. Serum levels of cytokines including interleukin (IL)-1α, IL-1β, tumor necrosis factor α, IL-10, IL-2, and interferon-γ were measured to assess biological mediation between sleep and survival. Survival was measured as time from diagnosis to death. RESULTS Fifty-nine percent of patients reported poor sleep quality, 53% reported poor sleep efficiency, 39% reported sleep latency greater than 30 minutes, and 45% reported sleeping less than 6 hours or greater than 10 hours. We found a significant association between sleep duration and symptom burden. Shorter sleep duration was significantly associated with higher levels of fatigue (r = -0.169, p = .01), pain (r = -0.302, p = .01), anxiety (r = -0.182, p = .01), depression (r = -0.172, p = .003), and lower levels of quality of life (r = 0.240, p = .01). After adjustment for demographic, psychological, and disease-specific factors, short sleep duration was associated with reduced survival (hazard ratio [HR] linear = 0.485, 95% confidence interval = 0.275-0.857) and there was also evidence for a quadratic pattern (HR quadrati = 1.064, 95% confidence interval = 1.015-1.115) suggesting a curvilinear relationship between sleep duration and survival. Interleukin 2 was the only cytokine significantly related to survival (HR = 1.01, p = .003) and sleep duration (β = -30.11, p = .027). When of IL-2 was added to the multivariable model, short and long sleep (β = -0.557, p = .097; β = 0.046, p = .114) were no longer significantly related to survival, suggesting mediation by IL-2. CONCLUSION Sleep duration was associated with symptom burden and poorer survival and IL-2 was found to mediate the association between sleep and survival. Screening and treatment of sleep problems in patients diagnosed with cancer are warranted.
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Affiliation(s)
- Jennifer L Steel
- From the Departments of Surgery, Psychiatry, and Psychology (Steel), Occupational Therapy (Terhorst), Surgery, Mathematica Policy Research (Collins), Surgery (Geller, Vodovotz, Kim, Krane, Marsh, Tsung), University of Pittsburg, Pennsylvania; Department of Psychology (Antoni), University of Miami, Florida; School of Nursing (Burke), and Department of Medicine, Surgery and Immunology (Butterfield), University of Pittsburgh, Pennsylvania; Department of Medical Social Sciences, Psychology, and Psychiatry and Behavioral Sciences (Penedo), Northwestern University, Evantson, Illinois; and Department of Psychiatry (Buysse), University of Pittsburgh, Pennsylvania
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Pepin E, Gillet P, Sauvet F, Gomez-Merino D, Thaon I, Chennaoui M, Leger D. Shift work, night work and sleep disorders among pastry cookers and shopkeepers in France: a cross-sectional survey. BMJ Open 2018; 8:e019098. [PMID: 29743318 PMCID: PMC5942435 DOI: 10.1136/bmjopen-2017-019098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/23/2018] [Accepted: 03/07/2018] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Most research on night and shift work focuses on employee health in large companies, primarily in the healthcare and transportation sectors. However, many night workers work on their own or in small businesses related to services or food. This survey focuses on sleep habits and disorders concerning night work in pastry production and sales. METHODS An epidemiological telephone cross-sectional survey of night shift workers and their sleep habits was proposed to all employers and employees in the French pastry industry via their insurance health prevention company. Sleep logs allow us to estimate the total sleep time (TST) on workdays and enquire on napping episodes and length. In order to estimate the ideal TST, we added a question on the ideal amount of sleep the subjects need to be in good shape in the morning. We also define sleep debt as the difference between the ideal TST and TST on workdays, and considered a sleep debt when the difference was above 60 min and severe sleep debt above 90 min. Finally we retained subjects as long sleepers for those with a TSTof more than 7 hours and short sleepers when TST was under 5 hours. Insomnia, sleepiness and sleep apnoea have been defined based on the International Classification of Sleep Disorders-Third Edition and the classification of mental disorders (Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition). Bivariate and multivariate logistic regression models were applied to investigate the association with short TST, long TST, sleep debt and napping. RESULTS We analysed 2622 complete questionnaires from 1313 men and 1309 women aged 22-50 years old. 1397 workers began work before 07:00, whereas 1225 began later. The 24-hour TST was 6.7±1.4 hours, whereas the ideal TST was 7.0±1.2 hours. Severe sleep debt (>90 min) was reported by 6% women versus 5% men, whereas moderate sleep debt (>60 min) was reported by 11.5% women versus 9.3% men. Napping is one way to improve 24-hour TST for 58% of pastry producers (75±13 min) and 23% of shopkeepers (45±8 min). Nevertheless, 26.2% of the respondents complained of chronic insomnia, especially women aged 45-54 years old (31%). Finally, 29.6% had evocative criteria for obstructive sleep apnoea, although only 9.1% had a high score on the Berlin Questionnaire. CONCLUSION Our study demonstrates that both pastry producers and shopkeepers can have disturbed sleep schedules and a high prevalence of sleep disorders, although many have used napping as a behavioural countermeasure to fight sleep debt. The results of our survey lead us to conclude that, besides the need to take care of night workers in big industries, more information and occupational prevention must be focused on night workers in individual and small businesses.
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Affiliation(s)
- Emilie Pepin
- Université Paris Descartes, Sorbonne Paris Cité, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France
- APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Paris, France
- CHRU de Nancy, Centre de consultations de pathologies professionnelles, Vandoeuvre-lès-Nancy, France
| | | | - Fabien Sauvet
- Université Paris Descartes, Sorbonne Paris Cité, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France
- IRBA (Institut de recherche biomédicale des armées), Unité Fatigue et Vigilance, Bretigny-sur-Orge, France
| | - Danielle Gomez-Merino
- Université Paris Descartes, Sorbonne Paris Cité, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France
- IRBA (Institut de recherche biomédicale des armées), Unité Fatigue et Vigilance, Bretigny-sur-Orge, France
| | - Isabelle Thaon
- CHRU de Nancy, Centre de consultations de pathologies professionnelles, Vandoeuvre-lès-Nancy, France
- EA 7298 INGRES, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Mounir Chennaoui
- Université Paris Descartes, Sorbonne Paris Cité, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France
- IRBA (Institut de recherche biomédicale des armées), Unité Fatigue et Vigilance, Bretigny-sur-Orge, France
| | - Damien Leger
- Université Paris Descartes, Sorbonne Paris Cité, EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris, France
- APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Paris, France
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Daytime sleepiness, driving performance, reaction time and inhibitory control during sleep restriction therapy for Chronic Insomnia Disorder. Sleep Med 2018; 45:44-48. [DOI: 10.1016/j.sleep.2017.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 12/17/2022]
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Investigating Clinical Benefits of a Novel Sleep-Focused Mind-Body Program on Gulf War Illness Symptoms: A Randomized Controlled Trial. Psychosom Med 2018; 79:706-718. [PMID: 28406803 DOI: 10.1097/psy.0000000000000469] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Mind-Body Bridging (MBB) has been shown to be effective for improving disturbed sleep. In this prospective randomized controlled trial, we evaluated the efficacy of sleep-focused MBB compared with sleep education control (SED) for improving sleep in previously deployed Gulf War veterans. METHODS US military service members with sleep and physical health complaints who were deployed in 1990-1991 were randomized to receive three weekly sessions of either MBB (n = 33) or SED (n = 27) between 2012 and 2015. The primary outcome of Medical Outcomes Study Sleep Scale was completed at baseline, weekly during treatment, postintervention, and 3-month follow-up. Secondary outcome measures for posttraumatic stress disorder, depression, fatigue, quality of life, symptom severity, and mindfulness were completed at baseline, postintervention and 3-month follow-up. Salivary samples were collected at five time points per day at each visit for cortisol and α-amylase assessment. Clinician-administered assessments of sleep and co-occurring conditions were conducted at baseline and postintervention. RESULTS MBB was significantly more efficacious than SED in reducing disturbed sleep at follow-up (F(1,180.54) = 4.04, p = .046). In addition, self-reported posttraumatic stress disorder (F(1,56.42) = 4.50, p = .038) for the treatment effect, depression (F(1,93.70) = 4.44, p = .038), and fatigue symptoms (F(1,68.58) = 3.90, p = .050) at follow-up improved in MBB compared with those in SED. Consistently higher percentages of veterans in MBB reported improvements of sleep, pain, and composite sleep/general co-occurring symptoms at the postclinical evaluation, as compared with veterans in SED. Finally, the mean waking level of salivary α-amylase in the MBB declined to a greater extent than that in the SED, at follow-up (F(1,88.99) = 3.78, p = .055), whereas no effects were found on cortisol. CONCLUSIONS Sleep-focused MBB can improve sleep and possibly also co-occurring symptoms in Gulf War veterans. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT01543997.
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Measurements and status of sleep quality in patients with cancers. Support Care Cancer 2017; 26:405-414. [DOI: 10.1007/s00520-017-3927-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 10/09/2017] [Indexed: 01/04/2023]
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Bernert RA, Hom MA, Iwata NG, Joiner TE. Objectively Assessed Sleep Variability as an Acute Warning Sign of Suicidal Ideation in a Longitudinal Evaluation of Young Adults at High Suicide Risk. J Clin Psychiatry 2017; 78:e678-e687. [PMID: 28682534 PMCID: PMC6613567 DOI: 10.4088/jcp.16m11193] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 01/05/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Young adults attempt suicide at disproportionately high rates relative to other groups and demonstrate high rates of sleep disturbance. No study has yet prospectively evaluated disturbed sleep as an acute indicator of risk using an objective index of sleep. We investigated objective and subjective parameters of disturbed sleep as a warning sign of suicidal ideation among young adults over an acute period. METHODS A longitudinal study across a 21-day observation period and 3 time points. Fifty of 4,847 participants (aged 18-23 years) were prescreened from a university undergraduate research pool (February 2007-June 2008) on the basis of suicide attempt history and recent suicidal ideation. Actigraphic and subjective sleep parameters were evaluated as acute predictors of suicidal ideation (Beck Scale for Suicide Ideation), with adjustment for baseline symptoms. Hierarchical regression analyses were employed to predict residual change scores. RESULTS Ninety-six percent of participants (n = 48) endorsed a suicide attempt history. Mean actigraphy values revealed objectively disturbed sleep parameters; 78% (n = 39) and 36% (n = 18) endorsed clinically significant insomnia and nightmares, respectively. When results were controlled for baseline suicidal and depressive symptoms, actigraphic and subjective sleep parameters predicted suicidal ideation residual change scores at 7- and 21-day follow-ups (P < .001). Specifically, actigraphy-defined variability in sleep timing, insomnia, and nightmares predicted increases in suicidal ideation (P < .05). In a test of competing risk factors, sleep variability outperformed depressive symptoms in the longitudinal prediction of suicidal ideation across time points (P < .05). CONCLUSIONS Objectively and subjectively measured sleep disturbances predicted acute suicidal ideation increases in this population, independent of depressed mood. Self-reported insomnia and nightmares and actigraphically assessed sleep variability emerged as acute warning signs of suicidal ideation. These findings highlight the potential utility of sleep as a proposed biomarker of suicide risk and a therapeutic target.
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Affiliation(s)
- Rebecca A. Bernert
- Stanford University School of Medicine, Stanford Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | - Melanie A. Hom
- Florida State University, Department of Psychology, Tallahassee, FL, United States
| | - Naomi G. Iwata
- Stanford University School of Medicine, Stanford Mood Disorders Center, Department of Psychiatry and Behavioral Sciences, Stanford, CA, United States
| | - Thomas E. Joiner
- Florida State University, Department of Psychology, Tallahassee, FL, United States
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Bidirectionality Between Sleep Symptoms and Core Depressive Symptoms and Their Long-Term Course in Major Depression. Psychosom Med 2017; 79:336-344. [PMID: 27806023 DOI: 10.1097/psy.0000000000000407] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the bidirectional dynamic relationship between sleep symptoms and core depressive symptoms and to identify subgroups differing with respect to their course. METHODS The weekly state of depressive symptoms in depressed primary care patients (N = 267) was assessed retrospectively every 3 months for 3 consecutive years. The bidirectional relationship between sleep and core symptoms was estimated by means of manifest Markov modeling. Data-driven subgroups were estimated with parallel processes-latent class growth analyses to identify differences in courses of sleep and core symptoms. RESULTS In total, core symptoms were associated with next-week development (odds = 1.42; 95% confidence interval [CI] = 1.20-1.67; p < .001) and remission of sleep symptoms (odds = 0.86; 95% CI 0.75 to 0.99, p = .033).Evidence was also found for a reverse pathway such that sleep symptoms were associated with the development (odds = 1.26; 95% CI = 1.05-1.50; p = .012) and remission of core symptoms (odds = 0.87; 95% CI = 0.76-0.99; p = .038). Three classes with different 3-year courses were derived. In class 1, the likelihood that core symptoms remitted was reduced if sleep symptoms were present, and symptoms remained present over 3 years. In class 2, symptoms were bidirectionally related and remitted over 3 years. In class 3, symptoms were not associated, and sleep symptoms declined less steeply than core depressive symptoms. CONCLUSIONS The results suggest that sleep symptoms should be treated alongside core depressive symptoms in patients with an asynchronic decrease of sleep and core symptoms and in patients that do not respond to treatment to increase the chance of complete remission.
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Andreeva VA, Torres MJ, Léger D, Bayon V, Gonzalez P, de Edelenyi FS, Hercberg S, Galan P. Major Change in Body Weight over 5 Years and Total Sleep Time: Investigation of Effect Modification by Sex and Obesity in a Large e-Cohort. Int J Behav Med 2017; 24:493-500. [DOI: 10.1007/s12529-017-9635-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Validation study of the Italian version of the Insomnia Severity Index (ISI). Neurol Sci 2016; 37:1517-24. [DOI: 10.1007/s10072-016-2620-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/23/2016] [Indexed: 11/27/2022]
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Crowley SK, O’Buckley TK, Schiller CE, Stuebe A, Morrow AL, Girdler SS. Blunted neuroactive steroid and HPA axis responses to stress are associated with reduced sleep quality and negative affect in pregnancy: a pilot study. Psychopharmacology (Berl) 2016; 233:1299-310. [PMID: 26856852 PMCID: PMC4803569 DOI: 10.1007/s00213-016-4217-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/14/2016] [Indexed: 01/24/2023]
Abstract
RATIONALE Anxiety during pregnancy has been linked to adverse maternal health outcomes, including postpartum depression (PPD). However, there has been limited study of biological mechanisms underlying behavioral predictors of PPD during pregnancy. OBJECTIVES Considering the shared etiology of chronic stress amongst antenatal behavioral predictors, the primary goal of this pilot study was to examine associations among stress-related physiological factors (including GABA-ergic neurosteroids) and stress-related behavioral indices of anxiety during pregnancy. METHODS Fourteen nulliparous women in their second trimester of a singleton pregnancy underwent speech and mental arithmetic stress, following a 2-week subjective and objective recording of sleep-wake behavior. RESULTS Lower cortisol, progesterone, and a combined measure of ALLO + pregnanolone throughout the entire stressor protocol (area under the curve, AUC) were associated with greater negative emotional responses to stress, and lower cortisol AUC was associated with worse sleep quality. Lower adrenocorticotropic hormone was associated with greater anxious and depressive symptoms. Stress produced paradoxical reductions in cortisol, progesterone, and a combined measure of allopregnanolone + pregnanolone, while tetrahydrodeoxycorticosterone levels were elevated. CONCLUSIONS These data suggest that cortisol, progesterone, and ALLO + pregnanolone levels in the second trimester of pregnancy are inversely related to negative emotional symptoms, and the negative impact of acute stress challenge appears to exert its effects by reducing these steroids to further promote negative emotional responses.
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Affiliation(s)
- Shannon K. Crowley
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
| | - Todd K. O’Buckley
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
| | - Crystal E. Schiller
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
| | - Alison Stuebe
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
| | - A. Leslie Morrow
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
- Bowles Center for Alcohol Studies, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
| | - Susan S. Girdler
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7175, USA
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Validation of Capturing Sleep Diary Data via a Wrist-Worn Device. SLEEP DISORDERS 2015; 2015:758937. [PMID: 26788374 PMCID: PMC4693024 DOI: 10.1155/2015/758937] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/23/2015] [Indexed: 02/04/2023]
Abstract
Paper sleep diaries are the gold standard for assessment of sleep continuity variables in clinical practice as well as research. Unfortunately, paper diaries can be filled out weekly instead of daily, lost, illegible or destroyed; and are considered out of date according to the newer technology savvy generations. In this study, we assessed the reliability and validity of using a wrist-worn electronic sleep diary. Design. A prospective design was used to compare capturing 14 days of sleep continuity data via paper to a wrist-worn electronic device that also captured actigraphy data. Results. Thirty-five healthy community dwelling adults with mean (sd) age of 36 (15), 80% Caucasians, and 74% females were enrolled. All sleep continuity variables via electronic and paper diary capture methods were significantly correlated with moderate, positive relationships. Assessment of validity revealed that electronic data capture had a significant relationship with objective measure of sleep continuity variables as measured by actigraphy. Paper diary variables were not significantly associated with objective measures. Conclusions. The use of a wrist-worn device to capture daily sleep diary data is as accurate as and for some variables more accurate than using paper diaries.
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