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Lok R, Weed L, Winer J, Zeitzer JM. Perils of the nighttime: Impact of behavioral timing and preference on mental health in 73,888 community-dwelling adults. Psychiatry Res 2024; 337:115956. [PMID: 38763081 DOI: 10.1016/j.psychres.2024.115956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Mental health is independently influenced by the inclination to sleep at specific times (chronotype) and the actual sleep timing (behavior). Chronotype and timing of actual sleep are, however, often misaligned. This study aims to determine how chronotype, sleep timing, and the alignment between the two impact mental health. In a community-dwelling cohort of middle- and older-aged adults (UK Biobank, n = 73,888), we examined the impact of chronotype (questionnaire-based), the timing of behavior (determined with 7-day accelerometry), and the alignment between the two on mental, behavioral, neurodevelopmental disorders (MBN), depression, and anxiety, as assessed through ICD-10 codes. As compared to morning types with early behavior (aligned), morning types with late behavior (misaligned) had an increased risk of having MBN, depression, and anxiety (p's<0.001). As compared to evening-types with late behavior (aligned), however, evening-types with early behavior (misaligned) had a decreased risk of depression (p < 0.01), with a trend for MBN (p = 0.04) and anxiety (p = 0.05). Longitudinal analyses, in which the likelihood of developing de novo mental health disorders was associated with chronotype, behavioral timing, and alignment between the two, confirmed cross-sectional findings. To age healthily, individuals should start sleeping before 1AM, despite chronobiological preferences.
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Affiliation(s)
- Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford CA 94305, USA
| | - Lara Weed
- Department of Bioengineering, Stanford University, Stanford CA 94305, USA
| | - Joseph Winer
- Department of Neurology, Stanford University, Stanford CA 94305, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford CA 94305, USA; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto CA 94304, USA.
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Zeitzer JM. The utility of sleep wearables-well, that depends. Sleep 2024; 47:zsae019. [PMID: 38266044 DOI: 10.1093/sleep/zsae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Indexed: 01/26/2024] Open
Affiliation(s)
- Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Olsen M, Zeitzer JM, Nakase-Richardson R, Musgrave VH, Sorensen HBD, Mignot E, Jennum PJ. A deep transfer learning approach for sleep stage classification and sleep apnea detection using wrist-worn consumer sleep technologies. IEEE Trans Biomed Eng 2024; PP:1-12. [PMID: 38498753 DOI: 10.1109/tbme.2024.3378480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Obstructive sleep apnea (OSA) is a common, underdiagnosed sleep-related breathing disorder with serious health implications Objective - We propose a deep transfer learning approach for sleep stage classification and sleep apnea (SA) detection using wrist-worn consumer sleep technologies (CST). Methods - Our model is based on a deep convolutional neural network (DNN) utilizing accelerometers and photo-plethysmography signals from nocturnal recordings. The DNN was trained and tested on internal datasets that include raw data from clinical and wrist-worn devices; external validation was performed on a hold-out test dataset containing raw data from a wrist-worn CST. Results - Training on clinical data improves performance significantly, and feature enrichment through a sleep stage stream gives only minor improvements. Raw data input outperforms feature-based input in CST datasets. The system generalizes well but performs slightly worse on wearable device data compared to clinical data. However, it excels in detecting events during REM sleep and is associated with arousal and oxygen desaturation. We found; cases that were significantly underestimated were characterized by fewer of such event associations. Conclusion - This study showcases the potential of using CSTs as alternate screening solution for undiagnosed cases of OSA. Significance - This work is significant for its development of a deep transfer learning approach using wrist-worn consumer sleep technologies, offering comprehensive validation for data utilization, and learning techniques, ultimately improving sleep apnea detection across diverse devices.
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Suh S, Lok R, Weed L, Cho A, Mignot E, Leary EB, Zeitzer JM. Fatigued but not sleepy? An empirical investigation of the differentiation between fatigue and sleepiness in sleep disorder patients in a cross-sectional study. J Psychosom Res 2024; 178:111606. [PMID: 38359639 DOI: 10.1016/j.jpsychores.2024.111606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Sleepiness and fatigue are common complaints among individuals with sleep disorders. The two concepts are often used interchangeably, causing difficulty with differential diagnosis and treatment decisions. The current study investigated sleep disorder patients to determine which factors best differentiated sleepiness from fatigue. METHODS The study used a subset of participants from a multi-site study (n = 606), using a cross-sectional study design. We selected 60 variables associated with either sleepiness or fatigue, including demographic, mental health, and lifestyle factors, medical history, sleep questionnaires, rest-activity rhythms (actigraphy), polysomnographic (PSG) variables, and sleep diaries. Fatigue was measured with the Fatigue Severity Scale and sleepiness was measured with the Epworth Sleepiness Scale. A Random Forest machine learning approach was utilized for analysis. RESULTS Participants' average age was 47.5 years (SD 14.0), 54.6% female, and the most common sleep disorder diagnosis was obstructive sleep apnea (67.4%). Sleepiness and fatigue were moderately correlated (r = 0.334). The model for fatigue (explained variance 49.5%) indicated depression was the strongest predictor (relative explained variance 42.7%), followed by insomnia severity (12.3%). The model for sleepiness (explained variance 17.9%), indicated insomnia symptoms was the strongest predictor (relative explained variance 17.6%). A post hoc receiver operating characteristic analysis indicated depression could be used to discriminate fatigue (AUC = 0.856) but not sleepiness (AUC = 0.643). CONCLUSIONS The moderate correlation between fatigue and sleepiness supports previous literature that the two concepts are overlapping yet distinct. Importantly, depression played a more prominent role in characterizing fatigue than sleepiness, suggesting depression could be used to differentiate the two concepts.
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Affiliation(s)
- Sooyeon Suh
- Department of Psychology, Sungshin Women's University, South Korea; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
| | - Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Lara Weed
- Department of Biomechanical Engineering, Stanford University, Stanford, CA, USA
| | - Ayeong Cho
- Department of Psychology, Sungshin Women's University, South Korea
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Eileen B Leary
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Winer JR, Lok R, Weed L, He Z, Poston KL, Mormino EC, Zeitzer JM. Impaired 24-h activity patterns are associated with an increased risk of Alzheimer's disease, Parkinson's disease, and cognitive decline. Alzheimers Res Ther 2024; 16:35. [PMID: 38355598 PMCID: PMC10865579 DOI: 10.1186/s13195-024-01411-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Sleep-wake regulating circuits are affected during prodromal stages in the pathological progression of both Alzheimer's disease (AD) and Parkinson's disease (PD), and this disturbance can be measured passively using wearable devices. Our objective was to determine whether accelerometer-based measures of 24-h activity are associated with subsequent development of AD, PD, and cognitive decline. METHODS This study obtained UK Biobank data from 82,829 individuals with wrist-worn accelerometer data aged 40 to 79 years with a mean (± SD) follow-up of 6.8 (± 0.9) years. Outcomes were accelerometer-derived measures of 24-h activity (derived by cosinor, nonparametric, and functional principal component methods), incident AD and PD diagnosis (obtained through hospitalization or primary care records), and prospective longitudinal cognitive testing. RESULTS One hundred eighty-seven individuals progressed to AD and 265 to PD. Interdaily stability (a measure of regularity, hazard ratio [HR] per SD increase 1.25, 95% confidence interval [CI] 1.05-1.48), diurnal amplitude (HR 0.79, CI 0.65-0.96), mesor (mean activity; HR 0.77, CI 0.59-0.998), and activity during most active 10 h (HR 0.75, CI 0.61-0.94), were associated with risk of AD. Diurnal amplitude (HR 0.28, CI 0.23-0.34), mesor (HR 0.13, CI 0.10-0.16), activity during least active 5 h (HR 0.24, CI 0.08-0.69), and activity during most active 10 h (HR 0.20, CI 0.16-0.25) were associated with risk of PD. Several measures were additionally predictive of longitudinal cognitive test performance. CONCLUSIONS In this community-based longitudinal study, accelerometer-derived metrics were associated with elevated risk of AD, PD, and accelerated cognitive decline. These findings suggest 24-h rhythm integrity, as measured by affordable, non-invasive wearable devices, may serve as a scalable early marker of neurodegenerative disease.
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Affiliation(s)
- Joseph R Winer
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Lara Weed
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Zihuai He
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
| | - Kathleen L Poston
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Elizabeth C Mormino
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA, 94304, USA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
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Mathersul DC, Zeitzer JM, Schulz-Heik RJ, Avery TJ, Bayley PJ. Emotion regulation and heart rate variability may identify the optimal posttraumatic stress disorder treatment: analyses from a randomized controlled trial. Front Psychiatry 2024; 15:1331569. [PMID: 38389985 PMCID: PMC10881770 DOI: 10.3389/fpsyt.2024.1331569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction High variability in response and retention rates for posttraumatic stress disorder (PTSD) treatment highlights the need to identify "personalized" or "precision" medicine factors that can inform optimal intervention selection before an individual commences treatment. In secondary analyses from a non-inferiority randomized controlled trial, behavioral and physiological emotion regulation were examined as non-specific predictors (that identify which individuals are more likely to respond to treatment, regardless of treatment type) and treatment moderators (that identify which treatment works best for whom) of PTSD outcome. Methods There were 85 US Veterans with clinically significant PTSD symptoms randomized to 6 weeks of either cognitive processing therapy (CPT; n = 44) or a breathing-based yoga practice (Sudarshan kriya yoga; SKY; n = 41). Baseline self-reported emotion regulation (Difficulties in Emotion Regulation Scale) and heart rate variability (HRV) were assessed prior to treatment, and self-reported PTSD symptoms were assessed at baseline, end-of-treatment, 1-month follow-up, and 1-year follow-up. Results Greater baseline deficit in self-reported emotional awareness (similar to alexithymia) predicted better overall PTSD improvement in both the short- and long-term, following either CPT or SKY. High self-reported levels of emotional response non-acceptance were associated with better PTSD treatment response with CPT than with SKY. However, all significant HRV indices were stronger moderators than all self-reported emotion regulation scales, both in the short- and long-term. Veterans with lower baseline HRV had better PTSD treatment response with SKY, whereas Veterans with higher or average-to-high baseline HRV had better PTSD treatment response with CPT. Conclusions To our knowledge, this is the first study to examine both self-reported emotion regulation and HRV, within the same study, as both non-specific predictors and moderators of PTSD treatment outcome. Veterans with poorer autonomic regulation prior to treatment had better PTSD outcome with a yoga-based intervention, whereas those with better autonomic regulation did better with a trauma-focused psychological therapy. Findings show potential for the use of HRV in clinical practice to personalize PTSD treatment. Clinical trial registration ClinicalTrials.gov identifier, NCT02366403.
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Affiliation(s)
- Danielle C Mathersul
- School of Psychology, Murdoch University, Murdoch, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - R Jay Schulz-Heik
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Timothy J Avery
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Peter J Bayley
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Specht A, Kolosov G, Cederberg KLJ, Bueno F, Arrona-Palacios A, Pardilla-Delgado E, Ruiz-Herrera N, Zitting KM, Kramer A, Zeitzer JM, Czeisler CA, Duffy JF, Mignot E. Circadian protein expression patterns in healthy young adults. Sleep Health 2024; 10:S41-S51. [PMID: 38087675 PMCID: PMC11031319 DOI: 10.1016/j.sleh.2023.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To explore how the blood plasma proteome fluctuates across the 24-hour day and identify a subset of proteins that show endogenous circadian rhythmicity. METHODS Plasma samples from 17 healthy adults were collected hourly under controlled conditions designed to unmask endogenous circadian rhythmicity; in a subset of 8 participants, we also collected samples across a day on a typical sleep-wake schedule. A total of 6916 proteins were analyzed from each sample using the SomaScan aptamer-based multiplexed platform. We used differential rhythmicity analysis based on a cosinor model with mixed effects to identify a subset of proteins that showed circadian rhythmicity in their abundance. RESULTS One thousand and sixty-three (15%) proteins exhibited significant daily rhythmicity. Of those, 431 (6.2%) proteins displayed consistent endogenous circadian rhythms on both a sleep-wake schedule and under controlled conditions: it included both known and novel proteins. When models were fitted with two harmonics, an additional 259 (3.7%) proteins exhibited significant endogenous circadian rhythmicity, indicating that some rhythmic proteins cannot be solely captured by a simple sinusoidal model. Overall, we found that the largest number of proteins had their peak levels in the late afternoon/evening, with another smaller group peaking in the early morning. CONCLUSIONS This study reveals that hundreds of plasma proteins exhibit endogenous circadian rhythmicity in humans. Future analyses will likely reveal novel physiological pathways regulated by circadian clocks and pave the way for improved diagnosis and treatment for patients with circadian disorders and other pathologies. It will also advance efforts to include knowledge about time-of-day, thereby incorporating circadian medicine into personalized medicine.
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Affiliation(s)
- Adrien Specht
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - German Kolosov
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Katie L J Cederberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Flavia Bueno
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Arturo Arrona-Palacios
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Enmanuelle Pardilla-Delgado
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Noelia Ruiz-Herrera
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kirsi-Marja Zitting
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Achim Kramer
- Division of Chronobiology, Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women's Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA.
| | - Emmanuel Mignot
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA.
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Lok R, Chawra D, Zeitzer JM. A threshold by any other name: is 5 minutes of wake "long" enough to degrade sleep quality? Sleep 2024; 47:zsad295. [PMID: 37950748 DOI: 10.1093/sleep/zsad295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Indexed: 11/13/2023] Open
Affiliation(s)
- Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Dwijen Chawra
- College of Science, Purdue University, West Lafayette, IN, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Blum DJ, Hernandez B, Zeitzer JM. Early time-restricted eating advances sleep in late sleepers: a pilot randomized controlled trial. J Clin Sleep Med 2023; 19:2097-2106. [PMID: 37559551 PMCID: PMC10692922 DOI: 10.5664/jcsm.10754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
STUDY OBJECTIVES This study evaluated the effects of early time-restricted eating (eTRE) on shifting the timing of sleep among late sleepers. Primary outcomes included actigraphy- and sleep diary-derived sleep onset, midsleep phase, and wake time with total sleep time as a secondary outcome. METHODS Fifteen healthy adults with habitual late sleep timing were randomized to receive either eTRE or sleep and nutrition hygiene (control) via a single 30-minute synchronous video session. Participants completed an initial 1-week baseline phase followed by a 2-week intervention phase. Measures included continuous sleep monitoring and sleep and nutrition diaries. RESULTS Linear mixed-effects modeling demonstrated that eTRE significantly advanced sleep timing compared with controls. Self-reported sleep onset (56.1 [95% confidence interval: 20.5, 91.7] minutes), midpoint (19.5 [7.2, 31.9] minutes), and offset (42.2 [2.9, 81.5] minutes) each moved earlier in eTRE as compared with controls. Similarly, objectively determined sleep onset (66.5 [29.6, 103.4] minutes), midpoint (21.9 [9.1, 34.7] minutes), and offset (39.3 [1.3, 77.3] minutes) each moved earlier in eTRE as compared with controls. Total sleep time showed a nonsignificant increase in the eTRE group as compared with controls. CONCLUSIONS Late sleepers who were instructed in a single session about eTRE significantly advanced their sleep timing, especially sleep onset. eTRE shows potential as a clinical strategy for advancing sleep timing in late sleepers. CLINICAL TRIAL REGISTRATION Registry: Chinese Clinical Trial Registry; Name: FAST Asleep: It's All About Timing; URL: https://www.chictr.org.cn/showproj.html?proj=122504; Identifier: ChiCTR2100043691. CITATION Blum DJ, Hernandez B, Zeitzer JM. Early time-restricted eating advances sleep in late sleepers: a pilot randomized controlled trial. J Clin Sleep Med. 2023;19(12):2097-2106.
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Affiliation(s)
- Daniel Jin Blum
- Department of Arts and Sciences, NYU Shanghai, Shanghai, China
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Stanford, California
| | - Beatriz Hernandez
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Stanford, California
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Stanford University, Stanford, California
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
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Antonsdottir IM, Low DV, Chen D, Rabinowitz JA, Yue Y, Urbanek J, Wu MN, Zeitzer JM, Rosenberg PB, Friedman LF, Sheikh JI, Yesavage JA, Zipunnikov V, Spira AP. 24 h Rest/Activity Rhythms in Older Adults with Memory Impairment: Associations with Cognitive Performance and Depressive Symptomatology. Adv Biol (Weinh) 2023; 7:e2300138. [PMID: 37423973 DOI: 10.1002/adbi.202300138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/16/2023] [Indexed: 07/11/2023]
Abstract
Little is known about links of circadian rhythm alterations with neuropsychiatric symptoms and cognition in memory impaired older adults. Associations of actigraphic rest/activity rhythms (RAR) with depressive symptoms and cognition are examined using function-on-scalar regression (FOSR). Forty-four older adults with memory impairment (mean: 76.84 ± 8.15 years; 40.9% female) completed 6.37 ± 0.93 days of actigraphy, the Beck depression inventory-II (BDI-II), mini-mental state examination (MMSE) and consortium to establish a registry for Alzheimer's disease (CERAD) delayed word recall. FOSR models with BDI-II, MMSE, or CERAD as individual predictors adjusted for demographics (Models A1-A3) and all three predictors and demographics (Model B). In Model B, higher BDI-II scores are associated with greater activity from 12:00-11:50 a.m., 2:10-5:50 p.m., 8:40-9:40 p.m., 11:20-12:00 a.m., higher CERAD scores with greater activity from 9:20-10:00 p.m., and higher MMSE scores with greater activity from 5:50-10:50 a.m. and 12:40-5:00 p.m. Greater depressive symptomatology is associated with greater activity in midafternoon, evening, and overnight into midday; better delayed recall with greater late evening activity; and higher global cognitive performance with greater morning and afternoon activity (Model B). Time-of-day specific RAR alterations may affect mood and cognitive performance in this population.
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Affiliation(s)
- Inga M Antonsdottir
- Johns Hopkins School of Nursing, 525 N. Wolfe Street, Baltimore, MD, 21205, USA
- Richman Family Precision Medicine Center of Excellence in Alzheimer's Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, 21224, USA
| | - Dominique V Low
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Diefei Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, 21205, USA
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Yiwei Yue
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Jacek Urbanek
- Regeneron Pharmaceuticals Inc., Johns Hopkins University, 777 Old Saw Mill River Rd, Tarrytown, NY, 10591, USA
| | - Mark N Wu
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, 94305, USA
| | - Paul B Rosenberg
- Richman Family Precision Medicine Center of Excellence in Alzheimer's Disease, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, MD, 21224, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
| | - Leah F Friedman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, 94305, USA
| | - Javaid I Sheikh
- AI Center for Precision Health, Weill Cornell Medicine-Qatar, Doha, 24144, Qatar
| | - Jerome A Yesavage
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, 94305, USA
| | - Vadim Zipunnikov
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Adam P Spira
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, 21205, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Hampton House, Baltimore, MD, 21205, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5300 Alpha Commons Drive, Baltimore, MD, 21224, USA
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Blackwell TL, Figueiro MG, Tranah GJ, Zeitzer JM, Yaffe K, Ancoli-Israel S, Kado DM, Ensrud KE, Lane NE, Leng Y, Stone KL. Associations of 24-Hour Light Exposure and Activity Patterns and Risk of Cognitive Impairment and Decline in Older Men: The MrOS Sleep Study. J Gerontol A Biol Sci Med Sci 2023; 78:1834-1843. [PMID: 36156079 PMCID: PMC10562886 DOI: 10.1093/gerona/glac187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Older men with the worse alignment of activity and light may have lower levels of cognition and increased rates of cognitive decline. METHODS This cohort consisted of 1 036 older men (81.1 ± 4.6 years) from the MrOS Sleep Study (2009-2012). Light and activity levels were gathered by wrist actigraphy. Phasor analysis was used to quantify the alignment of light-dark and rest-activity patterns (magnitude) and their temporal relationship (angle). Global cognitive function (Modified Mini-Mental State examination [3MS]) and executive function (Trails B test) were measured, then repeated 4.2 ± 0.8 years later. Linear regression models examined the associations of phasor magnitude and angle with cognition and cognitive decline. Models were adjusted for age, clinic, race, education, and season. RESULTS Smaller phasor magnitude (worse aligned light and activity patterns) was associated with lower initial level and increased decline in executive function. Compared to those with higher phasor magnitude, those with lower magnitude took an average of 11.1 seconds longer to complete the Trails B test (quartile 1 vs quartile 4, p = .02). After follow-up, Trails B completion time increased an average of 5.5 seconds per standard deviation decrease in phasor magnitude (95% confidence interval [CI] 0.7-10.4, p = .03). There were no associations with phasor angle, and none with magnitude and global cognition (3MS). CONCLUSION Among older men, worse alignment of light and activity patterns was associated with worse initial performance and increased decline in executive function, but not related to global cognition. Interventions that improve the alignment of light and activity may slow cognitive decline in older adults.
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Affiliation(s)
- Terri L Blackwell
- Research Institute, California Pacific Medical Center, San Francisco, California,USA
| | - Mariana G Figueiro
- Department of Population Health Science and Policy, Light and Health Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gregory J Tranah
- Research Institute, California Pacific Medical Center, San Francisco, California,USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Center for Sleep and Circadian Sciences, Stanford University, Palo Alto, California, USA
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco, California,USA
- the San Francisco VA Medical Center
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Deborah M Kado
- Department of Medicine, Stanford University, Stanford, California and VA Palo Alto, Palo Alto, California, USA
- Geriatric Research Education and Clinical Center (GRECC), VA Palo Alto, Palo Alto, California, USA
| | - Kristine E Ensrud
- Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, Minneapolis, Minnesota, USA
- Division of Epidemiology and Community Health, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Nancy E Lane
- Department of Medicine, Center for Musculoskeletal Health, University of California at Davis School of Medicine, Sacramento, California, USA
- Department of Epidemiology, University of California at San Francisco, San Francisco, California,USA
| | - Yue Leng
- Department of Psychiatry, University of California, San Francisco, California,USA
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, California,USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California,USA
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Abstract
In humans, exposure to continuous light is typically used to change the timing of the circadian clock. This study examines the efficiency of a sequence of light flashes ("flash therapy") applied during sleep to shift the clock. Healthy participants (n = 10) took part in two 36-h laboratory stays, receiving a placebo (goggles, no light) during one visit and the intervention (goggles, 2-ms flashes broad-spectrum light for 60 min, delivered every 15 s, starting 30 min after habitual sleep onset) during the other. Circadian phase shift was assessed with changes in salivary dim light melatonin onset (DLMO). Sleep, measured with polysomnography, was analyzed to assess changes in sleep architecture and spectral power. After 1 h of flashes, DLMO showed a substantial delay (1.13 ± 1.27 h) compared to placebo (12 ± 20 min). Two individuals exhibited very large shifts of 6.4 and 3.1 h. There were no substantive differences in sleep architecture, but some evidence for greater instability in sleep. 1 h of flash therapy during sleep evokes large changes in circadian timing, up to 6 h, and does so with only minimal, if any, impact on sleep. Flash therapy may offer a practical option to delay the circadian clock in shift workers and jet travelers.
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Affiliation(s)
- Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Marisol Duran
- Palo Alto Veterans Institute for Research, Palo Alto, CA, 94304, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, 94304, USA.
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13
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Gouldthorpe C, Ancoli-Israel S, Cash E, Innominato P, Jakobsen G, Lévi F, Miaskowski C, Parganiha A, Pati AK, Pereira D, Revell V, Zeitzer JM, Davies A. International e-Delphi Consensus Recommendations for the Assessment and Diagnosis of Circadian rest-Activity Rhythm Disorders (CARDs) in Patients with Cancer. Cancers (Basel) 2023; 15:3784. [PMID: 37568600 PMCID: PMC10416864 DOI: 10.3390/cancers15153784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Circadian rest-Activity Rhythm Disorders (CARDs) are common in patients with cancer, particularly in advanced disease. CARDs are associated with increased symptom burden, poorer quality of life, and shorter survival. Research and reporting practices lack standardization, and formal diagnostic criteria do not exist. This electronic Delphi (e-Delphi) study aimed to formulate international recommendations for the assessment and diagnosis of CARDs in patients with cancer. METHODS An international e-Delphi was performed using an online platform (Welphi). Round 1 developed statements regarding circadian rest-activity rhythms, diagnostic criteria, and assessment techniques. Rounds 2 and 3 involved participants rating their level of agreement with the statements and providing comments until consensus (defined internally as 67%) and stability between rounds were achieved. Recommendations were then created and distributed to participants for comments before being finalized. RESULTS Sixteen participants from nine different clinical specialties and seven different countries, with 5-35 years of relevant research experience, were recruited, and thirteen participants completed all three rounds. Of the 164 generated statements, 66% achieved consensus, and responses were stable between the final two rounds. CONCLUSIONS The e-Delphi resulted in international recommendations for assessing and diagnosing CARDs in patients with cancer. These recommendations should ensure standardized research and reporting practices in future studies.
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Affiliation(s)
- Craig Gouldthorpe
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California San Diego School of Medicine, La Jolla, CA 92093, USA
| | - Elizabeth Cash
- Department of Otolaryngology-Head & Neck Surgery & Communicative Disorders, UofL Healthcare-Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Pasquale Innominato
- Oncology Department, Alaw, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK
- Cancer Research Centre, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of Medicine, Paris-Saclay University, 94800 Villejuif, France
| | - Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Francis Lévi
- UPR “Chronotherapy, Cancers and Transplantation”, Faculty of Medicine, Paris-Saclay University, 94800 Villejuif, France
- Gastro-Intestinal and General Oncology Service, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris, 94800 Villejuif, France
- Division of Biomedical Sciences, Cancer Chronotherapy Team, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Christine Miaskowski
- Department of Physiological Nursing, University of California, San Francisco, CA 94143, USA
| | - Arti Parganiha
- School of Studies in Life Science & Centre for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur 492010, India
| | - Atanu Kumar Pati
- School of Studies in Life Science & Centre for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur 492010, India
- Odisha State Higher Education Council, Government of Odisha, Bhubaneswar 751001, India
- Kalinga Institute of Social Sciences, Bhubaneswar 751024, India
| | - Deidre Pereira
- Department of Clinical and Health Psychology, University of Florida Health, Gainesville, FL 32610, USA
| | - Victoria Revell
- Surrey Sleep Research Centre, University of Surrey, Surrey GU2 7XH, UK
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Andrew Davies
- School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
- Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, D6W RY72 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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14
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Brink-Kjaer A, Winer J, Zeitzer JM, Sorensen HBD, Jennum P, Mignot E, During E. Fully Automated Detection of Isolated Rapid-Eye-Movement Sleep Behavior Disorder Using Actigraphy. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-5. [PMID: 38083699 DOI: 10.1109/embc40787.2023.10341133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Isolated rapid-eye-movement (REM) sleep behavior disorder (iRBD) is caused by motor disinhibition during REM sleep and is a strong early predictor of Parkinson's disease. However, screening questionnaires for iRBD lack specificity due to other sleep disorders that mimic the symptoms. Nocturnal wrist actigraphy has shown promise in detecting iRBD by measuring sleep-related motor activity, but it relies on sleep diary-defined sleep periods, which are not always available. Our aim was to precisely detect iRBD using actigraphy alone by combining two actigraphy-based markers of iRBD - abnormal nighttime activity and 24-hour rhythm disruption. In a sample of 42 iRBD patients and 42 controls (21 clinical controls with other sleep disorders and 21 community controls) from the Stanford Sleep Clinic, the nighttime actigraphy model was optimized using automated detection of sleep periods. Using a subset of 38 iRBD patients with daytime data and 110 age-, sex-, and body-mass-index-matched controls from the UK Biobank, the 24-hour rhythm actigraphy model was optimized. Both nighttime and 24-hour rhythm features were found to distinguish iRBD from controls. To improve the accuracy of iRBD detection, we fused the nighttime and 24-hour rhythm disruption classifiers using logistic regression, which achieved a sensitivity of 78.9%, a specificity of 96.4%, and an AUC of 0.954. This study preliminarily validates a fully automated method for detecting iRBD using actigraphy in a general population.Clinical relevance- Actigraphy-based iRBD detection has potential for large-scale screening of iRBD in the general population.
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Balban MY, Neri E, Kogon MM, Weed L, Nouriani B, Jo B, Holl G, Zeitzer JM, Spiegel D, Huberman AD. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med 2023; 4:100895. [PMID: 36630953 PMCID: PMC9873947 DOI: 10.1016/j.xcrm.2022.100895] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/06/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023]
Abstract
Controlled breathwork practices have emerged as potential tools for stress management and well-being. Here, we report a remote, randomized, controlled study (NCT05304000) of three different daily 5-min breathwork exercises compared with an equivalent period of mindfulness meditation over 1 month. The breathing conditions are (1) cyclic sighing, which emphasizes prolonged exhalations; (2) box breathing, which is equal duration of inhalations, breath retentions, and exhalations; and (3) cyclic hyperventilation with retention, with longer inhalations and shorter exhalations. The primary endpoints are improvement in mood and anxiety as well as reduced physiological arousal (respiratory rate, heart rate, and heart rate variability). Using a mixed-effects model, we show that breathwork, especially the exhale-focused cyclic sighing, produces greater improvement in mood (p < 0.05) and reduction in respiratory rate (p < 0.05) compared with mindfulness meditation. Daily 5-min cyclic sighing has promise as an effective stress management exercise.
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Affiliation(s)
- Melis Yilmaz Balban
- Department of Neurobiology, School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Eric Neri
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Manuela M. Kogon
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305, USA,Stanford Center for Integrative Medicine, Stanford Health Care, Palo Alto, CA 94304, USA
| | - Lara Weed
- Department of Bioengineering, School of Engineering and School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Bita Nouriani
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Booil Jo
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Gary Holl
- Department of Neurobiology, School of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Jamie M. Zeitzer
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305, USA,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care Service, Palo Alto, CA 94304, USA
| | - David Spiegel
- Department of Psychiatry & Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305, USA; Center for Stress and Health, School of Medicine, Stanford University, Stanford, CA 94305, USA.
| | - Andrew D. Huberman
- Department of Neurobiology, School of Medicine, Stanford University, Stanford, CA 94305, USA,Department of Ophthalmology, School of Medicine, Stanford University, Stanford, CA 94305, USA,BioX, School of Medicine, Stanford University, Stanford, CA 94305, USA,Corresponding author
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16
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Yang YTC, Chang HY, Hsu CY, Lin CY, Zeitzer JM. Chinese translation and validation of the adolescent sleep wake scale. Sleep Science Practice 2022. [DOI: 10.1186/s41606-022-00078-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Inadequate sleep is a problem for teens world-wide. Identifying the biological and cultural factors that underlie this phenomenon is dependent on tools that can accurately query sleep-related behaviors. While there are many sleep-related questionnaires available in English, there are a paucity of validated Chinese language versions. As such, it was the purpose of this study to translate the Adolescent Sleep Wake Scale into Chinese and to provide a preliminary validation of this questionnaire.
Methods
We used a dual forward translation-back translation approach to translate the Adolescent Sleep Wake Scale into Chinese. We then tested the sensitivity, specificity, and internal consistency of the translated questionnaire using 517 adolescents from Taiwan. Preliminary criterion validity was examined through comparison with a measure of chronotype, with the a priori assumption that evening chronotypes would have worse sleep-related behavior.
Results
Internal consistency for both the overall scale (α = .86) and five subscales (α’s > .81) were good. These five subscales explained 62.6% of the total variance. Confirmatory Factory Analysis indicated a good fit of the data. The overall scale and each of the subscales also showed the expected relationship with chronotype, with worse sleep-related behavior in evening-types.
Conclusion
Our Chinese translation of the Adolescent Sleep Wake Scale is valid and has preliminary criterion validity. This can be a useful tool to explore sleep quality among Chinese-speaking adolescents as well as cross-cultural aspects of sleep behavior between Chinese- and English-speaking adolescents.
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17
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Bayley PJ, Schulz-Heik RJ, Tang JS, Mathersul DC, Avery T, Wong M, Zeitzer JM, Rosen CS, Burn AS, Hernandez B, Lazzeroni LC, Seppälä EM. Randomised clinical non-inferiority trial of breathing-based meditation and cognitive processing therapy for symptoms of post-traumatic stress disorder in military veterans. BMJ Open 2022; 12:e056609. [PMID: 36008059 PMCID: PMC9422818 DOI: 10.1136/bmjopen-2021-056609] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Test whether Sudarshan Kriya Yoga (SKY) was non-inferior to cognitive processing therapy (CPT) for treating symptoms of post-traumatic stress disorder (PTSD) among veterans via a parallel randomised controlled non-inferiority trial. SETTING Outpatient Veterans Affairs healthcare centre. PARTICIPANTS 85 veterans (75 men, 61% white, mean age 56.9) with symptoms of PTSD participated between October 2015 and March 2020: 59 participants completed the study. INTERVENTIONS SKY emphasises breathing routines and was delivered in group format in a 15-hour workshop followed by two 1-hour sessions per week for 5 weeks. CPT is an individual psychotherapy which emphasises shifting cognitive appraisals and was delivered in two 1-hour sessions per week for 6 weeks. MEASURES The primary outcome measure was the PTSD Checklist-Civilian Version (PCL-C). The secondary measures were the Beck Depression Inventory-II (BDI-II) and Positive and Negative Affect Scale (PANAS). RESULTS Mean PCL-C at baseline was 56.5 (±12.6). Intent-to-treat analyses showed that PCL-C scores were reduced at 6 weeks (end of treatment) relative to baseline (SKY, -5.6, d=0.41, n=41: CPT, -6.8, d=0.58, n=44). The between-treatment difference in change scores was within the non-inferiority margin of 10 points (-1.2, 95% CI -5.7 to 3.3), suggesting SKY was not inferior to CPT. SKY was also non-inferior at 1-month (CPT-SKY: -2.1, 95% CI -6.9 to 2.8) and 1-year (CPT-SKY: -1.8, 95% CI -6.6 to 2.9) assessments. SKY was also non-inferior to CPT on the BDI-II and PANAS at end of treatment and 1 month, but SKY was inferior to CPT on both BDI-II and PANAS at 1 year. Dropout rates were similar (SKY, 27%, CPT, 34%: OR=1.36, 95% CI 0.51 to 3.62, p=0.54). CONCLUSIONS SKY may be non-inferior to CPT for treating symptoms of PTSD and merits further consideration as a treatment for PTSD. TRIAL REGISTRATION NUMBER NCT02366403.
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Affiliation(s)
- Peter J Bayley
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - R Jay Schulz-Heik
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Julia S Tang
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Tim Avery
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Veterans Affairs, National Center for PTSD, Menlo Park, California, USA
| | - Melinda Wong
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Craig S Rosen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Department of Veterans Affairs, National Center for PTSD, Menlo Park, California, USA
| | - Adam S Burn
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Beatriz Hernandez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Laura C Lazzeroni
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Emma M Seppälä
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- School of Management, Yale University, New Haven, Connecticut, USA
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18
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Olsen M, Zeitzer JM, Richardson RN, Davidenko P, Jennum PJ, Sorensen HBD, Mignot E. A flexible deep learning architecture for temporal sleep stage classification using accelerometry and photoplethysmography. IEEE Trans Biomed Eng 2022; 70:228-237. [PMID: 35786544 DOI: 10.1109/tbme.2022.3187945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Wrist-worn consumer sleep technologies (CST) that contain accelerometers (ACC) and photoplethysmography (PPG) are increasingly common and hold great potential to function as out-of-clinic (OOC) sleep monitoring systems. However, very few validation studies exist because raw data from CSTs are rarely made accessible for external use. We present a deep neural network (DNN) with a strong temporal core, inspired by U-Net, that can process multivariate time series inputs with different dimensionality to predict sleep stages (wake, light-, deep-, and REM sleep) using ACC and PPG signals from nocturnal recordings. The DNN was trained and tested on 3 internal datasets, comprising raw data both from clinical and wrist-worn devices from 301 recordings (PSG-PPG: 266, Wrist-worn PPG: 35). External validation was performed on a hold-out test dataset containing 35 recordings comprising only raw data from a wrist-worn CST. An accuracy = 0.71±0.09, 0.76±0.07, 0.73±0.06, and κ = 0.58±0.13, 0.64±0.09, 0.59±0.09 was achieved on the internal test sets. Our experiments show that spectral preprocessing yields superior performance when compared to surrogate-, feature-, raw data-based preparation. Combining both modalities produce the overall best performance, although PPG proved to be the most impactful and was the only modality capable of detecting REM sleep well. Including ACC improved model precision to wake and sleep metric estimation. Increasing input segment size improved performance consistently; the best performance was achieved using 1024 epochs (∼8.5 hrs.). An accuracy = 0.69±0.13 and κ = 0.58±0.18 was achieved on the hold-out test dataset, proving the generalizability and robustness of our approach to raw data collected with a wrist-worn CST.
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19
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Lok R, Joyce DS, Zeitzer JM. Impact of daytime spectral tuning on cognitive function. J Photochem Photobiol B 2022; 230:112439. [PMID: 35398657 DOI: 10.1016/j.jphotobiol.2022.112439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
Light at night can improve alertness and cognition. Exposure to daytime light, however, has yielded less conclusive results. In addition to direct effects, daytime light may also mitigate the impact of nocturnal light exposure on alertness. To examine the impact of daytime lighting on daytime cognitive performance, and evening alertness, we studied nine healthy individuals using a within subject crossover design. On four visits, participants were exposed to one of four lighting conditions for 10 h (dim fluorescent, room fluorescent, broad-spectrum LED, standard white LED; the latter three conditions were matched for 100 lx) followed by an exposure to bright evening light. Cognitive performance, subjective and objective measures of alertness were regularly obtained. While daytime alertness was not impacted by light exposure, the broad-spectrum LED light improved several aspects of daytime cognition. The impact of evening light on alertness was not mitigated by the pre-exposure to different daytime lighting conditions. Results suggest that daytime exposure to white light with high melanopic efficacy has the potential to improve daytime cognitive function and that such improvements are likely to be direct rather than a consequence of light-induced changes in alertness.
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Affiliation(s)
- Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, United States of America
| | - Daniel S Joyce
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, United States of America; Department of Psychology, University of Nevada, Reno, Reno, NV 89557, United States of America
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, United States of America; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, United States of America.
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20
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Mathersul DC, Dixit K, Schulz-Heik RJ, Avery TJ, Zeitzer JM, Bayley PJ. Emotion dysregulation and heart rate variability improve in US veterans undergoing treatment for posttraumatic stress disorder: Secondary exploratory analyses from a randomised controlled trial. BMC Psychiatry 2022; 22:268. [PMID: 35428258 PMCID: PMC9012004 DOI: 10.1186/s12888-022-03886-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/24/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Emotion regulation (ER) is a key process underlying posttraumatic stress disorder (PTSD), yet, little is known about how ER changes with PTSD treatment. Understanding these effects may shed light on treatment processes. METHODS We recently completed a non-inferiority design randomised controlled trial demonstrating that a breathing-based yoga practice (Sudarshan kriya yoga; SKY) was not clinically inferior to cognitive processing therapy (CPT) across symptoms of PTSD, depression, or negative affect. Here, in secondary exploratory analyses (intent-to-treat N = 85; per protocol N = 59), we examined whether self-reported ER (Difficulties in Emotion Regulation Scale; DERS) and physiological ER (heart rate variability; HRV) improved with treatment for clinically significant PTSD symptoms among US Veterans. RESULTS DERS-Total and all six subscales improved with small-to-moderate effect sizes (d = .24-.66) following CPT or SKY, with no differences between treatment groups. Following SKY (but not CPT), HR max-min (average difference between maximum and minimum beats per minute), LF/HF (low-to-high frequency) ratio, and normalised HF-HRV (high frequency power) improved (moved towards a healthier profile; d = .42-.55). CONCLUSIONS To our knowledge, this is the first study to demonstrate that a breathing-based yoga (SKY) improved both voluntary/intentional and automatic/physiological ER. In contrast, trauma-focused therapy (CPT) only reliably improved self-reported ER. Findings have implications for PTSD treatment and interventions for emotional disorders more broadly. TRIAL REGISTRATION Secondary analyses of ClinicalTrials.gov NCT02366403 .
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Affiliation(s)
- Danielle C. Mathersul
- grid.280747.e0000 0004 0419 2556War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304 USA ,grid.168010.e0000000419368956Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305 USA ,grid.1025.60000 0004 0436 6763Discipline of Psychology, Murdoch University, Building 440, 90 South Street, Murdoch, WA 6150 Australia ,grid.1025.60000 0004 0436 6763Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Building 440, 90 South Street, Murdoch, WA 6150 Australia
| | - Kamini Dixit
- grid.280747.e0000 0004 0419 2556War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304 USA
| | - R. Jay Schulz-Heik
- grid.280747.e0000 0004 0419 2556War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304 USA
| | - Timothy J. Avery
- grid.280747.e0000 0004 0419 2556War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304 USA ,grid.168010.e0000000419368956Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305 USA ,National Centre for Posttraumatic Stress Disorder (NCPTSD), Veterans Affairs Menlo Park Health Care System, Menlo Park, CA 94025 USA
| | - Jamie M. Zeitzer
- grid.168010.e0000000419368956Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305 USA ,grid.280747.e0000 0004 0419 2556Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304 USA
| | - Peter J. Bayley
- grid.280747.e0000 0004 0419 2556War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304 USA ,grid.168010.e0000000419368956Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305 USA
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21
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Xiao Q, Lu J, Zeitzer JM, Matthews CE, Saint-Maurice PF, Bauer C. Rest-activity profiles among U.S. adults in a nationally representative sample: a functional principal component analysis. Int J Behav Nutr Phys Act 2022; 19:32. [PMID: 35331274 PMCID: PMC8944104 DOI: 10.1186/s12966-022-01274-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background The 24-h rest and activity behaviors (i.e., physical activity, sedentary behaviors and sleep) are fundamental human behaviors essential to health and well-being. Functional principal component analysis (fPCA) is a flexible approach for characterizing rest-activity rhythms and does not rely on a priori assumptions about the activity shape. The objective of our study is to apply fPCA to a nationally representative sample of American adults to characterize variations in the 24-h rest-activity pattern, determine how the pattern differs according to demographic, socioeconomic and work characteristics, and examine its associations with general health status. Methods The current analysis used data from adults 25 or older in the National Health and Nutrition Examination Survey (NHANES, 2011–2014). Using 7-day 24-h actigraphy recordings, we applied fPCA to derive profiles for overall, weekday and weekend rest-activity patterns. We examined the association between each rest-activity profile in relation to age, gender, race/ethnicity, education, income and working status using multiple linear regression. We also used multiple logistic regression to determine the relationship between each rest-activity profile and the likelihood of reporting poor or fair health. Results We identified four distinct profiles (i.e., high amplitude, early rise, prolonged activity window, biphasic pattern) that together accounted for 86.8% of total variation in the study sample. We identified numerous associations between each rest-activity profile and multiple sociodemographic characteristics. We also found evidence suggesting the associations differed between weekdays and weekends. Finally, we reported that the rest-activity profiles were associated with self-rated health. Conclusions Our study provided evidence suggesting that rest-activity patterns in human populations are shaped by multiple demographic, socioeconomic and work factors, and are correlated with health status. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01274-4.
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Affiliation(s)
- Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Health, School of Public Health, the University of Texas Health Science Center at Houston, 1200 Pressler St., TX, Houston, USA.
| | - Jiachen Lu
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, 1200 Pressler St., TX, Houston, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Pedro F Saint-Maurice
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Cici Bauer
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, 1200 Pressler St., TX, Houston, USA.
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22
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Joyce DS, Spitschan M, Zeitzer JM. Duration invariance and intensity dependence of the human circadian system phase shifting response to brief light flashes. Proc Biol Sci 2022; 289:20211943. [PMID: 35259981 PMCID: PMC8905166 DOI: 10.1098/rspb.2021.1943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/14/2022] [Indexed: 01/09/2023] Open
Abstract
The melanopsin-containing intrinsically photosensitive retinal ganglion cells (ipRGCs) are characterized by a delayed off-time following the cessation of light stimulation. Here, we exploited this unusual physiologic property to characterize the exquisite sensitivity of the human circadian system to flashed light. In a 34 h in-laboratory between-subjects design, we examined phase shifting in response to variable-intensity (3-9500 photopic lux) flashes at fixed duration (2 ms; n = 28 participants) and variable-duration (10 µs-10 s) flashes at fixed intensity (2000 photopic lux; n = 31 participants). Acute melatonin suppression, objective alertness and subjective sleepiness during the flash sequence were also assessed. We find a dose-response relationship between flash intensity and circadian phase shift, with an indication of a possible threshold-like behaviour. We find a slight parametric relationship between flash duration and circadian phase shift. Consistent with prior studies, we observe no dose-response relationship to either flash intensity or duration and the acute impact of light on melatonin suppression, objective alertness or subjective sleepiness. Our findings are consistent with circadian responses to a sequence of flashes being mediated by rod or cone photoreceptors via ipRGC integration.
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Affiliation(s)
- Daniel S. Joyce
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychology, University of Nevada Reno, Reno, NV, USA
| | - Manuel Spitschan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Translational Sensory and Circadian Neuroscience, Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- TUM Department of Sport and Health Sciences (TUM SG), Technical University of Munich, Munich, Germany
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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23
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Kaladchibachi S, Negelspach DC, Zeitzer JM, Fernandez FX. Investigation of the aging clock's intermittent-light responses uncovers selective deficits to green millisecond flashes. J Photochem Photobiol B 2022; 228:112389. [PMID: 35086027 DOI: 10.1016/j.jphotobiol.2022.112389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
The central pacemaker of flies, rodents, and humans generates less robust circadian output signals across normative aging. It is not well understood how changes in light sensitivity might contribute to this phenomenon. In the present study, we summarize results from an extended data series (n = 5681) showing that the locomotor activity rhythm of aged Drosophila can phase-shift normally to intermittently spaced episodes of bright polychromatic light exposure (600 lx) but that deficits emerge in response to 8, 16, and 120-millisecond flashes of narrowband blue (λm, 452 nm) and green (λm, 525 nm) LED light. For blue, phase-resetting of the activity rhythm of older flies is not as energy efficient as it is in younger flies at the fastest flash-exposures tested (8 milliseconds), suggesting there might be different floors of light duration necessary to incur photohabituation in each age group. For green, the responses of older flies are universally crippled relative to those of younger flies across the slate of protocols we tested. The difference in green flash photosensitivity is one of the most salient age-related phenotypes that has been documented in the circadian phase-shifting literature thus far. These data provide further impetus for investigations on pacemaker aging and how it might relate to changes in the circadian system's responses to particular sequences of light exposure tuned for wavelength, intensity, duration, and tempo.
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Affiliation(s)
| | | | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences and Stanford Center for Sleep Sciences and Medicine, Stanford University, Stanford, CA, USA; Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Fabian-Xosé Fernandez
- Department of Psychology, University of Arizona, Tucson, AZ, USA; Department of Neurology, University of Arizona, Tucson, AZ, USA; BIO5 and McKnight Brain Research Institutes, University of Arizona, Tucson, AZ, USA.
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24
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Miner B, Stone KL, Zeitzer JM, Han L, Doyle M, Blackwell T, Gill TM, Redeker NS, Hajduk A, Yaggi HK. Self-reported and actigraphic short sleep duration in older adults. J Clin Sleep Med 2022; 18:403-413. [PMID: 34338629 PMCID: PMC8804982 DOI: 10.5664/jcsm.9584] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY OBJECTIVES Persons > 65 years with short sleep duration (≤ 6 hours) are at risk for adverse outcomes, but the accuracy of self-reported sleep duration may be affected by reduced symptom awareness. We evaluated the performance characteristics of self-reported vs objectively measured sleep duration in this age group. METHODS In 2,980 men from the Osteoporotic Fractures in Men Sleep Study and 2,855 women from the Study of Osteoporotic Fractures we examined the agreement and accuracy of self-reported vs actigraphy-measured short and normal (> 6 but < 9 hours) sleep duration. We evaluated associations of select factors (demographics; medical, physical, and neuropsychiatric conditions; medication and substance use; and sleep-related measures) with risk of false-negative (normal sleep duration by self-report but short sleep duration by actigraphy) and false-positive (short sleep duration by self-report and normal sleep duration by actigraphy) designations, respectively, using logistic regression. RESULTS Average ages were 76.3 ± 5.5 and 83.5 ± 3.7 years in men and women, respectively. There was poor agreement between self-reported and actigraphic sleep duration (kappa ≤ 0.24). False negatives occurred in nearly half and false positives in over a quarter of older persons. In multivariable models in men and women, false negatives were independently associated with obesity, daytime sleepiness, and napping, while false positives were significantly lower with obesity. CONCLUSIONS Under- and overreporting of short sleep is common among older persons. Reliance on self-report may lead to missed opportunities to prevent adverse outcomes or unnecessary interventions. Self-reported sleep duration should be objectively confirmed when evaluating the effect of sleep duration on health outcomes. CITATION Miner B, Stone KL, Zeitzer JM, et al. Self-reported and actigraphic short sleep duration in older adults. J Clin Sleep Med. 2022;18(2):403-413.
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Affiliation(s)
- Brienne Miner
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Address correspondence to: Brienne Miner, MD, 333 Cedar Street, New Haven, CT 06520; Tel: (203) 688-9423; Fax (203) 688-4209;
| | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
| | - Margaret Doyle
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco, California
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nancy S. Redeker
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Yale School of Nursing, West Haven, Connecticut
| | - Alexandra Hajduk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Henry Klar Yaggi
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Veterans Affairs Clinical Epidemiology Research Center, West Haven, Connecticut
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25
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Lok R, Chawra D, Hon F, Ha M, Kaplan KA, Zeitzer JM. Objective underpinnings of self-reported sleep quality in middle-aged and older adults: the importance of N2 and wakefulness. Biol Psychol 2022; 170:108290. [PMID: 35192907 PMCID: PMC9038649 DOI: 10.1016/j.biopsycho.2022.108290] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVES The measurable aspects of brain function (polysomnography, PSG) that are correlated with sleep satisfaction are poorly understood. Using recent developments in automated sleep scoring, which remove the within- and between-rater error associated with human scoring, we examine whether PSG measures are associated with sleep satisfaction. DESIGN AND SETTING A single night of PSG data was compared to contemporaneously collected measures of sleep satisfaction with Random Forest regressions. Whole and partial night PSG data were scored using a novel machine learning algorithm. PARTICIPANTS Community-dwelling adults (N = 3165) who participated in the Sleep Heart Health Study. INTERVENTIONS None. MEASUREMENTS AND RESULTS Models explained 30% of sleep depth and 27% of sleep restfulness, with a similar top four predictors: minutes of N2 sleep, sleep efficiency, age, and minutes of wake after sleep onset (WASO). With increasing self-reported sleep quality, there was a progressive increase in N2 and decrease in WASO of similar magnitude, without systematic changes in N1, N3 or REM sleep. In comparing those with the best and worst self-reported sleep satisfaction, there was a range of approximately 30 min more N2, 30 min less WASO, an improvement of sleep efficiency of 7-8%, and an age span of 3-5 years. Examination of sleep most proximal to morning awakening revealed no greater explanatory power than the whole-night data set. CONCLUSIONS Higher N2 and concomitant lower wake is associated with improved sleep satisfaction. Interventions that specifically target these may be suitable for improving the self-reported sleep experience.
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Affiliation(s)
- Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Dwijen Chawra
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Flora Hon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA; College of Literature, Science, and The Arts, University of Michigan, Ann Arbor, MI 48109, USA
| | - Michelle Ha
- Department of Mathematics and Statistics, San Jose State University, San Jose, CA 95112, USA
| | - Katherine A Kaplan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA.
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26
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Xiao Q, Sampson JN, LaCroix AZ, Shadyab AH, Zeitzer JM, Ancoli-Israel S, Yaffe K, Stone K. Nonparametric parameters of 24-hour rest-activity rhythms and long-term cognitive decline and incident cognitive impairment in older men. J Gerontol A Biol Sci Med Sci 2021; 77:250-258. [PMID: 34558603 DOI: 10.1093/gerona/glab275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Indexed: 11/14/2022] Open
Abstract
Altered 24-hour rest-activity rhythms may be associated with cognitive impairment in older adults, but evidence from prospective studies is limited. Non-parametric methods were used to assess actigraphy-based activity patterns in 2,496 older men. Incident cognitive impairment was assessed four times over 12 years using the Modified Mini Mental State Examination (3MS) and Trails B tests, self-reported medication use, and clinical diagnosis. The highest quartile (vs. the lowest) of intradaily variability and the lowest quartiles (vs. the highest) of interdaily stability and relative amplitude were associated with incident cognitive impairment ((Hazard ratio (95% confidence interval): 1.82 (1.31, 2.53)), 1.36 (0.99, 1.86), and 1.85 (1.33, 2.56), respectively). A larger increase in intradaily variability over 7.5 years was associated with a greater subsequent decline in 3MS scores but not in Trails B performance. In conclusion, less stable and more variable rest-activity rhythms may represent early biomarkers of cognitive impairment in older men.
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Affiliation(s)
- Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Health, School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX
| | - Joshua N Sampson
- Biostatistics Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, MD
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA.,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto CA
| | - Sonia Ancoli-Israel
- Department of Psychiatry, Center for Circadian Biology, University of California, San Diego, La Jolla, CA
| | - Kristin Yaffe
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA
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27
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Lok R, Zeitzer JM. Physiological correlates of the Epworth Sleepiness Scale reveal different dimensions of daytime sleepiness. ACTA ACUST UNITED AC 2021; 2:zpab008. [PMID: 34250482 PMCID: PMC8266524 DOI: 10.1093/sleepadvances/zpab008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/04/2021] [Indexed: 11/12/2022]
Abstract
The Epworth Sleepiness Scale is commonly used to examine self-reported daytime sleepiness in clinical populations; the physiologic correlates of this scale, however, are not well understood. Furthermore, how well this scale correlates with parallel objective and self-reported concepts of daytime sleepiness is not well described. As such, we used machine learning algorithms to examine the association between Epworth Sleepiness Scale scores and 55 sleep and medical variables in the Sleep Heart Health Study (N = 2105). Secondary analyses examined data stratified by age and gender and the relationship between the Epworth and other measures of daytime sleepiness. Analyses of the main data set resulted in low explained variance (7.15%-10.0%), with self-reported frequency of not getting enough sleep as most important predictor (10.3%-13.9% of the model variance). Stratification by neither age nor gender significantly improved explained variance. Cross-correlational analysis revealed low correlation of other daytime sleepiness measures to Epworth scores. We find that Epworth scores are not well explained by habitual or polysomnographic sleep values, or other biomedical characteristics. These analyses indicate that there are different, potentially orthogonal dimensions of the concept of "daytime sleepiness" that may be driven by different aspects of sleep physiology. As the physiologic correlates of the Epworth Sleepiness Scale remain to be elucidated, interpretation of the clinical meaning of these scores should be done with caution.
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Affiliation(s)
- Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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28
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Mathersul DC, Dixit K, Avery TJ, Schulz-Heik RJ, Zeitzer JM, Mahoney LA, Cho RH, Bayley PJ. Heart rate and heart rate variability as outcomes and longitudinal moderators of treatment for pain across follow-up in Veterans with Gulf War illness. Life Sci 2021; 277:119604. [PMID: 33984356 DOI: 10.1016/j.lfs.2021.119604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Abstract
AIMS Accumulating evidence suggests Gulf War illness (GWI) is characterised by autonomic nervous system dysfunction (higher heart rate [HR], lower heart rate variability [HRV]). Yoga - an ancient mind-body practice combining mindfulness, breathwork, and physical postures - is proposed to improve autonomic dysfunction yet this remains untested in GWI. We aimed to determine (i) whether HR and HRV improve among Veterans with GWI receiving either yoga or cognitive behavioural therapy (CBT) for pain; and (ii) whether baseline autonomic functioning predicts treatment-related pain outcomes across follow-up. MAIN METHODS We present secondary analyses of 24-hour ambulatory cardiac data (mean HR, square root of the mean squared differences between successive R-R intervals [RMSSD], high frequency power [HF-HFV], and low-to-high frequency ratio [LF/HF] extracted from a 5-min window during the first hour of sleep) from our randomised controlled trial of yoga versus CBT for pain among Veterans with GWI (ClinicalTrials.govNCT02378025; N = 75). KEY FINDINGS Veterans who received CBT tended towards higher mean HR at end-of-treatment. Better autonomic function (lower mean HR, higher RMSSD/HF-HRV) at baseline predicted greater reductions in pain across follow-up, regardless of treatment group. Better baseline autonomic function (mid-range-to-high RMSSD/HF-HRV) also predicted greater pain reductions with yoga, while worse baseline autonomic function (higher mean HR, lower RMSSD/HF-HRV) predicted greater pain reductions with CBT. SIGNIFICANCE To our knowledge, this is the first study to suggest that among Veterans with GWI, HR may increase with CBT yet remain stable with yoga. Furthermore, HR and HRV moderated pain outcome across follow-up for yoga and CBT.
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Affiliation(s)
- Danielle C Mathersul
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America; Discipline of Psychology, Murdoch University, Murdoch, WA 6150, Australia.
| | - Kamini Dixit
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Timothy J Avery
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America; National Centre for Posttraumatic Stress Disorder (NCPTSD), Veterans Affairs Menlo Park Health Care System, Menlo Park, CA 94025, United States of America
| | - R Jay Schulz-Heik
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America; Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Louise A Mahoney
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Rachael H Cho
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America
| | - Peter J Bayley
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304, United States of America; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, United States of America
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29
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Posner AB, Tranah GJ, Blackwell T, Yaffe K, Ancoli-Israel S, Redline S, Leng Y, Zeitzer JM, Chen DM, Webber KR, Stone KL. Predicting incident dementia and mild cognitive impairment in older women with nonparametric analysis of circadian activity rhythms in the Study of Osteoporotic Fractures. Sleep 2021; 44:6272553. [PMID: 33964167 PMCID: PMC8503832 DOI: 10.1093/sleep/zsab119] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/31/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Disrupted daily rhythms are associated with mild cognitive impairment (MCI) and dementia. The specific nature of how rhythms and cognition are related, however, is unknown. We hypothesized characteristics from a nonparametric estimate of circadian rest-activity rhythm patterns would be associated to the development of MCI or dementia. METHODS Wrist actigraphy from 1232 cognitively healthy, community-dwelling women (mean age 82.6 years) from the Study of Osteoporotic Fractures was used to estimate rest-activity patterns, including intradaily variability (IV), interdaily stability (IS), most active 10-hour period (M10), least active 5-hour period (L5), and relative amplitude (RA). Logistic regression examined associations of these predictors with 5-year incidence of MCI or dementia. Models were adjusted for potential confounders. RESULTS Women with earlier sleep/wake times had higher risk of dementia, but not MCI, (early vs. average L5 midpoint: OR, 1.66; 95% CI, 1.08-2.55) as did women with smaller day/night activity differentials (low vs. high RA: OR, 1.96; 95% CI, 1.14-3.35). IV, IS, and M10 were not associated with MCI or dementia. CONCLUSION The timing and difference in day/night amplitude, but not variability of activity, may be useful as predictors of dementia.
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Affiliation(s)
- Alexander B Posner
- Research Institute, California Pacific Medical Center, San Francisco, CA.,Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Gregory J Tranah
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Terri Blackwell
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Kristine Yaffe
- San Francisco VA Medical Center, San Francisco, CA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA.,Department of Neurology, University of California, San Francisco San Francisco, CA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA
| | | | - Susan Redline
- Departments of Medicine and Neurology, Brigham and Women's Hospital, and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yue Leng
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA.,Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA.,Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, CA
| | - Dorothy M Chen
- Research Institute, California Pacific Medical Center, San Francisco, CA.,Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Katey R Webber
- Research Institute, California Pacific Medical Center, San Francisco, CA.,Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Katie L Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA
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30
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Gabel V, Miglis M, Zeitzer JM. Effect of artificial dawn light on cardiovascular function, alertness, and balance in middle-aged and older adults. Sleep 2021; 43:5822621. [PMID: 32307533 DOI: 10.1093/sleep/zsaa082] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 03/10/2020] [Indexed: 11/15/2022] Open
Abstract
STUDY OBJECTIVES When arising in the morning, many older people experience dizziness and difficulty maintaining proper balance, as the cardiovascular system is not able to compensate to the postural shift (standing) and maintain sufficient blood flow to the brain. Such changes in cardiovascular function are observed in young individuals exposed to a dawn simulation light. In this study, we examined whether exposure to a dawn simulation light could impact cardiovascular function and consequent changes in balance in middle-aged and older adults. METHODS Twenty-three participants (67.3 ± 8.8 y), 12 of whom reported a history of dizziness in the morning, underwent two overnight stays in our laboratory. During both nights, they slept in complete darkness, except for the last 30 minutes of one of the nights during which a dawn simulation light was used. Continuous blood pressure (BP) and heart rate (HR) were monitored. Subjective and objective alertness, salivary cortisol, and mobile and standing balance were examined upon arising. RESULTS Dawn simulation light decreased (33%) the amount of sleep before morning awakening, lowered BP (6.24 mmHg), and increased HR (0.93 bpm). Despite these changes in physiology, there was no significant impact of dawn simulation on subjective or objective alertness, measures of standing or ambulatory balance, morning cortisol awakening response, or cardiovascular function after awakening. CONCLUSION While the dawn simulation did cause an increase in wake and a change in cardiovascular function prior to morning arousal in older adults, we could find no evidence of a functional change in either cardiovascular function or balance upon standing. CLINICAL TRIAL Registered on Clinicaltrials.gov, #NCT02632318, https://clinicaltrials.gov/ct2/show/NCT02632318.
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Affiliation(s)
- Virginie Gabel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Mitchell Miglis
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA.,Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA
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Yang YT, Chang HY, Hsu CY, Zeitzer JM. Translation and Validation of a Chinese Version of the Cleveland Adolescent Sleepiness Questionnaire. Nat Sci Sleep 2021; 13:695-702. [PMID: 34104022 PMCID: PMC8179797 DOI: 10.2147/nss.s262572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The Cleveland Adolescent Sleepiness Questionnaire was originally developed and published in English and has served as a valid and effective tool for the assessment of adolescents' experiences with sleepiness in a variety of situations. To allow for comparisons between sleepiness in adolescents from different cultures, and with different linguistic backgrounds, reliable and valid measurement tools are necessary. The purpose of this study was to translate and validate a Chinese version of the Cleveland Adolescent Sleepiness Questionnaire (C-CASQ). MATERIALS AND METHODS Sensitivity, specificity, internal consistency, and criterion validity data for the C-CASQ were tested using 458 adolescents in Taiwan. Data from 191 participants were used to establish internal consistency reliability and conduct exploratory factor analysis (EFA), while data from 267 participants were used to establish criterion validity and conduct confirmatory factor analysis (CFA). Initial criterion validity was established through a comparison of the C-CASQ with scores from the Chinese version of the Morningness-Eveningness Scale for Children, a measure of chronotype. RESULTS EFA resulted in four factors, consistent with the original English version of the CASQ, while CFA established goodness of fit. The scale demonstrated acceptable to good internal consistency (α = 0.77~0.86). Initial criterion validity was evident as the total score and each of the subscale scores on the C-CASQ was significantly higher (greater sleepiness) in evening-types. CONCLUSION The C-CASQ appears to be a psychometrically sound measure to evaluate sleepiness in Chinese-speaking adolescents.
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Affiliation(s)
- Ya-Ting Yang
- Institute of Education, National Cheng Kung University, Tainan City, Taiwan.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Han-Yun Chang
- Institute of Education, National Cheng Kung University, Tainan City, Taiwan
| | - Chung-Yao Hsu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Yang YT, Chang HY, Hsu CY, Lin CY, Zeitzer JM. Chinese Translation and Validation of the Child and Adolescent Sleep Checklist for Parents. Sleep Med Res 2020. [DOI: 10.17241/smr.2020.00710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The circadian wake drive is a mathematic representation of the observed increased propensity to stay awake late in the day, peaking in the hours just before anticipated bed time. It has been called the "forbidden zone" due to the difficulty in initiating sleep during this time and is responsible for the problems initiating sleep when traveling eastward, for maintaining daytime sleep in shift workers, and for initiating sleep in some individuals with insomnia. Evidence culled from studies in individuals with narcolepsy, who lack production of hypocretin (orexin) neuropeptides, as well as a primate model of human wake consolidation and pharmacologic studies of hypocretin antagonists indicate that hypocretin-1 may be the physiologic instantiation of the circadian wake drive. This review will discuss the evidence in support of this hypothesis.
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Affiliation(s)
- Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, United States; Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue (151Y), Palo Alto, CA 94304, United States.
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Lok R, Zeitzer JM. A Temporal Threshold for Distinguishing Off-Wrist from Inactivity Periods: A Retrospective Actigraphy Analysis. Clocks Sleep 2020; 2:466-472. [PMID: 33198122 PMCID: PMC7712166 DOI: 10.3390/clockssleep2040034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background. To facilitate accurate actigraphy data analysis, inactive periods have to be distinguished from periods during which the device is not being worn. The current analysis investigates the degree to which off-wrist and inactive periods can be automatically identified. (2) Methods. In total, 125 actigraphy records were manually scored for ‘off-wrist’ and ‘inactivity’ (99 collected with the Motionlogger AMI, 26 (sampling frequency of 60 (n = 20) and 120 (n = 6) s) with the Philips Actiwatch 2.) Data were plotted with cumulative frequency percentage and analyzed with receiver operating characteristic curves. To confirm findings, the thresholds determined in a subset of the Motionlogger dataset (n = 74) were tested in the remaining dataset (n = 25). (3) Results. Inactivity data lasted shorter than off-wrist periods, with 95% of inactive events being shorter than 11 min (Motionlogger), 20 min (Actiwatch 2; 60 s epochs) or 30 min (Actiwatch 2; 120 s epochs), correctly identifying 35, 92 or 66% of the off-wrist periods. The optimal accurate detection of both inactive and off-wrist periods for the Motionlogger was 3 min (Youden’s Index (J) = 0.37), while it was 18 (J = 0.89) and 16 min (J = 0.81) for the Actiwatch 2 (60 and 120 s epochs, respectively). The thresholds as determined in the subset of the Motionlogger dataset showed similar results in the remaining dataset. (4) Conclusion. Off-wrist periods can be automatically identified from inactivity data based on a temporal threshold. Depending on the goal of the analysis, a threshold can be chosen to favor inactivity data’s inclusion or accurate off-wrist detection.
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Affiliation(s)
- Renske Lok
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA;
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA;
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
- Correspondence:
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Cheung J, Leary EB, Lu H, Zeitzer JM, Mignot E. PSG Validation of minute-to-minute scoring for sleep and wake periods in a consumer wearable device. PLoS One 2020; 15:e0238464. [PMID: 32941498 PMCID: PMC7498244 DOI: 10.1371/journal.pone.0238464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/17/2020] [Indexed: 01/24/2023] Open
Abstract
Background Actigraphs are wrist-worn devices that record tri-axial accelerometry data used clinically and in research studies. The expense of research-grade actigraphs, however, limit their widespread adoption, especially in clinical settings. Tri-axial accelerometer-based consumer wearable devices have gained worldwide popularity and hold potential for a cost-effective alternative. The lack of independent validation of minute-to-minute accelerometer data with polysomnographic data or even research-grade actigraphs, as well as access to raw data has hindered the utility and acceptance of consumer-grade actigraphs. Methods Sleep clinic patients wore a consumer-grade wearable (Huami Arc) on their non-dominant wrist while undergoing an overnight polysomnography (PSG) study. The sample was split into two, 20 in a training group and 21 in a testing group. In addition to the Arc, the testing group also wore a research-grade actigraph (Philips Actiwatch Spectrum). Sleep was scored for each 60-s epoch on both devices using the Cole-Kripke algorithm. Results Based on analysis of our training group, Arc and PSG data were aligned best when a threshold of 10 units was used to examine the Arc data. Using this threshold value in our testing group, the Arc has an accuracy of 90.3%±4.3%, sleep sensitivity (or wake specificity) of 95.5%±3.5%, and sleep specificity (wake sensitivity) of 55.6%±22.7%. Compared to PSG, Actiwatch has an accuracy of 88.7%±4.5%, sleep sensitivity of 92.6%±5.2%, and sleep specificity of 60.5%±20.2%, comparable to that observed in the Arc. Conclusions An optimized sleep/wake threshold value was identified for a consumer-grade wearable Arc trained by PSG data. By applying this sleep/wake threshold value for Arc generated accelerometer data, when compared to PSG, sleep and wake estimates were adequate and comparable to those generated by a clinical-grade actigraph. As with other actigraphs, sleep specificity plateaus due to limitations in distinguishing wake without movement from sleep. Further studies are needed to evaluate the Arc’s ability to differentiate between sleep and wake using other sources of data available from the Arc, such as high resolution accelerometry and photoplethysmography.
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Affiliation(s)
- Joseph Cheung
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California, United States of America
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America
- * E-mail:
| | - Eileen B. Leary
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California, United States of America
| | - Haoyang Lu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America
| | - Jamie M. Zeitzer
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California, United States of America
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Emmanuel Mignot
- Stanford University Center for Sleep Sciences and Medicine, Palo Alto, California, United States of America
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America
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Yang YT, Kaplan KA, Zeitzer JM. A comparison of sleep, depressive symptoms, and parental perceptions between U.S. and Taiwan adolescents with self-reported sleep problems. ACTA ACUST UNITED AC 2020; 1:zpaa004. [PMID: 33345187 PMCID: PMC7731573 DOI: 10.1093/sleepadvances/zpaa004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/20/2020] [Indexed: 12/13/2022]
Abstract
Study Objectives Inadequate sleep is pervasive among teens worldwide, resulting in daytime sleepiness and, in some cases, depressive symptoms. In addition to their own behavioral choices, parent perceptions may also play a role in adolescent sleep. This study conducted a preliminary evaluation of the antecedents and consequences of sleep factors among adolescents in the United States and Taiwan. Methods Participants were adolescents with self-reported sleep concerns from academically similar schools in Taiwan (n = 548) and northern California, United States (n = 128). Questionnaires on sleep and mood were administered to both the teens and parents. Results While Taiwanese students’ self-reported sleep behavior was generally better than U.S. students (p < .01), Taiwanese students had higher overall self-reported sleepiness (p < .01). Furthermore, Taiwanese parents reported teen sleep durations of 6.53 ± .827 hours per night during the week (with 45% perceiving this as sufficient), while U.S. parents reported teen sleep durations of 7.22 ± .930 hours (with 27% perceiving this as sufficient). Adolescents in both cohorts had high levels of symptoms consistent with depression (Taiwan: 70%, United States: 62%), which was associated with shorter sleep times for both cohorts and evening chronotype in the Taiwanese, but not U.S., adolescents. Conclusions Some differences exist between Taiwanese and U.S. adolescents, with generally better sleep and less sleepiness reported among students in the United States, and Taiwanese students’ sleep influenced more strongly by chronotype. Furthermore, Taiwanese parents reported less concern about their child’s insufficient sleep, despite the fact that inadequate sleep is strongly associated with depressive symptoms for both cohorts.
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Affiliation(s)
- Ya-Ting Yang
- Institute of Education, National Cheng Kung University, Tainan City, Taiwan, ROC.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Katherine A Kaplan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA.,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA
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Zeitzer JM, Joyce DS, McBean A, Quevedo YL, Hernandez B, Holty JE. Effect of Suvorexant vs Placebo on Total Daytime Sleep Hours in Shift Workers: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e206614. [PMID: 32484552 PMCID: PMC7267849 DOI: 10.1001/jamanetworkopen.2020.6614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Many shift workers have difficulty sleeping during the daytime owing to an inappropriately timed circadian drive for wakefulness. OBJECTIVE To determine whether a dual hypocretin receptor antagonist would enable shift workers to have more daytime sleep. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled randomized clinical trial included 2 weeks of baseline data and 3 weeks of intervention data, from March 2016 to December 2018. Individuals were recruited through poster advertisements in the broader San Francisco Bay area in California. From an initial voluntary recruitment cohort of 38 shift workers, 19 individuals with self-reported difficulty sleeping during the daytime following night work shift were included. Data were analyzed from Janaury to March 2019. INTERVENTIONS 1 week of 10 mg suvorexant or placebo, titrated upward to 20 mg suvorexant or placebo for 2 additional weeks. MAIN OUTCOMES AND MEASURES Objective (ie, actigraphy) and subjective (ie, sleep logs) measures of sleep. RESULTS Among 19 participants who completed the study (mean [SD] age, 37.7 [11.1] years; 13 [68%] men), 8 participants (42%) were assigned to the suvorexant group and 11 participants (58%) were assigned to the placebo group. Compared with individuals in the placebo group, individuals in the suvorexant group increased their objective total sleep time by a mean (SE) of 1.04 (0.53) hours (P = .05) at the end of 1 week of 10-mg doses and by 2.16 (0.75) hours (P = .004) by the end of the 2 weeks of 20-mg doses. Subjective sleep was similarly improved as, compared with the placebo group, individuals in the suvorexant group increased their subjective total sleep time by a mean (SE) of 2.08 (0.47) hours (P < .001) at the end of 1 week of 10-mg doses and by 2.97 (0.56) hours (P < .001) by the end of the 2 weeks of 20-mg doses. Physician ratings of daytime sleep aligned with these measures, as there was no change in the placebo group and a much improved change in the suvorexant group. No adverse events were reported in the suvorexant group. CONCLUSIONS AND RELEVANCE This pilot study found that the use of a dual hypocretin receptor antagonist in shift workers under real-world conditions resulted in more than 2 extra hours of daytime sleep per episode. Future research should confirm this pilot finding in a larger sample size and examine whether, over the long term, use of this medication has a concomitant improvement in medical and psychiatric health as well as workplace performance and safety. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02491788.
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Affiliation(s)
- Jamie M. Zeitzer
- Stanford Center for Sleep Sciences And Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
| | - Daniel S. Joyce
- Stanford Center for Sleep Sciences And Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Amanda McBean
- Stanford Center for Sleep Sciences And Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Yvonne L. Quevedo
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
| | - Beatriz Hernandez
- Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
| | - Jon-Erik Holty
- Pulmonary, Critical Care, and Sleep Medicine Section, VA Palo Alto Health Care System, Palo Alto, California
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, California
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Zeitzer JM, Joyce DS, Sterkel AL, Quevedo YL, Hernandez B, Holty J. 0781 Impact Of Suvorexant On Total Daytime Sleep Hours In Shift Workers: A Randomized, Double-blind, Placebo-controlled Clinical Field Trial. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Many shift workers have an inability to sleep during the daytime following a night shift not due to insomnia or lack of sleep pressure, but because a circadian signal promoting wakefulness is hampering their ability to maintain sleep. We have previously hypothesized that the neuropeptide hypocretin-1 is, in part, responsible for the physiologic expression of this circadian wake signal. As such, it was our intent to determine whether a pharmacologic blockade of hypocretin would enable shift workers to obtain more daytime sleep.
Methods
Nineteen shift workers took part in a placebo-controlled, double-blind field study of suvorexant. Following two weeks of baseline, participants received 10 mg suvorexant/placebo for one week and were titrated upward to 20 mg suvorexant/placebo for an additional two weeks. Subjective (diaries) and objective (actigraphy) sleep were monitored throughout. No restrictions were placed on participants’ schedules.
Results
Both subjective and objective measures of total sleep time significantly improved in the active vs. the placebo condition, increasing by 2.08 ± 0.47 hours (diary) or 1.04 ± 0.53 hours (actigraphy) by the end of the 10 mg condition, and increasing by 2.97 ± 0.56 hours (diary) or 2.16 ± 0.75 hours (actigraphy) by the end of the 20 mg condition. Physician ratings of change in the severity of symptoms similarly improved in the active group. There were no adverse events reported in the active condition.
Conclusion
Robust changes in total sleep time were observed after administration of suvorexant, a dual-hypocretin antagonist, prior to daytime sleep in a field study of shift workers. The very large changes in total sleep time, coupled with the permissive nature of the therapeutic mechanism (i.e., suppressing wake rather than inducing sleep) indicate that this could be a viable and important therapy for shift workers.
Support
Merck Sharpe and Dohme investigator-initiated study #53236
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Affiliation(s)
| | | | | | - Y L Quevedo
- VA Palo Alto Health Care System, Palo Alto, CA
| | - B Hernandez
- VA Palo Alto Health Care System, Palo Alto, CA
| | - J Holty
- Stanford University, Palo Alto, CA
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Allende S, Medina JL, Spiegel D, Zeitzer JM. Evening salivary cortisol as a single stress marker in women with metastatic breast cancer. Psychoneuroendocrinology 2020; 115:104648. [PMID: 32171899 DOI: 10.1016/j.psyneuen.2020.104648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Flattened diurnal salivary cortisol patterns predict shorter subsequent survival with breast, lung, and renal cell carcinomas. The underlying cause of this flattened slope is undetermined, though it has been hypothesized to be secondary to a deficit in the amplitude of the circadian clock. To gain greater insight into the portions of the diurnal salivary curve that are associated with cancer survival, we examined (1) which points in the diurnal curve are predictive of the slope of the curve and (2) whether elevated evening cortisol levels alone are associated with reduced HPA-axis feedback inhibition (i.e., decreased sensitivity to the dexamethasone suppression test). METHOD We examined study hypotheses on adult women with advanced breast cancer (age = 54.3 ± 9.58 years; n = 99) using non-parametric Wilcoxon's rank-sum tests, Spearman correlation coefficients and an accuracy formula based on a confusion matrix. Cortisol was sampled five times per day for three consecutive days, with dexamethasone administered late on the second day. RESULTS Salivary cortisol concentrations did not vary between those with flat and steep slopes during the morning (p's > .05), but did vary in the evening (p's < 0.05). Furthermore, the concentration of the 2100h alone was 86% accurate in discriminating between individuals classified as having "flat" or "steep" slopes. Dexamethasone suppression was only associated with diurnal salivary cortisol slope (p = .0042). CONCLUSIONS Evening cortisol levels are a sensitive indicator flattened diurnal cortisol slope, suggesting evening cortisol may also be a useful predictor of breast cancer survival. Future research should focus on determining the causes of abnormally increased evening cortisol.
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Affiliation(s)
- Santiago Allende
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, 1791 Arastradero Road, Palo Alto, CA 94304, United States.
| | - Johnna L Medina
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road Stanford, CA 94305-5717, United States
| | - David Spiegel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road Stanford, CA 94305-5717, United States
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road Stanford, CA 94305-5717, United States
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Faerman A, Kaplan KA, Zeitzer JM. Subjective sleep quality is poorly associated with actigraphy and heart rate measures in community-dwelling older men. Sleep Med 2020; 73:154-161. [PMID: 32836083 DOI: 10.1016/j.sleep.2020.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/26/2020] [Accepted: 04/11/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES There has been a proliferation in the use of commercially-available accelerometry- and heart rate-based wearable devices to monitor sleep. While the underlying technology is reasonable at detecting sleep quantity, the ability of these devices to predict subjective sleep quality is currently unknown. We tested whether the fundamental signals from such devices are useful in determining subjective sleep quality. METHODS Older, community-dwelling men (76.5 ± 5.77 years) enrolled in the Osteoporotic Fractures in Men Study (MrOS) participated in an overnight sleep study during which sleep was monitored with actigraphy (wrist-worn accelerometry) and polysomnography (PSG), including electrocardiography (N = 1141). Subjective sleep quality was determined the next morning using 5-point Likert-type scales of sleep depth and restfulness. Lasso and random forest regression models analyzed the relationship between actigraph-determined sleep variables, the shape of the activity patterns during sleep (functional principal component analysis), average heart rate, heart rate variability (HRV), demographics, and self-reported depression, anxiety, habitual sleep, and daytime sleepiness measures. RESULTS Actigraphy data, in combination with heart rate, HRV, demographic, and psychological variables, do not predict well subjective sleep quality (R2 = 0.025 to 0.162). CONCLUSIONS Findings are consistent with previous studies that objective sleep measures are not well correlated with subjective sleep quality. Developing validated biomarkers of subjective sleep quality could improve both existing and novel treatment modalities and advance sleep medicine towards precision healthcare standards.
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Affiliation(s)
- Afik Faerman
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Katherine A Kaplan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA; Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA.
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Zeitzer JM, Hon F, Whyte J, Monden KR, Bogner J, Dahdah M, Wittine L, Bell KR, Nakase‐Richardson R. Coherence Between Sleep Detection by Actigraphy and Polysomnography in a Multi‐Center, Inpatient Cohort of Individuals with Traumatic Brain Injury. PM R 2020; 12:1205-1213. [DOI: 10.1002/pmrj.12353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/08/2020] [Accepted: 02/21/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences Stanford University Palo Alto CA USA
- Mental Illness Research Education and Clinical Center VA Palo Alto Health Care System Palo Alto CA USA
| | - Flora Hon
- Department of Psychiatry and Behavioral Sciences Stanford University Palo Alto CA USA
- College of Literature, Science, and the Arts University of Michigan Ann Arbor MI USA
| | - John Whyte
- Moss Rehabilitation Research Institute Albert Einstein Healthcare Network Elkins Park PA USA
| | - Kimberley R. Monden
- Craig Hospital Englewood CO USA
- Department of Physical Medicine and Rehabilitation University of Colorado School of Medicine Aurora CO USA
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, College of Medicine Ohio State University Columbus OH USA
| | - Marie Dahdah
- Baylor Scott & White Medical Center – Plano Plano TX USA
| | - Lara Wittine
- Morsani College of Medicine, Division of Pulmonary and Sleep Medicine University of South Florida Tampa FL USA
| | - Kathleen R. Bell
- Department of Physical Medicine and Rehabilitation University of Texas Southwestern Medical Center Dallas TX USA
| | - Risa Nakase‐Richardson
- Morsani College of Medicine, Division of Pulmonary and Sleep Medicine University of South Florida Tampa FL USA
- Mental Health and Behavioral Sciences Defense and Veterans Brain Injury Center at James A. Haley Veterans' Hospital Tampa FL USA
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Stack N, Zeitzer JM, Czeisler C, Diniz Behn C. Estimating Representative Group Intrinsic Circadian Period from Illuminance-Response Curve Data. J Biol Rhythms 2019; 35:195-206. [PMID: 31779499 DOI: 10.1177/0748730419886992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The human circadian pacemaker entrains to the 24-h day, but interindividual differences in properties of the pacemaker, such as intrinsic period, affect chronotype and mediate responses to challenges to the circadian system, such as shift work and jet lag, and the efficacy of therapeutic interventions such as light therapy. Robust characterization of circadian properties requires desynchronization of the circadian system from the rest-activity cycle, and these forced desynchrony protocols are very time and resource intensive. However, circadian protocols designed to derive the relationship between light intensity and phase shift, which is inherently affected by intrinsic period, may be applied more broadly. To exploit this relationship, we applied a mathematical model of the human circadian pacemaker with a Markov-Chain Monte Carlo parameter estimation algorithm to estimate the representative group intrinsic period for a group of participants using their collective illuminance-response curve data. We first validated this methodology using simulated illuminance-response curve data in which the intrinsic period was known. Over a physiological range of intrinsic periods, this method accurately estimated the representative intrinsic period of the group. We also applied the method to previously published experimental data describing the illuminance-response curve for a group of healthy adult participants. We estimated the study participants' representative group intrinsic period to be 24.26 and 24.27 h using uniform and normal priors, respectively, consistent with estimates of the average intrinsic period of healthy adults determined using forced desynchrony protocols. Our results establish an approach to estimate a population's representative intrinsic period from illuminance-response curve data, thereby facilitating the characterization of intrinsic period across a broader range of participant populations than could be studied using forced desynchrony protocols. Future applications of this approach may improve the understanding of demographic differences in the intrinsic circadian period.
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Affiliation(s)
- Nora Stack
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, Colorado
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California.,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California
| | - Charles Czeisler
- Division of Sleep and Circadian Disorders, Department of Medicine and Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts
| | - Cecilia Diniz Behn
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, Colorado.,Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Kaplan KA, Mashash M, Williams R, Batchelder H, Starr-Glass L, Zeitzer JM. Effect of Light Flashes vs Sham Therapy During Sleep With Adjunct Cognitive Behavioral Therapy on Sleep Quality Among Adolescents: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1911944. [PMID: 31553469 PMCID: PMC6763980 DOI: 10.1001/jamanetworkopen.2019.11944] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Owing to biological, behavioral, and societal factors, sleep duration in teenagers is often severely truncated, leading to pervasive sleep deprivation. OBJECTIVE To determine whether a novel intervention, using both light exposure during sleep and cognitive behavioral therapy (CBT), would increase total sleep time in teenagers by enabling them to go to sleep earlier than usual. DESIGN, SETTING, AND PARTICIPANTS This double-blind, placebo-controlled, randomized clinical trial, conducted between November 1, 2013, and May 31, 2016, among 102 adolescents enrolled full-time in grades 9 to 12, who expressed difficulty going to bed earlier and waking up early enough, was composed of 2 phases. In phase 1, participants were assigned to receive either 3 weeks of light or sham therapy and were asked to try to go to sleep earlier. In phase 2, participants received 4 brief CBT sessions in addition to a modified light or sham therapy. All analyses were performed on an intent-to-treat basis. INTERVENTIONS Light therapy consisted of receiving a 3-millisecond light flash every 20 seconds during the final 3 hours of sleep (phase 1) or final 2 hours of sleep (phase 2). Sham therapy used an identical device, but delivered 1 minute of light pulses (appearing in 20-second intervals, for a total of 3 pulses) per hour during the final 3 hours of sleep (phase 1) or 2 hours of sleep (phase 2). Light therapy occurred every night during the 4-week intervention. Cognitive behavioral therapy consisted of four 50-minute in-person sessions once per week. MAIN OUTCOMES AND MEASURES Primary outcome measures included diary-based sleep times, momentary ratings of evening sleepiness, and subjective measures of sleepiness and sleep quality. RESULTS Among the 102 participants (54 female [52.9%]; mean [SD] age, 15.6 [1.1] years), 72 were enrolled in phase 1 and 30 were enrolled in phase 2. Mixed-effects models revealed that light therapy alone was inadequate in changing the timing of sleep. However, compared with sham therapy plus CBT alone, light therapy plus CBT significantly moved sleep onset a mean (SD) of 50.1 (27.5) minutes earlier and increased nightly total sleep time by a mean (SD) of 43.3 (35.0) minutes. Light therapy plus CBT also resulted in a 7-fold greater increase in bedtime compliance than that observed among participants receiving sham plus CBT (mean [SD], 2.21 [3.91] vs 0.29 [0.76]), as well as a mean 0.55-point increase in subjective evening sleepiness as compared with a mean 0.48-point decrease in participants receiving sham plus CBT as measured on a 7-point sleepiness scale. CONCLUSIONS AND RELEVANCE This study found that light exposure during sleep, in combination with a brief, motivation-focused CBT intervention, was able to consistently move bedtimes earlier and increase total sleep time in teenagers. This type of passive light intervention in teenagers may lead to novel therapeutic applications. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01406691.
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Affiliation(s)
- Katherine A. Kaplan
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Meital Mashash
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Rayma Williams
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | | | | | - Jamie M. Zeitzer
- Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
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Kaladchibachi S, Negelspach DC, Zeitzer JM, Fernandez F. Optimization of circadian responses with shorter and shorter millisecond flashes. Biol Lett 2019; 15:20190371. [PMID: 31387472 PMCID: PMC6731482 DOI: 10.1098/rsbl.2019.0371] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/15/2019] [Indexed: 12/20/2022] Open
Abstract
Recent work suggests that the circadian pacemaker responds optimally to millisecond flashes of light, not continuous light exposure as has been historically believed. It is unclear whether these responses are influenced by the physical characteristics of the pulsing. In the present study, Drosophila (n = 2199) were stimulated with 8, 16 or 120 ms flashes. For each duration, the energy content of the exposure was systematically varied by changing the pulse irradiance and the number of stimuli delivered over a fixed 15 min administration window (64 protocols surveyed in all). Results showed that per microjoule invested, 8 ms flashes were more effective at resetting the circadian activity rhythm than 16- and 120 ms flashes (i.e. left shift of the dose-response curve, as well as a higher estimated maximal response). These data suggest that the circadian pacemaker's photosensitivity declines within milliseconds of light contact. Further introduction of light beyond a floor of (at least) 8 ms leads to diminishing returns on phase-shifting.
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Affiliation(s)
| | | | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences and Stanford Center for Sleep Sciences and Medicine, Stanford University, Stanford, CA, USA
- Mental Illness Research, Education and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Fabian Fernandez
- Department of Psychology, University of Arizona, Tucson, AZ, USA
- Department of Neurology, University of Arizona, Tucson, AZ, USA
- BIO5 and McKnight Brain Research Institutes, University of Arizona, Tucson, AZ, USA
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Gabel V, Kass M, Joyce DS, Spitschan M, Zeitzer JM. Auditory psychomotor vigilance testing in older and young adults: a revised threshold setting procedure. Sleep Breath 2019; 23:1021-1025. [PMID: 31069648 DOI: 10.1007/s11325-019-01859-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/08/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND One of the most common ways to examine the daytime impact of sleep loss is the use of the psychomotor vigilance test (PVT). PVT metrics, including median reaction time (RT) and number of lapses, have been examined in a variety of studies in which both acute and chronic sleep times are manipulated. Most of these studies involve young, healthy individuals and use a visual stimulus. As light is a possible countermeasure to sleep loss, and sometimes incompatible with the use of visual PVT, PVT with auditory cues (aPVT) has been used. A threshold of 400 ms is commonly used to delineate lapses from normal RT in the aPVT. As aging can influence a variety of brain functions, we wanted to examine whether this lapse threshold was accurate for use in older adults. METHODS Twenty-eight young and 19 healthy older participants performed a 10-min auditory PVT approximately 90 min before habitual bedtime. The occurrence of lapses was determined by five objective RT thresholds: (1) 400 ms, (2) 500 ms, (3) 2 × median, (4) mean + 2 × SD, and (5) method 4 without outliers. Results of these methods were compared with a triplicate visual inspection of RT histograms to determine RT outside of the expected log normal distribution. RESULTS In both groups, methods 1, 4, and 5 performed poorly, while methods 2 and 3 were adequate, though method 3 was statistically superior. CONCLUSION In both age groups, the use of twice the median as an objective threshold had the best concurrence with visual scoring.
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Affiliation(s)
- Virginie Gabel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.
| | - Mirelle Kass
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.,Connecticut College, New London, CT, 06320, USA
| | - Daniel S Joyce
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Manuel Spitschan
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.,Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK
| | - Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA.,Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
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Zeitzer JM, Blackwell T, Hoffman AR, Cummings S, Ancoli-Israel S, Stone K. Daily Patterns of Accelerometer Activity Predict Changes in Sleep, Cognition, and Mortality in Older Men. J Gerontol A Biol Sci Med Sci 2019; 73:682-687. [PMID: 28158467 DOI: 10.1093/gerona/glw250] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 12/02/2016] [Indexed: 01/23/2023] Open
Abstract
Background There is growing interest in the area of "wearable tech" and its relationship to health. A common element of many of these devices is a triaxial accelerometer that can yield continuous information on gross motor activity levels; how such data might predict changes in health is less clear. Methods We examined accelerometry data from 2,976 older men who were part of the Osteoporotic Fractures in Men (MrOS) study. Using a shape-naive technique, functional principal component analysis, we examined the patterns of motor activity over the course of 4-7 days and determined whether these patterns were associated with changes in polysomnographic-determined sleep and cognitive function (Trail Making Test-Part B [Trails B], Modified Mini-Mental State Examination [3MS]), as well as mortality over 6.5-8 years of follow-up. Results In comparing baseline to 6.5 years later, multivariate modeling indicated that low daytime activity at baseline was associated with worsening of sleep efficiency (p < .05), more wake after sleep onset (p < .05), and a decrease in cognition (Trails B; p < .001), as well as a 1.6-fold higher rate of all-cause mortality (hazard ratio = 1.64 [1.34-2.00]). Earlier wake and bed times were associated with a decrease in cognition (3MS; p < .05). Having a late afternoon peak in activity was associated with a 1.4-fold higher rate of all-cause mortality (hazard ratio = 1.46 [1.21-1.77]). Those having a longer duration of their daytime activity with a bimodal activity pattern also had over a 1.4-fold higher rate of cardiovascular-related mortality (hazard ratio = 1.42 [1.02-1.98]). Conclusions Patterns of daily activity may be useful as predictive biomarkers for changes in clinically relevant outcomes, including mortality and changes in sleep and cognition in older men.
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Affiliation(s)
- Jamie M Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, California.,Mental Illness Research, Education, and Clinical Center, VA Palo Alto Health Care System, California.,Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California
| | - Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco
| | | | - Steve Cummings
- California Pacific Medical Center Research Institute, San Francisco
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, La Jolla.,Department of Medicine, University of California, San Diego, La Jolla
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco
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Abstract
Introduction Chronotype (morningness/eveningness) is associated with preference for the timing of many types of behavior, most notably sleep. Chronotype is also associated with differences in the timing of various physiologic events as well as aspects of personality. One aspect linked to personality, prosocial behavior, has not been studied before in the context of chronotype. There are many variables contributing to who, when, and why one human might help another and some of these factors appear fixed, while some change over time or with the environment. It was our intent to examine prosocial behavior in the context of chronotype and environment. Methods Randomly selected adults (N = 100, ages 18–72) were approached in a public space and asked to participate in a study. If the participants consented (n = 81), they completed the reduced Morning-Eveningness Questionnaire and the Stanford Sleepiness Scale, then prosocial behavior was assessed. Results/Conclusions We found that people exhibited greater prosocial behavior when they were studied further from their preferred time of day. This did not appear to be associated with subjective sleepiness or other environmental variables, such as ambient illumination. This suggests the importance of appreciating the differentiation between the same individual’s prosocial behavior at different times of day. Future studies should aim at replicating this result in larger samples and across other measures of prosocial behavior.
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Affiliation(s)
- Natalie L. Solomon
- PGSP Stanford Psy.D. Consortium, Palo Alto University, Palo Alto, California, United States of America
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, United States of America
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, California, United States of America
- * E-mail:
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Affiliation(s)
- Daniel J Blum
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Redwood City, CA, USA
| | - Emmanuel During
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Redwood City, CA, USA
- Stanford University Department of Neurology and Neurological Sciences, Palo Alto, CA, USA
| | - Fiona Barwick
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Redwood City, CA, USA
| | - Polina Davidenko
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Redwood City, CA, USA
| | - Jamie M Zeitzer
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford Center for Sleep Sciences and Medicine, Redwood City, CA, USA
- Mental Illness Research Education and Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Kaufmann CN, Gershon A, Depp CA, Miller S, Zeitzer JM, Ketter TA. Daytime midpoint as a digital biomarker for chronotype in bipolar disorder. J Affect Disord 2018; 241:586-591. [PMID: 30172210 PMCID: PMC6436809 DOI: 10.1016/j.jad.2018.08.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/23/2018] [Accepted: 08/07/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with later sleep and daily activity (evening rather than morning chronotype). Objective chronotype identification (e.g., based on actigraphs/smartphones) has potential utility, but to date, chronotype has mostly been assessed by questionnaires. Given the ubiquity of accelerometer-based devices (e.g. actigraphs/smartphones) worn/used during daytime and tendency to recharge rather than wear at night, we assessed chronotype using daytime (rather than sleep) interval midpoints. METHODS Sixty-one participants with BD type I (BD-I) or II (BD-II) and 61 healthy controls completed 25-50 days of continuous actigraphy. The Composite Scale of Morningness (CSM) was completed by a subset of this group. Daytime activity midpoint was calculated for each daytime interval, excluding naps. Evening chronotype was defined as having a daytime interval midpoint at or after 16:15:00 (4:15:00 PM). RESULTS BD versus controls had delayed daytime midpoint (mean ± standard deviation) (16:49:07 ± 01:26:19 versus 16:12:51 ± 01:02:14, p < 0.01), and greater midpoint variability (73.3 ± 33.9 min versus 58.1 ± 18.3 min, p < 0.01). Stratifying by gender and age, females and adolescents with BD had delayed and more variable daytime midpoints versus controls. Adults with BD had greater midpoint variability than controls. Within-person mean and standard deviations of daytime midpoints were highly correlated with sleep midpoints (r = 0.99, p < 0.01 and r = 0.86, p < 0.01, respectively). Daytime midpoint mean was also significantly correlated with the CSM (r = -0.56, p < 0.01). LIMITATIONS Small sample size; analyses not fully accounting for daytime napping. CONCLUSIONS Wrist actigraphy for determination of daytime midpoints is a potential tool to identify objective chronotype. Exploration of the use of consumer devices (wearables/smartphones) is needed.
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Affiliation(s)
- Christopher N. Kaufmann
- Division of Geriatrics and Gerontology, Department of Medicine, University of California San Diego, La Jolla, CA,Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA
| | - Anda Gershon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Colin A. Depp
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA,Department of Psychiatry, University of California San Diego, La Jolla, CA
| | - Shefali Miller
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Jamie M. Zeitzer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | - Terence A. Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
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Cheung J, Zeitzer JM, Lu H, Mignot E. Validation of minute-to-minute scoring for sleep and wake periods in a consumer wearable device compared to an actigraphy device. Sleep Science Practice 2018. [DOI: 10.1186/s41606-018-0029-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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