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Feldman EL, Slavish DC. Initial development of a sleep health literacy scale. Sleep Health 2024:S2352-7218(24)00177-3. [PMID: 39332924 DOI: 10.1016/j.sleh.2024.08.001] [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: 08/15/2023] [Revised: 07/22/2024] [Accepted: 08/02/2024] [Indexed: 09/29/2024]
Abstract
OBJECTIVES Health literacy includes the skills necessary for effective communication with health professionals, understanding health instructions, and recognizing health needs. Our study aimed to create a novel measure of sleep health literacy-an individual's capacity to comprehend sleep-related information and navigate sleep-related healthcare services. METHODS The Sleep Health Literacy scale consists of two subscales: "Sleep Health Communication" (11 Likert-scale items assessing access to resources and communication with healthcare providers) and "Sleep Health Knowledge" (46 true/false items assessing specific knowledge of sleep health). The Sleep Health Literacy scale was completed by 154 undergraduate students (mean age=20.96years; 79.87% female) in study 1. In study 2, an additional sample of 251 participants (mean age=20.23years; 79.87% female) completed the Sleep Health Literacy scale, along with measures of convergent and discriminant validity. RESULTS Exploratory factor analysis results in study 1 revealed a two-factor structure for the "Sleep Health Communication" subscale ("comprehension" and "critical application"). The subscale demonstrated good internal consistency (α = 0.81) and inter-item and item-total correlations. On the "Sleep Health Knowledge" subscale, participants answered 76.36% of items correctly. In study 2, the Sleep Health Literacy had good convergent validity with Sleep Beliefs Scale and the All Aspect of Health Literacy Scale. CONCLUSIONS The Sleep Health Literacy scale offers a standardized measure to assess sleep health literacy, an understudied domain that has important links to health. This measure may allow researchers and clinicians to better understand how to improve sleep health. Further validation of the Sleep Health Literacy scale is warranted in more diverse samples.
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Affiliation(s)
- Emily L Feldman
- Department of Psychology, University of North Texas, Denton, Texas, United States
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, Texas, United States.
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Chan WS, Cheng WY, Lok SHC, Cheah AKM, Lee AKW, Ng ASY, Kowatsch T. Assessing the Short-Term Efficacy of Digital Cognitive Behavioral Therapy for Insomnia With Different Types of Coaching: Randomized Controlled Comparative Trial. JMIR Ment Health 2024; 11:e51716. [PMID: 39110971 PMCID: PMC11339566 DOI: 10.2196/51716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/07/2024] [Accepted: 05/25/2024] [Indexed: 08/25/2024] Open
Abstract
BACKGROUND Digital cognitive behavioral therapy for insomnia (dCBTi) is an effective intervention for treating insomnia. The findings regarding its efficacy compared to face-to-face cognitive behavioral therapy for insomnia are inconclusive but suggest that dCBTi might be inferior. The lack of human support and low treatment adherence are believed to be barriers to dCBTi achieving its optimal efficacy. However, there has yet to be a direct comparative trial of dCBTi with different types of coaching support. OBJECTIVE This study examines whether adding chatbot-based and human coaching would improve the treatment efficacy of, and adherence to, dCBTi. METHODS Overall, 129 participants (n=98, 76% women; age: mean 34.09, SD 12.05 y) whose scores on the Insomnia Severity Index [ISI] were greater than 9 were recruited. A randomized controlled comparative trial with 5 arms was conducted: dCBTi with chatbot-based coaching and therapist support (dCBTi-therapist), dCBTi with chatbot-based coaching and research assistant support, dCBTi with chatbot-based coaching only, dCBTi without any coaching, and digital sleep hygiene and self-monitoring control. Participants were blinded to the condition assignment and study hypotheses, and the outcomes were self-assessed using questionnaires administered on the web. The outcomes included measures of insomnia (the ISI and the Sleep Condition Indicator), mood disturbances, fatigue, daytime sleepiness, quality of life, dysfunctional beliefs about sleep, and sleep-related safety behaviors administered at baseline, after treatment, and at 4-week follow-up. Treatment adherence was measured by the completion of video sessions and sleep diaries. An intention-to-treat analysis was conducted. RESULTS Significant condition-by-time interaction effects showed that dCBTi recipients, regardless of having any coaching, had greater improvements in insomnia measured by the Sleep Condition Indicator (P=.003; d=0.45) but not the ISI (P=.86; d=-0.28), depressive symptoms (P<.001; d=-0.62), anxiety (P=.01; d=-0.40), fatigue (P=.02; d=-0.35), dysfunctional beliefs about sleep (P<.001; d=-0.53), and safety behaviors related to sleep (P=.001; d=-0.50) than those who received digital sleep hygiene and self-monitoring control. The addition of chatbot-based coaching and human support did not improve treatment efficacy. However, adding human support promoted greater reductions in fatigue (P=.03; d=-0.33) and sleep-related safety behaviors (P=.05; d=-0.30) than dCBTi with chatbot-based coaching only at 4-week follow-up. dCBTi-therapist had the highest video and diary completion rates compared to other conditions (video: 16/25, 60% in dCBTi-therapist vs <3/21, <25% in dCBTi without any coaching), indicating greater treatment adherence. CONCLUSIONS Our findings support the efficacy of dCBTi in treating insomnia, reducing thoughts and behaviors that perpetuate insomnia, reducing mood disturbances and fatigue, and improving quality of life. Adding chatbot-based coaching and human support did not significantly improve the efficacy of dCBTi after treatment. However, adding human support had incremental benefits on reducing fatigue and behaviors that could perpetuate insomnia, and hence may improve long-term efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT05136638; https://www.clinicaltrials.gov/study/NCT05136638.
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Affiliation(s)
- Wai Sze Chan
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Wing Yee Cheng
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Samson Hoi Chun Lok
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Amanda Kah Mun Cheah
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Anna Kai Win Lee
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Albe Sin Ying Ng
- Department of Psychology, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
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Petrofsky LA, Heffernan CM, Gregg BT, Smith-Forbes EV, Sturdivant RX. Sleep and Military Leaders: Examining the Values, Beliefs, and Quality of Sleep and the Impact on Occupational Performance. Mil Med 2024; 189:1023-1031. [PMID: 36919969 DOI: 10.1093/milmed/usad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/06/2022] [Accepted: 02/03/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Sleep deprivation is rampant within the military population, and insufficient sleep can lead to physical and mental health problems impacting soldier's readiness and deployability. Past research has shown the importance of leadership's role in subordinates' sleep health. Understanding the values, beliefs, and quality of military leader sleep is essential to the development of effective interventions to optimize occupational performance and overall sleep health. Therefore, the purpose of this study was to examine the military leaders' values, beliefs, and sleep quality and the impact on occupational performance. The authors aimed to (1) identify military leaders' sleep quality and beliefs; (2) explore the relationship between military leaders' sleep quality, beliefs and attitudes about sleep, and impact on occupational performance; and (3) examine the value leaders place on sleep for themselves and subordinates in relation to occupational performance. MATERIALS AND METHODS This observational, mixed-methods study design recruited a convenience sample of 109 Army active duty medical service members currently serving in a leadership role. Participants completed an electronic survey to include general demographic information and three self-report measures: the Pittsburgh Quality of Sleep Index, the Dysfunctional Beliefs about Sleep, and the Functional Outcomes of Sleep Questionnaire. Eleven participants completed the semi-structured qualitative interview focusing on sleep values and the impacts on performance. Univariate and multivariate regressions were performed for statistical analysis of the quantitative survey data, whereas thematic analysis was used to analyze the qualitative interview data. This study was approved by the U.S. Army Medical Center of Excellence Institutional Review Board. RESULTS Multivariate regression analysis demonstrated small-to-medium effect sizes (R2 = 0.355-0.559) for relationships between sleep quality, sleep beliefs, functional performance, and demographic variables. More specifically, military grade, position, use of alcohol, time in service, and gender were all found to contribute significantly to scores on the Pittsburgh Sleep Quality Index, the Dysfunctional Beliefs About Sleep Scale-16, and the Functional Outcomes of Sleep Questionnaire-10 (P < .05). Qualitative data resulted in three primary themes: (1) Poor sleep degrades performance, (2) sleep is a top priority, and (3) leaders have a responsibility for subordinates' sleep health. CONCLUSIONS This sample of military leaders was found to perceive themselves as poor-quality sleepers despite demonstrating more functional attitudes and beliefs about sleep and reporting normal-to-mild impairments in daily functioning as a result of daytime sleepiness. Furthermore, findings suggest that leaders' sleep quality and beliefs stand to be further improved, whereas their sleep values need to be consistently demonstrated to subordinates. With a clearer understanding of military leaders' values, beliefs, and sleep quality, future research could focus on implementing and developing holistically based and individualized sleep interventions intended to optimize performance and sleep health.
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Affiliation(s)
- Lyddia A Petrofsky
- U.S. Army Medical Center of Excellence, San Antonio, TX 78234, USA
- U.S. Army-Baylor University, San Antonio, TX 78234, USA
| | - Corinne M Heffernan
- U.S. Army Medical Center of Excellence, San Antonio, TX 78234, USA
- U.S. Army-Baylor University, San Antonio, TX 78234, USA
| | - Brian T Gregg
- U.S. Army-Baylor University, San Antonio, TX 78234, USA
| | - Enrique V Smith-Forbes
- U.S. Army Medical Center of Excellence, San Antonio, TX 78234, USA
- U.S. Army-Baylor University, San Antonio, TX 78234, USA
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Chung HKS, Louie K, Chan WS. Development and evaluation of a Chinese short-form of the Sleep-related Behaviors Questionnaire in Hong Kong Chinese adults using item response theory. J Health Psychol 2024; 29:255-265. [PMID: 37688382 DOI: 10.1177/13591053231195518] [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] [Indexed: 09/10/2023] Open
Abstract
Insomnia-related safety behaviors are behaviors that aim to mitigate the negative consequences of insomnia but inadvertently perpetuate insomnia. This study aimed to develop and evaluate a Chinese short-form of the sleep-related behavior questionnaire (SRBQ-SF), a self-report measure of insomnia-related safety behaviors, using item response theory. The Chinese version of the original SRBQ was completed by 536 Chinese-speaking adults with clinically significant insomnia. The automatic item selection procedure of the Mokken scaling analysis was used to develop and evaluate the SRBQ-SF. A 23-item SRBQ-SF consisting of a 14-item reduced engagement and avoidance subscale (SRBQ-REA) and a 9-item preoccupation with sleep subscale (SRBQ-PS) was derived. Classical test theory-based estimates showed that the SRBQ-REA and SRBQ-PS had good internal consistency and acceptable convergent and discriminant validities, and they were only weakly correlated with each other. We recommend the use of the SRBQ-REA and SRBQ-PS separately to assess two dimensions of safety behaviors in the study and treatment of insomnia in Chinese-speaking adults.
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Chung KF, Lee CT, Au CH, Kam KY, Lee CK, Yeung WF, Lau EYY, Ho FYY, Ho LM. Cognitive behavioural therapy for insomnia as an early intervention of mood disorders with comorbid insomnia: A randomized controlled trial. Early Interv Psychiatry 2024; 18:82-93. [PMID: 37192756 DOI: 10.1111/eip.13435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/30/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of small-group nurse-administered cognitive behavioural therapy for insomnia (CBTI) as an early intervention of mood disorders with comorbid insomnia. METHODS A total of 200 patients with first-episode depressive or bipolar disorders and comorbid insomnia were randomized in a ratio of 1:1 to receiving 4-session CBTI or not in a routine psychiatric care setting. Primary outcome was Insomnia Severity Index. Secondary outcomes included response and remission status; daytime symptomatology and quality of life; medication burden; sleep-related cognitions and behaviours; and the credibility, satisfaction, adherence and adverse events of CBTI. Assessments were conducted at baseline, 3, 6, and 12-month. RESULTS Only a significant time-effect but no group-by-time interaction was found in the primary outcome. Several secondary outcomes had significantly greater improvements in CBTI group, including higher depression remission at 12-month (59.7% vs. 37.9%, χ2 = 6.57, p = .01), lower anxiolytic use at 3-month (18.1% vs. 33.3%, χ2 = 4.72, p = .03) and 12-month (12.5% vs. 25.8%, χ2 = 3.26, p = .047), and lesser sleep-related dysfunctional cognitions at 3 and 6-month (mixed-effects model, F = 5.12, p = .001 and .03, respectively). Depression remission rate was 28.6%, 40.3%, and 59.7% at 3, 6, and 12-month, respectively in CBTI group and 28.4%, 31.1%, and 37.9%, respectively in no CBTI group. CONCLUSION CBTI may be a useful early intervention to enhance depression remission and reduce medication burden in patients with first-episode depressive disorder and comorbid insomnia.
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Affiliation(s)
- Ka-Fai Chung
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Chit-Tat Lee
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
| | - Chi-Hung Au
- Department of Psychiatry, Queen Mary Hospital, Hong Kong, China
| | - Ka-Yee Kam
- Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Che-Kin Lee
- Department of Psychiatry, Kowloon Hospital, Hong Kong, China
| | - Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Esther Yuet Ying Lau
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Lai-Ming Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
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Tang NKY, Saconi B, Jansson‐Fröjmark M, Ong JC, Carney CE. Cognitive factors and processes in models of insomnia: A systematic review. J Sleep Res 2023; 32:e13923. [PMID: 37364869 PMCID: PMC10909484 DOI: 10.1111/jsr.13923] [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: 03/31/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 06/28/2023]
Abstract
Cognition is central to the experience of insomnia. Although unhelpful thoughts about and around insomnia are a primary treatment target of cognitive behaviour therapy for insomnia, cognitive constructs are termed and conceptualised differently in different theories of insomnia proposed over the past decades. In search of consensus in thinking, the current systematic review identified cognitive factors and processes featured in theoretical models of insomnia and mapped any commonality between models. We systematically searched PsycINFO and PubMed for published theoretical articles on the development, maintenance and remission of insomnia, from inception of databases to February, 2023. A total of 2458 records were identified for title and abstract screening. Of these, 34 were selected for full-text assessment and 12 included for analysis and data synthesis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified nine distinguishable models of insomnia published between 1982 and 2023 and extracted 20 cognitive factors and processes featured in these models; 39 if sub-factors were counted. After assigning similarity ratings, we observed a high degree of overlap between constructs despite apparent differences in terminologies and measurement methods. As a result, we highlight shifts in thinking around cognitions associated with insomnia and discuss future directions.
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Affiliation(s)
| | - Bruno Saconi
- Department of Population Health Sciences, GeisingerDanvillePennsylvaniaUSA
| | - Markus Jansson‐Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region StockholmStockholmSweden
| | | | - Colleen E. Carney
- Department of PsychologyToronto Metropolitan UniversityTorontoOntarioCanada
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Nielson SA, Perez E, Soto P, Boyle JT, Dzierzewski JM. Challenging beliefs for quality sleep: A systematic review of maladaptive sleep beliefs and treatment outcomes following cognitive behavioral therapy for insomnia. Sleep Med Rev 2023; 72:101856. [PMID: 37862834 DOI: 10.1016/j.smrv.2023.101856] [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: 08/26/2022] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 10/22/2023]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is an empirically supported intervention for insomnia. Given the strong, consistent support of its efficacy, scholars have become increasingly interested in the behavioral and cognitive mechanisms targeted during CBT-I. The purpose of the systematic review was to synthesize findings from the literature regarding the associations among maladaptive sleep beliefs, a cognitive mechanism implicated in maintaining insomnia, and treatment outcomes following CBT-I. The systematic review was completed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies were included in the final sample of reviewed articles and a study quality assessment was performed for all studies included in the review. The results suggested that reductions in maladaptive sleep beliefs were associated with improved insomnia severity; however, reductions in maladaptive beliefs were not associated with changes in sleep efficiency or other sleep parameters. Moreover, in some cases, improved sleep parameters preceded reductions in maladaptive beliefs. Maladaptive sleep beliefs may be an important target for improving insomnia. Targeting maladaptive sleep beliefs may initiate a trickle-down process that limits the influence of other cognitive and behavioral processes maintaining insomnia. Additional investigation is needed to evaluate the directional relationship between improved insomnia symptoms and reduced maladaptive beliefs.
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Affiliation(s)
- Spencer A Nielson
- Virginia Commonwealth University, Department of Psychology, Richmond, VA, USA
| | - Elliottnell Perez
- Virginia Commonwealth University, Department of Psychology, Richmond, VA, USA
| | - Pablo Soto
- Virginia Commonwealth University, Department of Psychology, Richmond, VA, USA
| | - Julia T Boyle
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Guo X, Meng Y, Lian H, Li Y, Xu Y, Zhang R, Xu J, Wang H, Xu S, Cai W, Xiao L, Su T, Tang Y. Marital status and living apart affect sleep quality in male military personnel: a study of the China's Navy during COVID-19. Front Psychiatry 2023; 14:1178235. [PMID: 37575585 PMCID: PMC10412872 DOI: 10.3389/fpsyt.2023.1178235] [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: 03/02/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Marital status is a robust sociodemographic predictor of sleep. Having to live apart from spouse may have different implications than those of cohabitants or singles, especially in military personnel. Further research on this group will help provide knowledge in advance and facilitate early targeted interventions. Methods An online questionnaire study was conducted from July to November 2021. A total of 1,832 male military personnel completed the questionnaire. The marital status was measured by a self-reported single choice question. Pittsburgh sleep quality index (PSQI), Epworth Sleepiness Scale (ESS) and The Dysfunctional Beliefs and Attitudes about sleep scale (DBAS-16) were used to measure sleep-related outcomes. Inverse probability weighting (IPW) was applied to reduce the effects of confounding. Logistic regression was used to analyze the relationship between marital status and sleep and explore the impact of living together or not. Results After inverse probability weighting, the prevalence of poor sleep quality, sleepiness and dysfunctional beliefs were 16.1, 20.1 and 7.1%, respectively. One-way ANOVA results for the means of both groups were statistically significantly different, except for the sleep latency and sleep disturbance dimensions of PSQI. Participants who were married were more likely to have poor sleep quality (OR: 1.408, 95% CI: [1.10, 1.80]), to have daytime sleepiness (OR: 1.560, 95% CI: [1.27, 1.92]) and to develop dysfunctional beliefs and attitudes (OR: 2.497, 95% CI: [1.65, 3.80]) than those who were unmarried. Further analysis showed that the odds of developing poor sleep quality and DBAS in participants who married but living apart were significantly bigger than those unmarried (OR: 1.548 and 3.991, respectively.), while there were no significant differences in the odds of daytime sleepiness (OR: 0.738, p = 0.050). Age was a protective factor for the development of bad sleep outcomes, while family economic was an independent risk factor. Conclusion Marital status appear important for sleep quality, daytime sleepiness and sleep beliefs. The effect of living apart or not should be considered separately as an important predictor of sleep.
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Affiliation(s)
- Xin Guo
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Yao Meng
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
- Department of Diving and Hyperbaric Medical Research, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Hao Lian
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Yinan Li
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Ying Xu
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Ruike Zhang
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Jingzhou Xu
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Hao Wang
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Shuyu Xu
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Wenpeng Cai
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Lei Xiao
- Department of Medical Psychology, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Tong Su
- Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Yunxiang Tang
- Faculty of Psychology, Naval Medical University, Shanghai, China
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Tully IA, Kim JP, Simpson N, Palaniappan L, Tutek J, Gumport NB, Dietch JR, Manber R. Beliefs about prescription sleep medications and interest in reducing hypnotic use: an examination of middle-aged and older adults with insomnia disorder. J Clin Sleep Med 2023; 19:1247-1257. [PMID: 36883379 PMCID: PMC10315611 DOI: 10.5664/jcsm.10552] [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: 09/14/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
STUDY OBJECTIVES To examine beliefs about prescription sleep medications (hypnotics) among individuals with insomnia disorder seeking cognitive behavioral therapy for insomnia and predictors of wishing to reduce use. METHODS Baseline data was collected from 245 adults 50 years and older enrolled in the "RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice" study. T-tests compared characteristics of prescription sleep medication users with those of nonusers. Linear regression assessed predictors of patients' beliefs about sleep medication necessity and hypnotic-related concerns. Among users, we examined predictors of wishing to reduce sleep medications, including perceived hypnotic dependence, beliefs about medications, and demographic characteristics. RESULTS Users endorsed stronger beliefs about the necessity of sleep medications and less concern about potential harms than nonusers (P < .01). Stronger dysfunctional sleep-related cognitions predicted greater beliefs about necessity and concern about use (P < .01). Patients wishing to reduce sleep medications reported greater perceived hypnotic dependence than those disinterested in reduction (P < .001). Self-reported dependence severity was the strongest predictor of wishing to reduce use (P = .002). CONCLUSIONS Despite expressing strong beliefs about necessity, and comparatively less concern about taking sleep medications, three-quarters of users wished to reduce prescription hypnotics. Results may not generalize to individuals with insomnia not seeking nonpharmacological treatments. Upon completion, the "RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice" study will provide information about the extent to which therapist-led and digital cognitive behavioral therapy for insomnia contribute to prescription hypnotic reduction. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The RESTING Insomnia Study: Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy (RESTING); URL: https://clinicaltrials.gov/ct2/show/NCT03532282; Identifier: NCT03532282. CITATION Tully IA, Kim JP, Simpson N, et al. Beliefs about prescription sleep medications and interest in reducing hypnotic use: an examination of middle-aged and older adults with insomnia disorder. J Clin Sleep Med. 2023;19(7):1247-1257.
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Affiliation(s)
- Isabelle A. Tully
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Jane P. Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Norah Simpson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
| | - Joshua Tutek
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Nicole B. Gumport
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Jessica R. Dietch
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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McPhillips MV, Li J, Petrovsky DV, Gooneratne NS, Aryal S, Hodgson NA. A randomized controlled trial to test a behavioral sleep intervention to improve insomnia symptoms in older adults with mild cognitive impairment: Multicomponent Behavioral Sleep Intervention (MBSI) protocol. Contemp Clin Trials 2023; 127:107137. [PMID: 36858255 PMCID: PMC10068807 DOI: 10.1016/j.cct.2023.107137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Insomnia symptoms in older adults with mild cognitive impairment represent a significant public health burden in terms of impaired quality of life, risks from untreated insomnia, and adverse effects from pharmaceutical insomnia treatment. To address current limitations in the most effective non-pharmacological treatments for insomnia in older adults with mild cognitive impairment, we are conducting a randomized pilot study to test a brief (4- week), tablet-based, personalized, multicomponent behavioral sleep intervention (MBSI) for insomnia, compared to a sleep education control, in a sample of older adults with mild cognitive impairment. METHODS Participants will be randomized in a 1:1 ratio to intervention or control group. Both groups will complete three virtual study data collection visits: baseline, 4-week post-intervention, and 12-week post-intervention follow-up. Key components of the 4-week intervention include sleep hygiene education, stimulating meaningful activity during the day and promoting relaxation therapy at night. We will determine preliminary immediate (4-week) and sustained efficacy (12-week) of MBSI compared to sleep education on sleep related outcomes and health related quality of life. Additionally, we will explore mechanisms by which the intervention affects sleep and health related quality of life using standardized questionnaires and inflammatory biomarkers. RESULTS (N/A). DISCUSSION The findings of the proposed project will inform future, larger scale clinical trials and may provide a novel and innovative way for older adults with mild cognitive impairment to achieve better sleep and health-related quality of life outcomes.
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Affiliation(s)
| | - Junxin Li
- School of Nursing, John Hopkins University, USA
| | - Darina V Petrovsky
- School of Nursing, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, USA
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Hartley S, Dagneaux S, Palethorpe C, Londe V, Liane MT, Decalf L, Aussert F, Colas des Francs C, Leymarie R, Royant-Parola S. [Does a short telemedicine-based CBT programme for insomnia lead to changes in dysfunctional beliefs about sleep?]. L'ENCEPHALE 2023; 49:124-129. [PMID: 36266102 DOI: 10.1016/j.encep.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION The Morphee Sleep network runs a short group CBT programme. During the pandemic, the programme was administered by videoconference. The programme focuses on behavioral modification. The objective of our study was to evaluate whether the videoconference programme produced changes in dysfunctional beliefs about sleep and whether these changes were linked to improvements in insomnia. METHODS Observational study of 3×90minute sessions of group CBT by videoconference over one month delivered by experienced psychologists. The outcome measures : insomnia severity scale (ISI), dysfunctional beliefs and attitudes about sleep short version (DBAS 16), hospital anxiety and depression scale (subscales depression HADD and anxiety HADA), and epworth sleepiness scale (ESS) completed before session 1 and at the end of session 3. The effectiveness of the programme on insomnia was evaluated by the decrease in the ISI score : full response R+ (>7 points), partial response, R- (4 - 6 points) non response, NR (<3 points). The effect on dysfunctional beliefs and attitudes about sleep were measured by the decrease in the DBAS 16 with response CR (>9 points) and no response CNR (<9 points). RESULTS There were fifty-five participants, 64 % women with a mean age of 49.1±16.1 years. The DBAS 16 was reduced by 6.12±1.29 to 5.09±1.57 (P< 0.0001) with 67 % of participants showing a response CR. The ISI score reduced from 17.7±3.6 to 14.0±4.9 (P< 0.0001) with 49 % showing at least a partial response (R+ and R-). A significant correlation (0.327, P=0.015) between the CBT response and dysfunctional beliefs about sleep was observed with a significant reduction in the DBAS 16 between responders R+ and non-responders (R+ vs. NR 1.67±1.3 vs. 0.57±1.28 P=0.012). Seventy-nine of R+ showed improvements in the DBAS 16 vs. 69 % of R- and 61 % of non-responders NR. CONCLUSION A short group CBT programme by videoconference focused on behavioral modification can reduce dysfunctional beliefs about sleep.
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Affiliation(s)
- S Hartley
- Réseau morphée, 2, grande rue, 92380 Garches, France; APHP hôpital Raymond Poincaré, sleep center, 92380 Garches, France; EA 4047, Université de Versailles Saint-Quentin en Yvelines, France.
| | - S Dagneaux
- Réseau morphée, 2, grande rue, 92380 Garches, France
| | - C Palethorpe
- Réseau morphée, 2, grande rue, 92380 Garches, France
| | - V Londe
- Réseau morphée, 2, grande rue, 92380 Garches, France
| | - M-T Liane
- Réseau morphée, 2, grande rue, 92380 Garches, France
| | - L Decalf
- Réseau morphée, 2, grande rue, 92380 Garches, France
| | - F Aussert
- Réseau morphée, 2, grande rue, 92380 Garches, France
| | | | - R Leymarie
- Réseau morphée, 2, grande rue, 92380 Garches, France
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12
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Clemente V, Marques DR, Miller-Mendes M, Morin CM, Serra J, Allen Gomes A. The dysfunctional beliefs and attitudes about sleep scale: Dimensions of the European Portuguese DBAS-30 and development of a new short version (DBAS–SF–16). Sleep Med 2023; 106:59-68. [PMID: 37044002 DOI: 10.1016/j.sleep.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVES The Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) is the most widely validated instrument for assessing sleep-related cognitions. This study aimed to examine the reliability of the DBAS-30 European Portuguese version, explore its dimensionality, and develop a new short version suitable for differentiating the presence/absence of insomnia. METHODS From 824 participants aged 18-85 years, the Insomnia Group (IG, n = 355, 261 females and 94 males) and Normal Sleepers Group (NSG, n = 292, 237 females, 54 males and 1 with no response) were constituted. Thirty-one patients with Obstructive Sleep Apnea Syndrome were also recruited. For the DBAS 16-items version, the ability to differentiate dysfunctional beliefs between people with and without insomnia was used as the main criterion for item retention. RESULTS DBAS-30 PT demonstrated good internal consistency and significantly discriminated IG from NSG. Based on a robust EFA (RDWLS), a three-dimensional structure was determined for IG (Ageing and Hopelessness, Sleep Expectations, and Consequences and Helplessness). DBAS-SF-16 presented as an internally-consistent measure with a reliable two-factor structure (Consequences and Helplessness, Medication and Hopelessness) and showed construct and known groups validity. ROC analysis demonstrated DBAS-SF-16's relevant clinical accuracy, and 4.3 provides the best cut-off score in detecting the level of dysfunctional beliefs associated with clinical insomnia. CONCLUSIONS A new and meaningful dimensionality of the DBAS-30 was found. DBAS-SF-16 showed to be a reliable, valid, and robust tool for evaluating dysfunctional beliefs about insomnia in clinical and non-clinical populations.
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Affiliation(s)
- Vanda Clemente
- Sleep Medicine Centre, Hospital and University Centre of Coimbra (CHUC), Coimbra, Portugal; University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal; Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal.
| | - Daniel Ruivo Marques
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal; University of Aveiro, Department of Education and Psychology, Aveiro, Portugal
| | - Mariana Miller-Mendes
- University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal; Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
| | - Charles M Morin
- Department of Psychology, Laval University, Quebec, Canada; CERVO Brain Research Centre, Quebec, Canada
| | - Joana Serra
- Sleep Medicine Centre, Hospital and University Centre of Coimbra (CHUC), Coimbra, Portugal
| | - Ana Allen Gomes
- University of Coimbra, Faculty of Psychology and Educational Sciences, Coimbra, Portugal; Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
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13
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Pei W, He T, Yang P, Lv X, Jiao B, Meng F, Yan Y, Cui L, He G, Zhou X, Wen G, Ruan J, Lu L. Acupuncture combined with cognitive-behavioural therapy for insomnia (CBT-I) in patients with insomnia: study protocol for a randomised controlled trial. BMJ Open 2022; 12:e063442. [PMID: 36585134 PMCID: PMC9809230 DOI: 10.1136/bmjopen-2022-063442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Insomnia affects physical and mental health due to the lack of continuous and complete sleep architecture. Polysomnograms (PSGs) are used to record electrical information to perform sleep architecture using deep learning. Although acupuncture combined with cognitive-behavioural therapy for insomnia (CBT-I) could not only improve sleep quality, solve anxiety, depression but also ameliorate poor sleep habits and detrimental cognition. Therefore, this study will focus on the effects of electroacupuncture combined with CBT-I on sleep architecture with deep learning. METHODS AND ANALYSIS This randomised controlled trial will evaluate the efficacy and effectiveness of electroacupuncture combined with CBT-I in patients with insomnia. Participants will be randomised to receive either electroacupuncture combined with CBT-I or sham acupuncture combined with CBT-I and followed up for 4 weeks. The primary outcome is sleep quality, which is evaluated by the Pittsburgh Sleep Quality Index. The secondary outcome measures include a measurement of depression severity, anxiety, maladaptive cognitions associated with sleep and adverse events. Sleep architecture will be assessed using deep learning on PSGs. ETHICS AND DISSEMINATION This trial has been approved by the institutional review boards and ethics committees of the First Affiliated Hospital of Sun Yat-sun University (2021763). The results will be disseminated through peer-reviewed journals. The results of this trial will be disseminated through peer-reviewed publications and conference abstracts or posters. TRIAL REGISTRATION NUMBER CTR2100052502.
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Affiliation(s)
- Wenya Pei
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Te He
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Pei Yang
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Xiaozhou Lv
- Department of Traditional Chinese Medicine, Zhongshan School of Medicine, Sun Yat-senUniversity, Guangzhou, China
| | - Boyu Jiao
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fanqi Meng
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yingshuo Yan
- Department of Respiratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liqian Cui
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangzho, China
| | - Guanheng He
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xin Zhou
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guihua Wen
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Jingwen Ruan
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liming Lu
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
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14
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Manber R, Tully IA, Palaniappan L, Kim JP, Simpson N, Zulman DM, Goldhaber-Fiebert JD, Rangel E, Dietch JR, Rosas LG. RCT of the effectiveness of stepped-care sleep therapy in general practice: The RESTING study protocol. Contemp Clin Trials 2022; 116:106749. [PMID: 35367385 PMCID: PMC10159730 DOI: 10.1016/j.cct.2022.106749] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 11/03/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is an effective, non-pharmacological intervention, designated by the American College of Physicians as the first-line treatment of insomnia disorder. The current randomized controlled study uses a Hybrid-Type-1 design to compare the effectiveness and implementation potential of two approaches to delivering CBT-I in primary care. One approach offers therapy to all patients through an automated, digital CBT-I program (ONLINE-ONLY). The other is a triaged STEPPED-CARE approach that uses a simple Decision Checklist to start patients in either digital or therapist-led treatment; patients making insufficient progress with digital treatment at 2 months are switched to therapist-led treatment. We will randomize 240 individuals (age 50 or older) with insomnia disorder to ONLINE-ONLY or STEPPED-CARE arms. The primary outcomes are insomnia severity and hypnotic medication use, assessed at baseline and at months 2, 4, 6, 9, and 12 after randomization. We hypothesize that STEPPED-CARE will be superior to ONLINE-ONLY in reducing insomnia severity and hypnotic use. We also aim to validate the Decision Checklist and explore moderators of outcome. Additionally, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will use mixed methods to obtain data on the potential for future dissemination and implementation of each approach. This triaged stepped-care approach has the potential to improve sleep, reduce use of hypnotic medications, promote safety, offer convenient access to treatment, and support dissemination of CBT-I to a large number of patients currently facing barriers to accessing treatment. Clinical trial registration:NCT03532282.
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Affiliation(s)
- Rachel Manber
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Isabelle A Tully
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Latha Palaniappan
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jane P Kim
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Norah Simpson
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Donna M Zulman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jeremy D Goldhaber-Fiebert
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, USA; Center for Health Policy, Freeman Spogli Institute, Stanford University, Stanford, CA 94305, USA
| | - Elizabeth Rangel
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; SDSU/ UC San Diego Joint Doctoral Program in Clinical Psychology, University of California, San Diego, San Diego State University, San Diego, CA 92120, USA
| | - Jessica R Dietch
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; School of Psychological Science, Oregon State University, Corvallis, OR 97331, USA
| | - Lisa G Rosas
- Center for Health Policy, Freeman Spogli Institute, Stanford University, Stanford, CA 94305, USA
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15
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Zhang Y, Zhang Z, Wang Y, Zhu F, Liu X, Chen W, Zhu H, Zhu H, Li J, Guo Z. Dysfunctional beliefs and attitudes about sleep are associated with regional homogeneity of left inferior occidental gyrus in primary insomnia patients: a preliminary resting state functional magnetic resonance imaging study. Sleep Med 2021; 81:188-193. [PMID: 33714848 DOI: 10.1016/j.sleep.2021.02.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/05/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The neural mechanisms of sleep beliefs and attitudes in primary insomnia (PI) patients at resting state remain unclear. The aim of this study was to investigate the features of regional homogeneity (ReHo) in PI using resting-state functional magnetic resonance imaging (rsfMRI). METHODS Thirty-two PI patients and 34 normal controls (NC) underwent rsfMRI using a 3 T scanner at Tongde Hospital of Zhejiang Province. Participants were assessed with the Dysfunctional Beliefs and Attitudes about Sleep scale (DBAS-16) and Pittsburgh Sleep Quality Index (PSQI). Statistical analyses were performed to determine the regions in which ReHo differed between the two groups. Correlation analyses were performed between the ReHo index of each of these regions and DBAS-16 in PI patients. RESULTS PI patients showed increased ReHo values in the right superior frontal gyrus, and decreased ReHo values in the left cerebellar gyrus, left inferior occipital gyrus (IOG) and left amygdala compared with those of NC. ReHo values in the left IOG were negatively correlated with total DBAS-16 scores, and scores for "consequences of insomnia" and"worry/helplessness about sleep"in PI patients. CONCLUSIONS These results suggest that ReHo alterations in the left IOG may play an important role in the dysfunctional beliefs and attitudes about sleep in PI.
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Affiliation(s)
- Yingchun Zhang
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang 310016, Hangzhou, China
| | - Zhenzhong Zhang
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China
| | - Yunling Wang
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China
| | - Feiyan Zhu
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China
| | - Xiaozheng Liu
- Department of Radiology of the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang 310016, Hangzhou, China
| | - Hong Zhu
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China
| | - Haokai Zhu
- The Second Clinical Medical College, Zhejiang Chinese Medicine University, Zhejiang 310000, China
| | - Jiapeng Li
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China.
| | - Zhongwei Guo
- Tongde Hospital of Zhejiang Province, Hangzhou and Mental Health Center of Zhejiang Province, Zhejiang 310012, China.
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16
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Cook JD, Rumble ME, Tran KM, Plante DT. Potential Maladaptive Sleep-Related Cognitions in Depression with Comorbid Hypersomnolence: An Exploratory Investigation. Behav Sleep Med 2021; 19:232-242. [PMID: 32088994 PMCID: PMC7483606 DOI: 10.1080/15402002.2020.1732390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective/Background: Dysfunctional sleep-related cognitions (SRCs) have been demonstrated in both insomnia and depression, but have not been evaluated in patients experiencing depression with co-occurring hypersomnolence. Given the prominence of maladaptive thinking in depression with comorbid insomnia, dysfunctional SRCs may also exist in depressed persons experiencing hypersomnolence. Identifying potentially maladaptive SRCs may assist development of cognitive-behavioral strategies to alleviate hypersomnolence and its related impairment, particularly when comorbid with depression. Participants: Twenty-two unmedicated persons with major depressive disorder (MDD) with comorbid hypersomnolence (MDD+/HYP+), as well as age- and sex-matched persons with MDD without hypersomnolence (MDD+/HYP-) and healthy controls (HC). Methods: Participants completed the Dysfunctional Beliefs and Attitudes About Sleep-16-item (DBAS-16) and underwent overnight polysomnography. Groups were compared across clinical and sleep domains, as well as DBAS-16 global, subscale, and individual item scores. Additional analyses evaluated DBAS-16 components while controlling for depression severity. Results: Groups significantly differed across all collected sleep and mood metrics consistent with diagnostic classification. MDD+/HYP+ DBAS-16 global score was significantly elevated, relative to HC, and was comparable to MDD+/HYP-. A DBAS-16 global score significant group effect was maintained while controlling for depression symptom severity, however only individual DBAS-16 items related to quantity and quality of sleep demonstrated particular relevance to MDD+/HYP+ compared to other groups. Conclusions: Results suggest potentially maladaptive SRCs in MDD+/HYP+. Further efforts are needed to clarify whether these beliefs and attitudes about sleep in persons with hypersomnolence are in fact dysfunctional, as well as identify relevant content for development of a novel hypersomnolence-related SRC metric.
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Affiliation(s)
- Jesse David Cook
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin,Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meredith Ellen Rumble
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Kieulinh Michelle Tran
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - David T. Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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17
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Consequences of ignoring the response-shift and measure non-invariant items in sleep studies: an empirical data based simulation of the treatment effect of CBT-I on dysfunctional sleep beliefs. Sleep Med 2020; 74:99-108. [PMID: 32841853 DOI: 10.1016/j.sleep.2020.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 04/08/2020] [Accepted: 05/06/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Previous studies have shown that psychological interventions do not only improve patients' mental symptoms (i.e., true change) but may also change the internal standards patients use to evaluate their symptoms (i.e., response shifts). Although the response shifts could reflect patients' cognitive changes toward their disorders as the interventions aim to achieve, failing to differentiate them from the true change during data analyses could bias the research conclusions. Considering this issue is seldom discussed in sleep studies, this study thus examined the impacts of response-shift items in an intervention study of cognitive behavioral therapy for insomnia (CBT-I) via empirical-data based simulations. METHOD We used longitudinal measurement invariance tests to identify the items in an abbreviated version of the Dysfunctional Beliefs and Attitudes about Sleep Scale that are non-invariant (response shifted) against CBT-I based on data from 114 insomnia patients. The partial invariance model built accordingly was then used as a population model for simulations to examine the impacts of the response-shift items on follow-up paired t-tests. RESULTS Invariance tests indicate CBT-I would lift the intercept of one item in DBAS-10 and cause non-uniform calibrations in three items. The following up simulations showed that failing to exclude the intercept-lifted item from the calculations of the subscale scores would lower the probability of using paired t-test to correctly detect the treatment effect by up to 53%. CONCLUSIONS We recommend sleep researchers to consider the issues of response-shift when assessing sleep-related constructs in interventional studies for insomnia.
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18
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Youn S, Kim C, Lee J, Yeo S, Suh S, Chung S. Development of Dysfunctional Beliefs and Attitude about Sleep Scale for Cancer Patients. Behav Sleep Med 2020; 18:287-297. [PMID: 30789064 DOI: 10.1080/15402002.2019.1578773] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Study objectives: This study aimed to develop a scale utilizing the original Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale that measured maladaptive cognitions associated with sleep that is especially sensitive to cancer patients. In addition to the original scale, we added two additional items that reflected cancer-specific dysfunctional beliefs about sleep. Methods: Participants consisted of 337 cancer patients (mean age 54.0 ± 11.8 years, 32.0% men). All participants completed the DBAS-16, two cancer specific items, and the Insomnia Severity Index. Item-to-total-score correlations, internal consistency, item selection, and factor structure were examined. Results: The DBAS-16 was found to be reliable, and internal consistency was also adequate when adding two cancer-specific questions (Cronbach's alpha = 0.89). A total of 14 items were selected, and a four-factor model was selected using exploratory factor analysis (Tucker-Lewis index = 0.86, root mean square error of approximation = 0.08). The four factors were (a) sleep expectations, (b) worry about insomnia, (c) perceived consequences of insomnia and medication, and (d) two cancer-related items. The modified 14 items of the Cancer-related DBAS (C-DBAS-14) well differentiated cancer patients with and without insomnia. Conclusions: The C-DBAS-14 is a promising measure that has adequate internal consistency. It is also sensitive to sleep-related cognitions in cancer patients and can discriminate patients with cancer who are experiencing insomnia from those who are good sleepers. The enhanced utility of the shortened 14-item scale tailored specifically to cancer patients may be useful in both clinical practice and research settings.Abbreviations: CBT: cognitive behavioral therapy; C-DBAS-14: Cancer-Related Dysfunctional Beliefs and Attitude about Sleep; C-DBS: Cancer-Related Dysfunctional Beliefs about Sleep; DBAS-16: Dysfunctional Beliefs and Attitudes about Sleep; ISI: Insomnia Severity Index.
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Affiliation(s)
- Soyoung Youn
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Changnam Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joohee Lee
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungook Yeo
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sooyeon Suh
- Department of Psychology, Sungshin Women's University, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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19
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Thakral M, Von Korff M, McCurry SM, Morin CM, Vitiello MV. Changes in dysfunctional beliefs about sleep after cognitive behavioral therapy for insomnia: A systematic literature review and meta-analysis. Sleep Med Rev 2020; 49:101230. [PMID: 31816582 PMCID: PMC7012685 DOI: 10.1016/j.smrv.2019.101230] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/30/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is the preferred treatment for chronic insomnia and sleep-related cognitions are one target of treatment. There has been little systematic investigation of how sleep-related cognitions are being assessed in CBT-I trials and no meta-analysis of the impact of CBT-I on dysfunctional beliefs about sleep, a core cognitive component of treatment. Academic Search Complete, Medline, CINAHL and PsychInfo from 1990 to 2018 were searched to identify randomized controlled trials of CBT-I in adults (≥18 years) reporting some measure of sleep-related cognitions. Sixteen randomized controlled trials were identified comparing 1134 CBT-I and 830 control subjects. The Dysfunctional Beliefs and Attitudes about Sleep Scale was utilized almost exclusively to assess sleep-related cognitions in these trials. Hedge's g at 95% confidence interval (CI) was calculated to assess CBT-I effect size at post-treatment compared to controls. CBT-I significantly reduced dysfunctional beliefs about sleep (g = -0.90, 95% CI -1.19, -0.62) at post-treatment. Three trials contributed data to estimate effect size for long-term effects (g = -1.04, 95% CI -2.07, -0.02) with follow up time ranging from 3 to 18 mo. We concluded that cognitive behavioral therapy for insomnia has moderate to large effects on dysfunctional beliefs about sleep.
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Affiliation(s)
- Manu Thakral
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA; University of Washington School of Nursing, Seattle, WA, USA.
| | - Michael Von Korff
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Susan M McCurry
- University of Washington School of Nursing, Seattle, WA, USA
| | - Charles M Morin
- School of Psychology, Université Laval, Quebec City, Quebec, Canada
| | - Michael V Vitiello
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
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20
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Ali RM, Zolezzi M, Awaisu A. A Systematic Review of Instruments for the Assessment of Insomnia in Adults. Nat Sci Sleep 2020; 12:377-409. [PMID: 32753991 PMCID: PMC7342485 DOI: 10.2147/nss.s250918] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Self-reported sleep instruments remain the most practical methods for the assessment of insomnia in clinical practice. This systematic review aims to identify, describe and summarize the psychometric properties of questionnaires available for the assessment of insomnia in the adult population. In addition, the review also aimed to identify sleep instruments available in the Arabic language. METHODS A systematic literature search was conducted using the following electronic databases: PubMed, EMBASE, ProQuest Central, SCOPUS, and Google Scholar. The quality assessment of the instruments was conducted using two established international criteria. RESULTS One hundred and seven articles were selected for inclusion, from which 31 instruments were identified and categorized based on the constructs they assess as: (1) screening for insomnia (n=14); (2) measuring the consequences of insomnia (n=8); (3) assessing the cognitive aspects of insomnia (n= 5); and (4) assessing sleep hygiene (n= 4). The review of the psychometric properties showed that the Insomnia Severity Index and the Functional Outcomes of Sleep Questionnaire were the most extensively evaluated instrument. Criterion validity and reliability measures were the most commonly reported properties. Only four of the identified instruments were available in Arabic. DISCUSSION Overall, the findings of this study indicate ample availability of sleep instruments. However, psychometric testing for several of the available sleep instruments remains incomplete, particularly responsiveness and interpretability. Our findings suggest that future studies should focus on reporting more psychometric measures to ensure the trustworthiness of these instruments.
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Affiliation(s)
| | - Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, Doha 2713, Qatar
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Chung KF, Yeung WF, Ho FYY, Ng TK. Dysfunctional cognition regarding sleep as a mediator of outcome following acupuncture for insomnia. Acupunct Med 2018; 36:193-194. [PMID: 29567667 DOI: 10.1136/acupmed-2017-011520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Ka Fai Chung
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fiona Yan Yee Ho
- Department of Psychology, Chinese University of Hong Kong, Hong Kong, China
| | - Ting Kin Ng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
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Chung KF, Yeung WF, Leung FCY, Yu BYM. When east meets west: Understanding the traditional Chinese medicine diagnoses on insomnia by Western medicine symptomatology. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jin L, Zhou J, Peng H, Ding S, Yuan H. Investigation on dysfunctional beliefs and attitudes about sleep in Chinese college students. Neuropsychiatr Dis Treat 2018; 14:1425-1432. [PMID: 29910619 PMCID: PMC5989819 DOI: 10.2147/ndt.s155722] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aims of this study were to evaluate a subset of sleep-related cognitions and to examine whether dysfunctional beliefs and attitudes about sleep were associated with sleep quality in college students. PATIENTS AND METHODS A total of 1,333 college students were enrolled in this study by randomized cluster sampling. A brief version of Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16) was administered to college students at several colleges. Sleep quality was also assessed using the Pittsburgh Sleep Quality Index (PSQI). The DBAS-16 scores were analyzed across different demographic variables, corresponding subscales of 7-item PSQI, and relevant sleep behavior variables. RESULTS A total of 343 participants were poor sleepers, while 990 were good sleepers, as defined by PSQI. The DBAS-16 scores were lower in poor sleepers than in good sleepers (46.32 ± 7.851 vs 49.87 ± 8.349, p < 0.001), and DBAS-16 scores were lower in females and nonmedical students when compared with those in males and medical students, respectively (48.20 ± 8.711 vs 49.73 ± 7.923, p = 0.001; 48.56 ± 8.406 vs 49.88 ± 8.208, p = 0.009, respectively). The total score for sleep quality, as measured by PSQI, was negatively correlated with the DBAS-16 total score (r = -0.197, p < 0.01). There were significant differences in PSQI scores between individuals with attitudes and those without attitudes about sleep with respect to good sleep habits (p < 0.001), self-relaxation (p = 0.001), physical exercise (p < 0.001), taking sleeping pills (p = 0.004), and taking no action (p < 0.001). CONCLUSION Dysfunctional beliefs about sleep are associated with sleep quality and should be discouraged, especially for females and nonmedical college students.
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Affiliation(s)
- Lairun Jin
- School of Public Health, Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Jun Zhou
- School of Public Health, Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Hui Peng
- Department of Hospital Infection Management, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Shushu Ding
- School of Public Health, Wannan Medical College, Wuhu, Anhui, People's Republic of China
| | - Hui Yuan
- School of Public Health, Wannan Medical College, Wuhu, Anhui, People's Republic of China
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Cole HV, Owusu-Dabo E, Iwelunmor J, Newsome V, Meeks K, Agyemang C, Jean-Louis G. Sleep duration is associated with increased risk for cardiovascular outcomes: a pilot study in a sample of community dwelling adults in Ghana. Sleep Med 2017; 34:118-125. [PMID: 28522079 DOI: 10.1016/j.sleep.2017.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/08/2017] [Accepted: 03/06/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Associations between sleep duration and cardiovascular disease (CVD) risk factors have been demonstrated in past studies. However, previous studies have not investigated these relationships using objective sleep measures in sub-Saharan Africa. Our objective was to investigate the association between sleep duration and cardiovascular risk factors in a sample of community-dwelling Ghanaian adults. METHODS We used wrist actigraphy along with a seven-day sleep diary to measure sleep duration, wake after sleep onset, sleep latency, and sleep quality. Participants were randomly selected from among those participating in the RODAM study in rural and urban Ghana. Outcome measurements included 10-year risk of CVD events, prevalent CVD, and metabolic syndrome. Additional participant characteristics were assessed using a structured questionnaire. Linear and logistic regression analyses were used to assess the relationships between sleep measures and CVD risk. RESULTS A total of 263 participants from rural and urban Ghana participated. Total sleep time was positively associated with a 10-year CVD risk; this association remained after adjusting for age, sex, urban vs rural location, socio-economic status, physical activity, and sleep disturbance (β = 0.990, p = 0.015). Short sleep, defined as sleeping less than seven hours per night on average, was negatively associated with a 10-year CVD risk, and this relationship remained in the fully adjusted model (β = -2.100, p = 0.011). Sleep duration was not associated with prevalence of CVD or metabolic syndrome. CONCLUSION Using actigraphy to measure sleep duration among a population of community-dwelling adults in sub-Saharan Africa is feasible. We found a positive association between sleep and CVD risk. No association was found between sleep duration and prevalent CVD or metabolic syndrome. The implications and new directions relating to these findings are stated.
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Affiliation(s)
- Helen V Cole
- Center for Healthful Behavior Change, Division of Health Behavior, Department of Population Health, NYU School of Medicine, 227 E. 30th St, 6th Floor, New York, NY 10016, USA.
| | - Ellis Owusu-Dabo
- School of Public Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Kumasi Centre for Collaborative Research, College of Health Sciences, Kwame Nkrumah University of Science and Technology, KCCR, UPO, PMB, KNUST, Kumasi, Ghana
| | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, 123 Huff Hall, 1206 South 4th Street, Champaign, IL 61820, USA
| | - Valerie Newsome
- Center for Healthful Behavior Change, Division of Health Behavior, Department of Population Health, NYU School of Medicine, 227 E. 30th St, 6th Floor, New York, NY 10016, USA
| | - Karlijn Meeks
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9 1105AZ, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9 1105AZ, Amsterdam, The Netherlands
| | - Girardin Jean-Louis
- Center for Healthful Behavior Change, Division of Health Behavior, Department of Population Health, NYU School of Medicine, 227 E. 30th St, 6th Floor, New York, NY 10016, USA
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Correlates and prognostic relevance of sleep irregularity in inter-episode bipolar disorder. Compr Psychiatry 2016; 69:155-62. [PMID: 27423356 DOI: 10.1016/j.comppsych.2016.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 05/05/2016] [Accepted: 05/28/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Sleep-wake disturbances, such as sleep irregularity, are common in bipolar disorder. Early studies suggest that sleep irregularity is associated with mood symptoms in bipolar disorder, but little research has been conducted to identify other correlates of sleep irregularity. We investigated the relationship between sleep irregularity and sleep quality, social rhythms, eveningness, sleep-related cognitions and behaviors, and past and future mood episodes in 84 patients with inter-episode bipolar I or II disorder. METHODS This is a retrospective and prospective, naturalistic follow-up study. The Expanded Consensus Sleep Diary, Pittsburgh Sleep Quality Index (PSQI), Social Rhythm Metric (SRM-II-5), Composite Scale of Morningness (CSM), Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS-16), and Sleep Hygiene Practice Scale (SHPS) were administered. The Square Successive Difference (SSD), derived from a week-long sleep diary, was used as an index of sleep irregularity. Multilevel modeling analysis, which adjusts for biases in parameter estimates, was used to minimize the impact of missing data. Bonferroni correction was performed to account for multiple testing. RESULTS Higher SSD scores of sleep diary variables were significantly associated with higher PSQI, SRM-II-5, DBAS-16, and SHPS scores. Irregularity in total sleep time was related to more depressive episodes in the past 5years (p=.002), while irregularity in wake after sleep onset predicted the onset of depressive episodes over the next 2years (p=.002). CONCLUSION Sleep irregularity was associated with poor sleep quality, irregular social rhythms, dysfunctional sleep-related cognitions and behaviors, and greater number of depressive episodes in bipolar disorder.
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