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Messman BA, Wiley JF, Feldman E, Dietch JR, Taylor DJ, Slavish DC. Irregular sleep is linked to poorer mental health: A pooled analysis of eight studies. Sleep Health 2024:S2352-7218(24)00060-3. [PMID: 38704353 DOI: 10.1016/j.sleh.2024.03.004] [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: 07/06/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES Greater sleep disturbances on average are a risk factor for impaired mental health. Recent research has shown that more intraindividual variability (i.e., inconsistency) in sleep (hereafter called "sleep intraindividual variability") may also be uniquely related to mental health, even above the influence of mean sleep patterns averaged across days. The current study examined associations between sleep intraindividual variability and symptoms of anxiety, depression, and insomnia across different facets of sleep intraindividual variability (sleep duration, efficiency, and timing) and sleep measurement types (sleep diary and actigraphy). METHODS We pooled eight datasets (N = 3053 participants) that assessed repeated measures of sleep diary- and/or actigraphy-determined sleep across multiple days, as well as one-time measures of mental health or sleep disorder symptoms (i.e., anxiety, depression, and insomnia). Multilevel regression analyses were conducted to examine associations between sleep intraindividual variability and mental health or sleep disorder symptoms. RESULTS Greater diary- and actigraphy-determined sleep duration intraindividual variability was associated with more depression symptoms (diary: b=0.02, p < .001; actigraphy: b=0.03, p = .006) and more insomnia symptoms (diary: b=0.02, p < .001; actigraphy: b=0.02, p < .001). Greater diary-determined sleep efficiency intraindividual variability was associated with fewer anxiety symptoms (b=-0.23, p = .019) and fewer insomnia symptoms (b=-0.15, p < .001). Greater diary- and actigraphy-determined sleep midpoint intraindividual variability was associated with more insomnia symptoms (diary: b=0.41, p = .044; actigraphy: b=0.66, p = .021). CONCLUSIONS More inconsistent sleep duration and sleep timing may be a correlate of poorer mental health. Future experimental work should examine whether stabilizing sleep patterns can improve mental health outcomes.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, Denton, Texas, USA.
| | - Joshua F Wiley
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Emily Feldman
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, Oregon, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, Texas, USA
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2
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Dietch JR, Blok AC, Zhou ES. Improve accessibility to evidence-based treatment for insomnia disorder. Transl Behav Med 2024; 14:301-303. [PMID: 38402594 PMCID: PMC11056884 DOI: 10.1093/tbm/ibae006] [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] [Indexed: 02/27/2024] Open
Abstract
The Society of Behavioral Medicine supports increasing access to evidence-based treatment of insomnia by addressing barriers at the patient, provider, and systemic levels including support from government agencies to raise awareness about sleep and sleep disorders, health payors providing fair reimbursement for evidence-based insomnia assessment and therapy consistent with standard of care recommendations, and relevant training programs (e.g. psychologists, nurses, physicians, social workers, licensed professional counselors) to prioritize sleep health education.
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Affiliation(s)
- Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Amanda C Blok
- VA Center for Clinical Management Research, Ann Arbor VA Healthcare System, Ann Arbor, MI, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Eric S Zhou
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
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3
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Burke CA, Seidler KJ, Rethorn ZD, Hoenig H, Allen K, Tabriz AA, Norman K, Murphy-McMillan LK, Sharpe J, Joseph LM, Dietch JR, Kosinski AS, Cantrell S, Gierisch JM, Ear B, Gordon A, Goldstein KM. Interventions to Improve Long-Term Adherence to Physical Rehabilitation: A Systematic Review. J Geriatr Phys Ther 2024:00139143-990000000-00044. [PMID: 38215396 DOI: 10.1519/jpt.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To evaluate the impact of physical rehabilitation interventions, supplemented with one or more adherence-enhancing components, on outcomes among adults with hip or knee osteoarthritis or chronic lower back pain. DESIGN Primary literature search from inception of each database to July 27, 2021, guided by relevant search terms and keywords to search titles and abstracts. All articles meeting eligibility criteria were included for data abstraction. DATA SOURCES MEDLINE, CINAHL Complete, and Embase. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomized and nonrandomized trials evaluating adherence-focused intervention components conducted in addition to an index usual care or usual care-like physical rehabilitation program among adults with hip or knee osteoarthritis or chronic low back pain. Eligible studies included a comparator group of the same index physical rehabilitation intervention without the adjunctive adherence components. Included studies measured outcomes at least 3 months after the rehabilitation course. RESULTS Of the 10 studies meeting inclusion criteria, 6 interventions were delivered concurrent to an index rehabilitation program and 4 were delivered sequentially. Of the 3 studies that reported a positive effect on long-term adherence, only 1 was a low risk of bias study. There is very limited evidence of a beneficial treatment effect of adjunct adherence interventions on long-term physical function, self-efficacy, or adverse events. CONCLUSION We found inadequate evidence evaluating adherence-enhancing interventions for the specific promotion of long-term adherence to home rehabilitation programs. Future studies should consider testing interventions specifically built to target behavioral maintenance of home rehabilitation programs.
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Affiliation(s)
- Colleen A Burke
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Katie J Seidler
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Zachary D Rethorn
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Helen Hoenig
- Durham VA Health Care System, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Kelli Allen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- University of North Carolina at Chapel Hill, Chapel Hill
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
- Department of Oncological Sciences, University of South Florida, Tampa, Florida
| | - Katherine Norman
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
| | | | - Jason Sharpe
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
| | - Letha M Joseph
- Durham VA Health Care System, Durham, North Carolina
- Duke University School of Nursing, Durham, North Carolina
| | - Jessica R Dietch
- Oregon State University School of Psychological Science, Corvallis
| | - Andrzej S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sarah Cantrell
- Duke University School of Medicine, Durham, North Carolina
| | - Jennifer M Gierisch
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Belinda Ear
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Adelaide Gordon
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
| | - Karen M Goldstein
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina
- Durham VA Medical Center Evidence Synthesis Program, Durham, North Carolina
- Durham VA Medical Center, Durham, North Carolina
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, North Carolina
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4
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Mundt JM, Schuiling MD, Warlick C, Dietch JR, Wescott AB, Hagenaars M, Furst A, Khorramdel K, Baron KG. Behavioral and psychological treatments for NREM parasomnias: A systematic review. Sleep Med 2023; 111:36-53. [PMID: 37716336 PMCID: PMC10591847 DOI: 10.1016/j.sleep.2023.09.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Non-rapid eye movement (NREM) parasomnias are often benign and transient, requiring no formal treatment. However, parasomnias can also be chronic, disrupt sleep quality, and pose a significant risk of harm to the patient or others. Numerous behavioral strategies have been described for the management of NREM parasomnias, but there have been no published comprehensive reviews. This systematic review was conducted to summarize the range of behavioral and psychological interventions and their efficacy. METHODS We conducted a systematic search of the literature to identify all reports of behavioral and psychological treatments for NREM parasomnias (confusional arousals, sexsomnia, sleepwalking, sleep terrors, sleep-related eating disorder, parasomnia overlap disorder). This review was conducted in line with PRISMA guidelines. The protocol was registered with PROSPERO (CRD42021230360). The search was conducted in the following databases (initially on March 10, 2021 and updated February 24, 2023): Ovid (MEDLINE), Cochrane Library databases (Wiley), CINAHL (EBSCO), PsycINFO (EBSCO), and Web of Science (Clarivate). Given a lack of standardized quantitative outcome measures, a narrative synthesis approach was used. Risk of bias assessment used tools from Joanna Briggs Institute. RESULTS A total of 72 publications in four languages were included, most of which were case reports (68%) or case series (21%). Children were included in 32 publications and adults in 44. The most common treatment was hypnosis (33 publications) followed by various types of psychotherapy (31), sleep hygiene (19), education/reassurance (15), relaxation (10), scheduled awakenings (9), sleep extension/scheduled naps (9), and mindfulness (5). Study designs and inconsistent outcome measures limited the evidence for specific treatments, but some evidence supports multicomponent CBT, sleep hygiene, scheduled awakenings, and hypnosis. CONCLUSIONS This review highlights the wide breadth of behavioral and psychological interventions for managing NREM parasomnias. Evidence for the efficacy of these treatments is limited by the retrospective and uncontrolled nature of most research as well as the infrequent use of validated quantitative outcome measures. Behavioral and psychological treatments have been studied alone and in various combinations, and recent publications suggest a trend toward preference for multicomponent cognitive behavioral therapies designed to specifically target priming and precipitating factors of NREM parasomnias.
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Affiliation(s)
- Jennifer M Mundt
- Department of Neurology, Northwestern University Feinberg School of Medicine, Abbott Hall 11th Floor, 710 N Lake Shore Drive, Chicago, IL, 60611, USA; Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, USA.
| | - Matthew D Schuiling
- Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford St., LD 119, Indianapolis, IN, 46202, USA.
| | - Chloe Warlick
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 710 N Lake Shore Drive, Chicago, IL, 60611, USA.
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR, 97331, USA.
| | - Annie B Wescott
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA.
| | - Muriel Hagenaars
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, Netherlands.
| | - Ansgar Furst
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Mailcode 151Y, Palo Alto, CA, 94304, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA; Department of Neurology and Neurological Sciences, Stanford University School of Medicine, USA; Polytrauma System of Care, VA Palo Alto Health Care System, USA.
| | - Kazem Khorramdel
- Department of Psychology and Education Science, Shiraz University, Shiraz, Fars, 71345, Iran.
| | - Kelly G Baron
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way Suite A, Room 142, Salt Lake City, UT, 84108, USA.
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5
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Zhuang YY, Wang LL, Song TH, Dietch JR, Wang TT, Qi M, Liu JM, Zhou SJ, Chen JX. Reliability and validity of the Chinese version of the Nightmare disorder index in adolescents. Stress Health 2023; 39:894-901. [PMID: 36719632 PMCID: PMC10387496 DOI: 10.1002/smi.3228] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/05/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
The Nightmare Disorder Index Questionnaire (NDI) was developed to measure the impact of nightmares. The purpose of this study was to investigate the psychometric properties of NDI among Chinese adolescents. This study investigated the validity and internal consistency of the Nightmare Disorder Index Chinese (NDI-CV) among 6014 Chinese adolescents who completed the NDI-CV, Nightmare Distress Questionnaire-Chinese Version (NDQ-CV), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Chinese Adolescent Daytime Sleepiness Scale (CADSS), Generalized Anxiety Disorder-7 Questionnaire (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). In addition, we investigated the test-retest reliability of the NDI-CV among 423 adolescents who completed a retest of the NDI-CV after a 2-week interval. Finally, NDI-CV demonstrated good psychometric properties in a sample of Chinese adolescents (Cronbach's α coefficient of 0.876), and the 95% confidence interval for the 2-week retest correlation coefficient was 0.675-0.977 (p < 0.001).
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Affiliation(s)
- Yun-Yue Zhuang
- Department of Psychology, Chengde Medical University, Chengde, China
| | - Lei-Lei Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Tian-He Song
- Department of Psychology, Chengde Medical University, Chengde, China
| | - Jessica R. Dietch
- School of Psychological Science, Oregon State University, Corvallis, Oregon, USA
| | | | - Meng Qi
- Department of Psychology, Chengde Medical University, Chengde, China
| | - Jin-Meng Liu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Shuang-Jiang Zhou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Jing-Xu Chen
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
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6
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Dietch JR, Huskey A, Dadeboe IO, Slavish DC, Taylor DJ. Intraindividual variability in sleep duration and college degree attainment. Chronobiol Int 2023; 40:1291-1295. [PMID: 37722693 PMCID: PMC10578456 DOI: 10.1080/07420528.2023.2256845] [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: 01/27/2023] [Accepted: 09/02/2023] [Indexed: 09/20/2023]
Abstract
The objective of the current study was to examine the relationship between sleep characteristics and college degree attainment. Participants were 968 college students (72% female; mean age 19.7 [1.7]). Participants completed a psychosocial and sleep questionnaire battery followed by one week of daily sleep diaries. Academic degree completion data was obtained from the university registrar 10 years later. Logistic regression examined whether mean and variability in sleep duration and sleep efficiency and insomnia symptoms predicted degree attainment, adjusting for age, gender, semester, grade point average (GPA), and perceived stress. The strongest predictors of degree attainment were female gender (OR = 0.67), greater age (OR = 1.32), GPA (OR = 1.97), and lower intraindividual variability in sleep duration (OR = 0.99). Results highlight the importance of examining variability in sleep duration in addition to mean sleep duration in predicting college retention. Future research should use a combination of objective and subjective measures to explore the impact of sleep factors, including variability, on degree completion and other academic metrics.
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Affiliation(s)
- Jessica R. Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR
| | - Alisa Huskey
- Department of Psychology, University of Arizona, Tucson, AZ
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7
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Taylor DJ, Pruiksma KE, Mintz J, Slavish DC, Wardle-Pinkston S, Dietch JR, Dondanville KA, Young-McCaughan S, Nicholson KL, Litz BT, Keane TM, Peterson AL, Resick PA. Treatment of comorbid sleep disorders and posttraumatic stress disorder in U.S. active duty military personnel: A pilot randomized clinical trial. J Trauma Stress 2023; 36:712-726. [PMID: 37322836 PMCID: PMC11057368 DOI: 10.1002/jts.22939] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 06/17/2023]
Abstract
Insomnia and nightmares are common in patients with posttraumatic stress disorder (PTSD). They are associated with worse psychological and physical health and worse PTSD treatment outcomes. In addition, they are resistant to PTSD treatments, which do not typically address sleep disorders. Cognitive behavioral therapy for insomnia and nightmares (CBT-I&N) and cognitive processing therapy (CPT) for PTSD are first-line treatments, but limited evidence exists guiding the treatment of individuals with all three disorders. The current study randomized U.S. military personnel (N = 93) to one of three conditions: CBT-I&N delivered before CPT, CBT-I&N delivered after CPT, or CPT alone; all groups received 18 sessions. Across groups, participants demonstrated significantly improved PTSD symptoms. Because the study was terminated prematurely due to challenges with recruitment and retention, it was underpowered to answer the initially intended research questions. Nonetheless, statistical findings and relevant clinically meaningful changes were observed. Compared to participants who received CPT alone, those who received CBT-I&N and CPT, regardless of sequencing, demonstrated larger improvements in PTSD symptoms, d = -0.36; insomnia, d = -0.77; sleep efficiency, d = 0.62; and nightmares, d = -.53. Compared to participants who received CBT-I&N delivered before CPT, those who received CBT-I&N delivered after CPT demonstrated larger improvements in PTSD symptoms, d = 0.48, and sleep efficiency, d = -0.44. This pilot study suggests that treating comorbid insomnia, nightmares, and PTSD symptoms results in clinically meaningful advantages in improvement for all three concerns compared to treating PTSD alone.
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Affiliation(s)
- Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
| | - Kristi E. Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Danica C. Slavish
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | | | - Jessica R. Dietch
- School of Psychological Science, Oregon State University, Corvallis, Oregon, USA
| | - Katherine A. Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Karin L. Nicholson
- Department of Medicine, Carl R. Darnall Army Medical Center, Fort Hood, Texas, USA
| | - Brett T. Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Terence M. Keane
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
- Behavioral Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, North Carolina, USA
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8
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Asbee J, Slavish D, Taylor DJ, Dietch JR. Using a frequentist and Bayesian approach to examine video game usage, substance use, and sleep among college students. J Sleep Res 2023; 32:e13844. [PMID: 36814416 PMCID: PMC10442460 DOI: 10.1111/jsr.13844] [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: 05/17/2022] [Revised: 09/26/2022] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
Video games are a popular form of entertainment. However, there is mixed evidence for the association between video game usage and poor sleep quality, short sleep duration, or delayed sleep timing. The current study examined associations between daily sleep behaviours and video game usage via a Bayesian and frequentist statistical approach. Caffeine and alcohol consumption were also assessed as moderators, as these behaviours may co-occur with video game usage and poor sleep. 1032 (72% female) undergraduate students were recruited between 2006-2007. Participants completed questionnaires examining video game and substance use, as well as sleep diaries for 1 week. Frequentist analyses revealed that video game usage was related to increased variability in the total sleep time, and a later average sleep midpoint, but not sleep efficiency. Alcohol use moderated the relationships between video game usage and both average and variability in total sleep time. Caffeine use was related to shorter average total sleep time and more variability in sleep efficiency. Alcohol consumption was related to more variability in the total sleep time and sleep midpoint, and a later average sleep midpoint. Bayesian models suggested strong evidence that video game playing was associated with later average sleep midpoint. Like the frequentist approach, alcohol consumption moderated the relationship between video game usage and both average and variability in total sleep time, but the evidence was weak. The effect sizes for both approaches tended to be small. Using a rigorous statistical approach and a large sample, this study provides robust evidence that video game usage may not be strongly associated with poor sleep among undergraduate students.
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Affiliation(s)
- Justin Asbee
- University of North Texas, Denton, Texas, USA
- University of Arkansas, Fayetteville, Arkansas, USA
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9
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Tully IA, Kim JP, Simpson N, Palaniappan L, Tutek J, Gumport NB, Dietch JR, Manber R. Beliefs about prescription sleep medications and interest in reducing hypnotic use: an examination of middle-aged and older adults with insomnia disorder. J Clin Sleep Med 2023; 19:1247-1257. [PMID: 36883379 PMCID: PMC10315611 DOI: 10.5664/jcsm.10552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 09/14/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
STUDY OBJECTIVES To examine beliefs about prescription sleep medications (hypnotics) among individuals with insomnia disorder seeking cognitive behavioral therapy for insomnia and predictors of wishing to reduce use. METHODS Baseline data was collected from 245 adults 50 years and older enrolled in the "RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice" study. T-tests compared characteristics of prescription sleep medication users with those of nonusers. Linear regression assessed predictors of patients' beliefs about sleep medication necessity and hypnotic-related concerns. Among users, we examined predictors of wishing to reduce sleep medications, including perceived hypnotic dependence, beliefs about medications, and demographic characteristics. RESULTS Users endorsed stronger beliefs about the necessity of sleep medications and less concern about potential harms than nonusers (P < .01). Stronger dysfunctional sleep-related cognitions predicted greater beliefs about necessity and concern about use (P < .01). Patients wishing to reduce sleep medications reported greater perceived hypnotic dependence than those disinterested in reduction (P < .001). Self-reported dependence severity was the strongest predictor of wishing to reduce use (P = .002). CONCLUSIONS Despite expressing strong beliefs about necessity, and comparatively less concern about taking sleep medications, three-quarters of users wished to reduce prescription hypnotics. Results may not generalize to individuals with insomnia not seeking nonpharmacological treatments. Upon completion, the "RCT of the Effectiveness of Stepped-Care Sleep Therapy in General Practice" study will provide information about the extent to which therapist-led and digital cognitive behavioral therapy for insomnia contribute to prescription hypnotic reduction. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The RESTING Insomnia Study: Randomized Controlled Study on Effectiveness of Stepped-Care Sleep Therapy (RESTING); URL: https://clinicaltrials.gov/ct2/show/NCT03532282; Identifier: NCT03532282. CITATION Tully IA, Kim JP, Simpson N, et al. Beliefs about prescription sleep medications and interest in reducing hypnotic use: an examination of middle-aged and older adults with insomnia disorder. J Clin Sleep Med. 2023;19(7):1247-1257.
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Affiliation(s)
- Isabelle A. Tully
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Jane P. Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Norah Simpson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- Department of Health Policy, Stanford University School of Medicine, Stanford, California
| | - Joshua Tutek
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Nicole B. Gumport
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Jessica R. Dietch
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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10
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Yoo J, Slavish D, Dietch JR, Kelly K, Ruggero C, Taylor DJ. Daily reactivity to stress and sleep disturbances: unique risk factors for insomnia. Sleep 2023; 46:zsac256. [PMID: 36301838 PMCID: PMC9905776 DOI: 10.1093/sleep/zsac256] [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: 11/24/2021] [Revised: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
STUDY OBJECTIVES To naturalistically measure sleep disturbances following stress exposure (i.e. sleep reactivity) and stress responses following sleep disturbances (i.e. stress reactivity) at the daily level and prospectively examine these reactivity measures as individual risk factors for insomnia. METHODS The study assessed 392 nurses' sleep and stress for 14 days using daily diaries and actigraphy. Self-reported insomnia symptoms were assessed at the end of the 14 days, as well as 6 and 11 months later. RESULTS In multilevel modeling, while negative fixed effects indicated that shorter total sleep time (TST) and lower sleep efficiency led to greater stress and vice versa, significant random effects indicated individual variability in sleep reactivity and stress reactivity. In latent score change modeling, greater sleep reactivity (lower diary-determined sleep efficiency following greater stress) and greater stress reactivity (greater stress following shorter diary-determined TST) at baseline were associated with greater insomnia symptoms at 11 months (b = 10.34, p = .026; b = 7.83, p = .03). Sleep reactivity and stress reactivity also interacted to predict insomnia symptoms, such that sleep reactivity was significantly associated with insomnia symptoms for those with high (+1 SD) stress reactivity (b = 17.23, p = .001), but not for those with low (-1 SD) stress reactivity (b = 5.16, p = .315). CONCLUSIONS Baseline stress reactivity and sleep reactivity independently as well as jointly predict greater insomnia symptoms 11 months later. The findings delineate processes underlying the stress-diathesis model of insomnia and highlight the utility of longitudinal and naturalistic measures of sleep and stress reactivity.
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Affiliation(s)
- Jiah Yoo
- Department of Psychology, University of Arizona, 1503 E University Blvd. Tucson, AZ 85721, USA
| | - Danica Slavish
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, 2950 SW Jefferson Way, Corvallis, OR 97331, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| | - Camilo Ruggero
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, 1503 E University Blvd. Tucson, AZ 85721, USA
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11
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Badon SE, Dietch JR, Simpson N, Lyell DJ, Manber R. Daytime napping and nighttime sleep in pregnant individuals with insomnia disorder. J Clin Sleep Med 2023; 19:371-377. [PMID: 36448328 PMCID: PMC9892727 DOI: 10.5664/jcsm.10350] [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: 07/15/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 12/02/2022]
Abstract
STUDY OBJECTIVES Examine bidirectional associations between daytime napping and nighttime sleep among pregnant individuals with insomnia disorder. METHODS We used baseline data from a randomized controlled trial of insomnia treatment during pregnancy (n = 116). Participants in their second or third trimester of pregnancy self-reported daytime napping and nighttime sleep parameters using a sleep diary and wore an Actiwatch-2 during the same 7-day period. Linear regression models, accounting for intraindividual correlation, were used to estimate associations between daytime napping and nighttime sleep parameters (duration, efficiency, quality, awakenings). Models were also stratified by trimester of pregnancy. RESULTS Sixty-three percent of participants reported napping on at least 1 day. Among participants in the second trimester (65%), napping 15-59 minutes was associated with 6.3% greater self-reported sleep efficiency (95% confidence interval: 2.3, 10.2) and 0.5 units greater self-reported sleep quality (95% confidence interval: 0.0, 0.9) that night; napping 60+ minutes was associated with 0.6 hours shorter actigraphy-measured sleep duration (95% confidence interval: -1.0, -0.2). Napping was not associated with nighttime sleep overall or during the third trimester. Nighttime sleep parameters were not associated with napping duration the following day. CONCLUSIONS Among pregnant individuals with insomnia in the second trimester, short napping duration was associated with higher self-reported sleep efficiency and quality; long napping duration was associated with shorter actigraphy-measured sleep duration. Additional research is needed to examine the interaction between nap duration and nap timing. In the future, these results may lead to more nuanced recommendations for daytime napping among pregnant individuals with insomnia disorder. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Treatment for Insomnia during Pregnancy; URL: https://clinicaltrials.gov/ct2/show/NCT01846585; Identifier: NCT01846585. CITATION Badon SE, Dietch R, Simpson N, Lyell DJ, Manber R. Daytime napping and nighttime sleep in pregnant individuals with insomnia disorder. J Clin Sleep Med. 2023;19(2):371-377.
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Affiliation(s)
- Sylvia E. Badon
- Kaiser Permanente Northern California Division of Research, Oakland, California
| | | | - Norah Simpson
- Stanford University School of Medicine, Stanford, California
| | | | - Rachel Manber
- Stanford University School of Medicine, Stanford, California
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12
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Abstract
BACKGROUND Individuals with poor sleep (e.g., insomnia) and mental health (e.g., depression) experience negative stigma but no studies have examined the relationship between stigma and evening chronotype. The present mixed methods study aimed to assess and describe explicit and implicit attitudes about evening and morning chronotypes in a sample of emerging adults. PARTICIPANTS 49 undergraduates (Mage = 19.9 [SD = 1.5], 83.7% female). METHODS Participants completed self-reports of demographics and chronotype. Attitudes about "night owls" and "early birds" were measured with self-report questionnaires (explicit attitudes) and an Implicit Association Task (implicit attitudes). Participants described associations with evening and morning chronotypes in free-text responses, which were qualitatively coded. RESULTS We found evidence of implicit bias against night owls and for early birds. The positive mean implicit d score was 0.57 (SD = 0.47), indicating a moderate implicit bias for pairing "bad" with "night owl" and "good" with "early bird." No baseline characteristics, including chronotype, were significantly associated with implicit bias. Analyses of explicit bias revealed participants perceived night owls as significantly more lazy, unhealthy, undisciplined, immature, creative, and young. Analysis of free-text responses provided further evidence of these associations. CONCLUSIONS Consistent with hypothesis, undergraduates demonstrated predominantly negative implicit and explicit stigma toward evening chronotypes compared to morning types. As stigma can lead to adverse consequences, future studies should assess the impact of negative societal and self-stigma on evening types. Consideration of societal stigma within clinical intervention contexts could have the potential to reduce shame or other emotions that interfere with sleep.
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Affiliation(s)
- Jessica R Dietch
- Department of Psychology, University of North Texas, Denton, Texas, USA.,School of Psychological Science, Oregon State University, Corvallis, Oregon, USA
| | - Megan Douglas
- Department of Psychology, University of North Texas, Denton, Texas, USA.,Trauma Research Consortium, Baylor Scott & White Research Institute, Dallas, Texas, USA
| | - Kelly Kim
- Department of Psychology, The University of Arizona, Tucson, Arizona, USA
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13
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Farmer HR, Slavish DC, Ruiz J, Dietch JR, Ruggero CJ, Messman BA, Kelly K, Kohut M, Taylor DJ. Racial/ethnic variations in inflammatory markers: exploring the role of sleep duration and sleep efficiency. J Behav Med 2022; 45:855-867. [PMID: 36029411 PMCID: PMC10062430 DOI: 10.1007/s10865-022-00357-8] [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: 03/25/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022]
Abstract
Individuals from minoritized racial/ethnic groups have higher levels of circulating inflammatory markers. However, the mechanisms underlying these differences remain understudied. The objective of this study was to examine racial/ethnic variations in multiple markers of inflammation and whether impaired sleep contributes to these racial/ethnic differences. Nurses from two regional hospitals in Texas (n = 377; 71.62% White; 6.90% Black; 11.14% Hispanic, 10.34% Asian; mean age = 39.46; 91.78% female) completed seven days of sleep diaries and actigraphy to assess mean and variability in total sleep time (TST) and sleep efficiency (SE). On day 7, blood was drawn to assess 4 inflammatory markers: C-reactive protein (CRP), Interleukin-6 (IL-6), Interleukin-1 beta (IL-1β), and tumor necrosis factor-alpha (TNF-α). Results from regression models showed differences in inflammatory markers by race/ethnicity, adjusting for age and gender. The associations between sleep parameters and inflammatory markers also varied by race/ethnicity. Among White nurses, lower mean and greater variability in actigraphy-determined TST and greater variability in diary-determined TST were associated with higher levels of IL-6. Among Black nurses, lower mean diary-determined SE was associated with higher levels of IL-6 and IL-1β. Among Hispanic nurses, greater diary-determined mean TST was associated with higher CRP. Among Asian nurses, greater intraindividual variability in actigraphy-determined SE was associated with lower CRP. Among nurses, we did not find racial/ethnic disparities in levels of inflammation. However, analyses revealed differential relationships between sleep and inflammatory markers by race/ethnicity. Results highlight the importance of using a within-group approach to understand predictors of inflammatory markers.
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Affiliation(s)
- Heather R Farmer
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, 19716, USA.
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - John Ruiz
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Marian Kohut
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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14
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Messman BA, Wiley JF, Yap Y, Tung YC, Almeida IM, Dietch JR, Taylor DJ, Slavish DC. How much does sleep vary from night-to-night? A quantitative summary of intraindividual variability in sleep by age, gender, and racial/ethnic identity across eight-pooled datasets. J Sleep Res 2022; 31:e13680. [PMID: 35811092 PMCID: PMC9649840 DOI: 10.1111/jsr.13680] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
Habitual sleep duration and efficiency vary widely by age, gender, and racial/ethnic identity. Despite growing research on the importance of night-to-night, intraindividual variability (IIV) in sleep, few studies have examined demographic differences in sleep IIV. The present study describes typical sleep IIV overall and by demographics among healthy sleepers. Eight datasets of healthy sleepers (N = 2,404; 26,121 total days of sleep data) were synthesised to examine age, gender, and racial/ethnic identity differences in sleep IIV measured via diaries, actigraphy, and electroencephalography (EEG). Sleep IIV estimates included the intraindividual standard deviation (iSD), root mean square of successive differences (RMSSD), coefficient of variation (CV), and a validated Bayesian Variability Model (BVM). There was substantial IIV in sleep across measurement types (diary, actigraphy, EEG) for both sleep duration (iSD: 85.80 [diary], 77.41 [actigraphy], 67.04 [EEG] minutes; RMSSD: 118.91, 108.89, 91.93 minutes; CV: 19.19%, 19.11%, 18.57%; BVM: 60.60, 58.20, 48.60 minutes) and sleep efficiency (iSD: 5.18% [diary], 5.22% [actigraphy], 6.46% [EEG]; RMSSD: 7.01%, 7.08%, 8.44%; CV: 5.80%, 6.27%, 8.14%; BVM: 3.40%, 3.58%, 4.16%). Younger adults had more diary and actigraphy sleep duration IIV. Gender differences were inconsistent. White and non-Hispanic/Latinx adults had less IIV in sleep duration and efficiency compared to racial/ethnic minority groups. Even among healthy sleepers, sleep varies widely from night-to-night. Like mean sleep, there also may be disparities in IIV in sleep by demographic characteristics. Study results help characterise normative values of sleep IIV in healthy sleepers.
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Affiliation(s)
- Brett A. Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Joshua F. Wiley
- Turner Institute for Brain and Mental Health, Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Yang Yap
- Turner Institute for Brain and Mental Health, Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Yan Chi Tung
- Turner Institute for Brain and Mental Health, Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Isamar M. Almeida
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Jessica R. Dietch
- Department of Psychology, University of North Texas, Denton, TX, USA
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Daniel J. Taylor
- Department of Psychology, University of North Texas, Denton, TX, USA
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Danica C. Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
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15
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Taylor DJ, Dietch JR, Wardle-Pinkston S, Slavish DC, Messman B, Ruggero CJ, Kelly K. Shift Work Disorder Index: initial validation and psychosocial associations in a sample of nurses. J Clin Sleep Med 2022; 18:2339-2351. [PMID: 35702020 PMCID: PMC9516570 DOI: 10.5664/jcsm.10108] [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: 01/03/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Shift work is common yet does not always result in Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5)-defined shift work sleep disorder (SWD). This study reports on the reliability and validity of the DSM-5 informed Shift Work Disorder Index (SWDI), the presence of probable SWD in nurses, and demographic, sleep, and psychosocial correlates. METHODS Nurses (n = 454) completed the SWDI, psychosocial, and demographic questionnaires. Of the sample, n = 400 completed 14 days of sleep diaries, actigraphy, and additional questionnaires. RESULTS The global SWDI demonstrated excellent internal consistency (α = .94), as well as good convergent and divergent validity in the nurse sample. Thirty-one percent of nurses were past-month shift workers, with 14% (ie, 44% of shift workers) having probable SWD based on SWDI. Nurses who worked shift work and/or met SWD criteria were more likely to be younger and unmarried and less likely to have children than day workers and reported greater evening chronotype, insomnia, nightmares, and sleep-related impairment, greater depression, anxiety, posttraumatic stress, and perceived stress symptoms, as well as later and more variable sleep midpoint (actigraphy), shorter sleep duration (actigraphy, diaries), and lower sleep efficiency (diaries). CONCLUSIONS The SWDI is an efficient and valid self-report assessment of DSM-5-defined SWD. Shift work and/or SWD were prevalent and associated with worse sleep and psychosocial health, particularly among nurses with probable SWD. CITATION Taylor DJ, Dietch JR, Wardle-Pinkston S, et al. Shift Work Disorder Index: initial validation and psychosocial associations in a sample of nurses. J Clin Sleep Med. 2022;18(10):2339-2351.
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Affiliation(s)
- Daniel J. Taylor
- Department of Psychology, University of North Texas, Denton, Texas
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Jessica R. Dietch
- Department of Psychology, University of North Texas, Denton, Texas
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Sophie Wardle-Pinkston
- Department of Psychology, University of North Texas, Denton, Texas
- Department of Psychology, University of Arizona, Tucson, Arizona
| | | | - Brett Messman
- Department of Psychology, University of North Texas, Denton, Texas
| | | | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, Texas
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16
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Slavish DC, Contractor AA, Dietch JR, Messman B, Lucke HR, Briggs M, Thornton J, Ruggero C, Kelly K, Kohut M, Taylor DJ. Characterizing Patterns of Nurses' Daily Sleep Health: a Latent Profile Analysis. Int J Behav Med 2022; 29:648-658. [PMID: 34988862 PMCID: PMC9253202 DOI: 10.1007/s12529-021-10048-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nursing is a demanding occupation characterized by dramatic sleep disruptions. Yet most studies on nurses' sleep treat sleep disturbances as a homogenous construct and do not use daily measures to address recall biases. Using person-centered analyses, we examined heterogeneity in nurses' daily sleep patterns in relation to psychological and physical health. METHODS Nurses (N = 392; 92% female, mean age = 39.54 years) completed 14 daily sleep diaries to assess sleep duration, efficiency, quality, and nightmare severity, as well as measures of psychological functioning and a blood draw to assess inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP). Using recommended fit indices and a 3-step approach, latent profile analysis was used to identify the best-fitting class solution. RESULTS The best-fitting solution suggested three classes: (1) "Poor Overall Sleep" (11.2%), (2) "Nightmares Only" (8.4%), (3) "Good Overall Sleep" (80.4%). Compared to nurses in the Good Overall Sleep class, nurses in the Poor Overall Sleep or Nightmares Only classes were more likely to be shift workers and had greater stress, PTSD symptoms, depression, anxiety, and insomnia severity. In multivariate models, every one-unit increase in insomnia severity and IL-6 was associated with a 33% and a 21% increase in the odds of being in the Poor Overall Sleep compared to the Good Overall Sleep class, respectively. CONCLUSION Nurses with more severe and diverse sleep disturbances experience worse health and may be in greatest need of sleep-related and other clinical interventions.
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17
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Ten Brink M, Dietch JR, Tutek J, Suh SA, Gross JJ, Manber R. Sleep and affect: A conceptual review. Sleep Med Rev 2022; 65:101670. [PMID: 36088755 PMCID: PMC10228665 DOI: 10.1016/j.smrv.2022.101670] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 12/02/2021] [Revised: 06/15/2022] [Accepted: 07/08/2022] [Indexed: 10/15/2022]
Abstract
Everyday experience suggests that sleep and affect are closely linked, with daytime affect influencing how we sleep, and sleep influencing subsequent affect. Yet empirical evidence for this bidirectional relationship between sleep and affect in non-clinical adult samples remains mixed, which may be due to heterogeneity in both construct definitions and measurement. This conceptual review proposes a granular framework that deconstructs sleep and affect findings according to three subordinate dimensions, namely domains (which are distinct for sleep and affect), methods (i.e., self-report vs. behavioral/physiological measures), and timescale (i.e., shorter vs. longer). We illustrate the value of our granular framework through a systematic review of empirical studies published in PubMed (N = 80 articles). We found that in some cases, particularly for sleep disturbances and sleep duration, our framework identified robust evidence for associations with affect that are separable by domain, method, and timescale. However, in most other cases, evidence was either inconclusive or too sparse, resulting in no clear patterns. Our review did not find support for granular bidirectionality between sleep and affect. We suggest a roadmap for future studies based on gaps identified by our review and discuss advantages and disadvantages of our granular dimensional framework.
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Affiliation(s)
- Maia Ten Brink
- Department of Psychology, Stanford University, Stanford, CA, USA.
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Joshua Tutek
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Sooyeon A Suh
- Department of Psychology, Sungshin University, Seoul, South Korea
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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18
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Lewinski AA, Walsh C, Rushton S, Soliman D, Carlson SM, Luedke MW, Halpern DJ, Crowley MJ, Shaw RJ, Sharpe JA, Alexopoulos AS, Tabriz AA, Dietch JR, Uthappa DM, Hwang S, Ball Ricks KA, Cantrell S, Kosinski AS, Ear B, Gordon AM, Gierisch JM, Williams JW, Goldstein KM. Telehealth for the Longitudinal Management of Chronic Conditions: Systematic Review. J Med Internet Res 2022; 24:e37100. [PMID: 36018711 PMCID: PMC9463619 DOI: 10.2196/37100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/12/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Extensive literature support telehealth as a supplement or adjunct to in-person care for the management of chronic conditions such as congestive heart failure (CHF) and type 2 diabetes mellitus (T2DM). Evidence is needed to support the use of telehealth as an equivalent and equitable replacement for in-person care and to assess potential adverse effects. OBJECTIVE We conducted a systematic review to address the following question: among adults, what is the effect of synchronous telehealth (real-time response among individuals via phone or phone and video) compared with in-person care (or compared with phone, if synchronous video care) for chronic management of CHF, chronic obstructive pulmonary disease, and T2DM on key disease-specific clinical outcomes and health care use? METHODS We followed systematic review methodologies and searched two databases (MEDLINE and Embase). We included randomized or quasi-experimental studies that evaluated the effect of synchronously delivered telehealth for relevant chronic conditions that occurred over ≥2 encounters and in which some or all in-person care was supplanted by care delivered via phone or video. We assessed the bias using the Cochrane Effective Practice and Organization of Care risk of bias (ROB) tool and the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation. We described the findings narratively and did not conduct meta-analysis owing to the small number of studies and the conceptual heterogeneity of the identified interventions. RESULTS We identified 8662 studies, and 129 (1.49%) were reviewed at the full-text stage. In total, 3.9% (5/129) of the articles were retained for data extraction, all of which (5/5, 100%) were randomized controlled trials. The CHF study (1/5, 20%) was found to have high ROB and randomized patients (n=210) to receive quarterly automated asynchronous web-based review and follow-up of telemetry data versus synchronous personal follow-up (in-person vs phone-based) for 1 year. A 3-way comparison across study arms found no significant differences in clinical outcomes. Overall, 80% (4/5) of the studies (n=466) evaluated synchronous care for patients with T2DM (ROB was judged to be low for 2, 50% of studies and high for 2, 50% of studies). In total, 20% (1/5) of the studies were adequately powered to assess the difference in glycosylated hemoglobin level between groups; however, no significant difference was found. Intervention design varied greatly from remote monitoring of blood glucose combined with video versus in-person visits to an endocrinology clinic to a brief, 3-week remote intervention to stabilize uncontrolled diabetes. No articles were identified for chronic obstructive pulmonary disease. CONCLUSIONS This review found few studies with a variety of designs and interventions that used telehealth as a replacement for in-person care. Future research should consider including observational studies and studies on additional highly prevalent chronic diseases.
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Affiliation(s)
- Allison A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- School of Nursing, Duke University, Durham, NC, United States
| | - Conor Walsh
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Sharron Rushton
- School of Nursing, Duke University, Durham, NC, United States
| | - Diana Soliman
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Scott M Carlson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Matthew W Luedke
- Department of Neurology, Duke University Medical Center, Durham, NC, United States
- Neurodiagnostic Center, Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - David J Halpern
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke Primary Care, Duke University Medical Center, Durham, NC, United States
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Ryan J Shaw
- School of Nursing, Duke University, Durham, NC, United States
| | - Jason A Sharpe
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Anastasia-Stefania Alexopoulos
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR, United States
| | - Diya M Uthappa
- Doctor of Medicine Program, Duke University School of Medicine, Durham, NC, United States
| | - Soohyun Hwang
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Katharine A Ball Ricks
- Cecil G Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, NC, United States
| | - Sarah Cantrell
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, United States
| | - Andrzej S Kosinski
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, United States
| | - Belinda Ear
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Adelaide M Gordon
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
| | - Jennifer M Gierisch
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
| | - John W Williams
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United States
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19
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Slavish DC, Dietch JR, Kane HS, Messman BA, Garcia O, Wiley JF, Yap Y, Kelly K, Ruggero C, Taylor DJ. Daily stress and sleep associations vary by work schedule: A between- and within-person analysis in nurses. J Sleep Res 2022; 31:e13506. [PMID: 34668259 PMCID: PMC10983823 DOI: 10.1111/jsr.13506] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 01/21/2023]
Abstract
Nurses experience poor sleep and high stress due to demanding work environments. Night shift work is common among nurses and may exacerbate stress-sleep associations. We examined bidirectional associations between daily stress and sleep, and moderation by recent shift worker status and daily work schedule among nurses. Participants were 392 nurses (92% female; 78% White, mean age = 39.54, SD = 11.15) who completed 14 days of electronic sleep diaries and actigraphy. They simultaneously completed assessments of daily stress and work schedule upon awakening (day shift vs. night shift [work between 9 p.m.-6 a.m.] vs. off work). Participants were classified as recent night shift workers if they worked at least one night shift during the past 14 days (n = 101; 26%). In the entire sample, greater daily stress predicted shorter self-reported total sleep time and lower self-reported sleep efficiency that night. Shorter self-reported and actigraphy total sleep time and lower self-reported sleep efficiency predicted higher next-day stress. Compared with recent night shift workers, day workers reported higher stress after nights with shorter total sleep time. Stress-sleep associations mostly did not vary by nurses' daily work schedule. Sleep disturbances and stress may unfold in a toxic cycle and are prime targets for tailored interventions among nurses. Night shift workers may be less susceptible to the effects of short sleep on next-day stress. Research is needed to understand the short- and long-term effects of shift work and address the unique sleep challenges nurses face.
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Affiliation(s)
- Danica C Slavish
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Jessica R Dietch
- Department of Psychology, Oregon State University, Corvallis, Oregon, USA
| | - Heidi S Kane
- Department of Psychology, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Brett A Messman
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Odalis Garcia
- Department of Psychology, North Dakota State University, Fargo, North Dakota, USA
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Vic., Australia
| | - Yang Yap
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Vic., Australia
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Camilo Ruggero
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
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20
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Shepherd-Banigan M, Drake C, Dietch JR, Shapiro A, Tabriz AA, Van Voorhees EE, Uthappa DM, Wang TW, Lusk JB, Rossitch SS, Fulton J, Gordon A, Ear B, Cantrell S, Gierisch JM, Williams JW, Goldstein KM. Primary Care Engagement Among Individuals with Experiences of Homelessness and Serious Mental Illness: an Evidence Map. J Gen Intern Med 2022; 37:1513-1523. [PMID: 35237885 PMCID: PMC9085989 DOI: 10.1007/s11606-021-07244-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Experiences of homelessness and serious mental illness (SMI) negatively impact health and receipt of healthcare. Interventions that promote the use of primary care services for people with both SMI and homelessness may improve health outcomes, but this literature has not been evaluated systematically. This evidence map examines the breadth of literature to describe what intervention strategies have been studied for this population, elements of primary care integration with other services used, and the level of intervention complexity to highlight gaps for future intervention research and program development. METHODS We followed an a priori protocol developed in collaboration with clinical stakeholders. We systematically searched the published literature to identify interventions for adults with homelessness who also had SMI. We excluded case reports, editorials, letters, and conference abstracts. Data abstraction methods followed standard practice. Data were categorized into intervention strategies and primary care integration strategies. Then we applied the Complexity Assessment Tool for Systematic Reviews (iCAT_SR) to characterize intervention complexity. RESULTS Twenty-two articles met our inclusion criteria evaluating 15 unique interventions to promote engagement in primary care for adults with experiences of homelessness and SMI. Study designs varied widely from randomized controlled trials and cohort studies to single-site program evaluations. Intervention strategies varied across studies but primarily targeted patients directly (e.g., health education, evidence-based interactions such as motivational interviewing) with fewer strategies employed at the clinic (e.g., employee training, multidisciplinary teams) or system levels (e.g., data sharing). We identified elements of primary care integration, including referral strategies, co-location, and interdisciplinary care planning. Interventions displayed notable complexity around the number of intervention components, interaction between intervention components, and extent to which interventions were tailored to specific patient populations. DISCUSSION We identified and categorized elements used in various combinations to address the primary care needs of individuals with experiences of homeless and SMI.
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Affiliation(s)
- Megan Shepherd-Banigan
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, USA.
- Margolis Center for Health Policy, Duke University, Durham, NC, USA.
| | - Connor Drake
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR, USA
| | - Abigail Shapiro
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
- Department of Oncological Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Elizabeth E Van Voorhees
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Diya M Uthappa
- Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Tsai-Wei Wang
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Jay B Lusk
- Duke University School of Medicine, Durham, NC, USA
- Duke University Fuqua School of Business, Durham, NC, USA
| | | | - Jessica Fulton
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Adelaide Gordon
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Belinda Ear
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Sarah Cantrell
- Duke University School of Medicine, Durham, NC, USA
- Duke University Medical Center Library & Archives, Durham, USA
| | - Jennifer M Gierisch
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - John W Williams
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - Karen M Goldstein
- Durham Center of Innovation To Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University, Durham, NC, USA
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21
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Manber R, Tully IA, Palaniappan L, Kim JP, Simpson N, Zulman DM, Goldhaber-Fiebert JD, Rangel E, Dietch JR, Rosas LG. RCT of the effectiveness of stepped-care sleep therapy in general practice: The RESTING study protocol. Contemp Clin Trials 2022; 116:106749. [PMID: 35367385 PMCID: PMC10159730 DOI: 10.1016/j.cct.2022.106749] [Citation(s) in RCA: 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: 10/25/2021] [Revised: 03/07/2022] [Accepted: 03/28/2022] [Indexed: 11/03/2022]
Abstract
Cognitive behavioral therapy for insomnia (CBT-I) is an effective, non-pharmacological intervention, designated by the American College of Physicians as the first-line treatment of insomnia disorder. The current randomized controlled study uses a Hybrid-Type-1 design to compare the effectiveness and implementation potential of two approaches to delivering CBT-I in primary care. One approach offers therapy to all patients through an automated, digital CBT-I program (ONLINE-ONLY). The other is a triaged STEPPED-CARE approach that uses a simple Decision Checklist to start patients in either digital or therapist-led treatment; patients making insufficient progress with digital treatment at 2 months are switched to therapist-led treatment. We will randomize 240 individuals (age 50 or older) with insomnia disorder to ONLINE-ONLY or STEPPED-CARE arms. The primary outcomes are insomnia severity and hypnotic medication use, assessed at baseline and at months 2, 4, 6, 9, and 12 after randomization. We hypothesize that STEPPED-CARE will be superior to ONLINE-ONLY in reducing insomnia severity and hypnotic use. We also aim to validate the Decision Checklist and explore moderators of outcome. Additionally, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we will use mixed methods to obtain data on the potential for future dissemination and implementation of each approach. This triaged stepped-care approach has the potential to improve sleep, reduce use of hypnotic medications, promote safety, offer convenient access to treatment, and support dissemination of CBT-I to a large number of patients currently facing barriers to accessing treatment. Clinical trial registration:NCT03532282.
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Affiliation(s)
- Rachel Manber
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Isabelle A Tully
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Latha Palaniappan
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jane P Kim
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Norah Simpson
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Donna M Zulman
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jeremy D Goldhaber-Fiebert
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, USA; Center for Health Policy, Freeman Spogli Institute, Stanford University, Stanford, CA 94305, USA
| | - Elizabeth Rangel
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; SDSU/ UC San Diego Joint Doctoral Program in Clinical Psychology, University of California, San Diego, San Diego State University, San Diego, CA 92120, USA
| | - Jessica R Dietch
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA; School of Psychological Science, Oregon State University, Corvallis, OR 97331, USA
| | - Lisa G Rosas
- Center for Health Policy, Freeman Spogli Institute, Stanford University, Stanford, CA 94305, USA
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22
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Cassiello-Robbins C, Dietch JR, Mochrie KD, Elbogen E, Rosenthal MZ. When does modifying the protocol go too far? Considerations for implementing evidence-based treatment in practice. Am Psychol 2022; 77:853-867. [PMID: 35357868 DOI: 10.1037/amp0000993] [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: 11/08/2022]
Abstract
The majority of evidence-based psychological treatments (EBTs) are packaged as manuals that provide guidance regarding when and how to deliver specific interventions (e.g., cognitive restructuring, exposure). However, clinical practice regularly necessitates flexibility in the timing and delivery of treatment strategies. Indeed, research on the dissemination and implementation of EBTs has highlighted the need to adapt these treatments to fit the needs of specific settings or patient populations. Adapting a treatment also means changing it from its original, evidence-based format, raising questions about how much or in which ways a treatment can be altered before it is no longer reflective of the original EBT. The purpose of this article is to discuss factors that contribute to the challenge of adapting EBTs, highlight considerations for clinicians with regard to modifying EBTs, and propose directions for future research that can provide guidelines for adapting EBTs in the future. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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23
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Miles SR, Pruiksma KE, Slavish D, Dietch JR, Wardle-Pinkston S, Litz BT, Rodgers M, Nicholson KL, Young-McCaughan S, Dondanville KA, Nakase-Richardson R, Mintz J, Keane TM, Peterson AL, Resick PA, Taylor DJ. Sleep disorder symptoms are associated with greater posttraumatic stress and anger symptoms in U.S. army service members seeking treatment for PTSD. J Clin Sleep Med 2022; 18:1617-1627. [PMID: 35197191 DOI: 10.5664/jcsm.9926] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Characterize associations between sleep impairments and posttraumatic stress disorder (PTSD) symptoms, including anger, in service members seeking treatment for PTSD. METHODS Ninety-three US Army personnel recruited into a PTSD treatment study completed the baseline assessment. State of the science sleep measurements included (1) retrospective, self-reported insomnia, (2) prospective sleep diaries assessing sleep patterns and nightmares, and (3) polysomnography (PSG) measured sleep architecture and obstructive sleep apnea-hypopnea (OSAH) severity. Dependent variables included self-report measures of PTSD severity and anger severity. Pearson correlations and multiple linear regression analyses examined if sleep symptoms, not generally measured in PTSD populations, were associated with PTSD and anger severity. RESULTS All participants met PTSD, insomnia, and nightmare diagnostic criteria. Mean sleep efficiency = 70%, total sleep time = 5.5 hours, obstructive sleep apnea/hypopnea (OSAH index ≥ 5) = 53%, and clinically significant anger = 85%. PTSD severity was associated with insomnia severity (β =.58), nightmare severity (β = .24), nightmare frequency (β = .31), and time spent in Stage 1 sleep (β = .27, all p < .05). Anger severity was associated with insomnia severity (β =37), nightmare severity (β = .28), and OSAH during rapid eye movement (β = .31, all p < .05). CONCLUSIONS Insomnia and nightmares were related to PTSD and anger severity, and OSAH was related to anger. Better assessment and evidence-based treatment of these comorbid sleep impairments in service members with PTSD and significant anger, should result in better PTSD, anger, and quality of life outcomes. CLINICAL TRIALS REGISTRATION Registry: ClinicalTrials.gov; Name: Treatment of Comorbid Sleep Disorders and Post Traumatic Stress Disorder; Identifier: NCT02773693; URL: https://clinicaltrials.gov/ct2/show/NCT02773693.
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Affiliation(s)
- Shannon R Miles
- James A. Haley Veterans' Hospital, Tampa, FL.,Division of Psychiatry & Behavioral Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Danica Slavish
- Department of Psychology, University of North Texas, Denton, TX
| | - Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR
| | | | - Brett T Litz
- Massachusetts Veterans Epidemiological Research and Information Center, VA Boston Healthcare System, Boston, MA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA.,Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | | | | | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Katherine A Dondanville
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Risa Nakase-Richardson
- James A. Haley Veterans' Hospital, Tampa, FL.,Division of Pulmonary and Sleep Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Terence M Keane
- Department of Psychiatry, Boston University School of Medicine, Boston, MA.,Behavioral Science Division, National Center for PTSD at VA Boston Healthcare System, Boston, MA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX
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24
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Wilkerson AK, Wardle-Pinkston S, Dietch JR, Pruiksma KE, Simmons RO, Bunnell BE, Taylor DJ. Web-based provider training of cognitive behavioral therapy of insomnia: engagement rates, knowledge acquisition, and provider acceptability. Cogn Behav Ther 2022; 51:343-352. [PMID: 35099360 DOI: 10.1080/16506073.2021.1996453] [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] [Indexed: 11/03/2022]
Abstract
Insomnia is common but severely underreported and undertreated. One possible reason for this problem is the lack of providers in cognitive behavioral therapy for insomnia (CBT-I). To address this we created CBTIweb.org, an online training platform for providers to learn the basics of sleep, assessing insomnia, and CBT-I. The present study assessed the reach of CBTIweb by examining engagement, knowledge acquisition, and perceived acceptability. Participants who registered for CBTIweb self-reported their practice setting and personal characteristics (i.e. degree, profession, licensure status). Knowledge acquisition was assessed with pre- and post-tests, and provider acceptability was assessed via a survey. In the first three months after launching CBTIweb, 2586 providers registered and 624 of these completed the training within three months of registering. Chi-square tests of independence revealed no differences in completion rates by education or profession, though trainees were more likely to initiate and complete treatment than licensed providers. Paired t tests revealed significant knowledge acquisition, and most providers positively rated the website navigation, content, aesthetics, and understanding of core CBT-I skills. This study demonstrated CBTIweb is an effective platform for training health professionals to be minimally proficient in the gold standard treatment for insomnia disorder.
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Affiliation(s)
- Allison K Wilkerson
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Sophie Wardle-Pinkston
- Department of Psychology, University of North Texas, Denton, TX, USA.,Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Jessica R Dietch
- Department of Psychology, University of North Texas, Denton, TX, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, UT Health San Antonio, San Antonio, TX, USA
| | - Richard Oliver Simmons
- Department of Psychiatry and Behavioral Sciences, The Medical University of South Carolina, Charleston, SC, USA
| | - Brian E Bunnell
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, FL, USA
| | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX, USA.,Department of Psychology, University of Arizona, Tucson, AZ, USA
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25
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Garcia O, Slavish DC, Dietch JR, Messman BA, Contractor AA, Haynes PL, Pruiksma KE, Kelly K, Ruggero C, Taylor DJ. What goes around comes around: Nightmares and daily stress are bidirectionally associated in nurses. Stress Health 2021; 37:1035-1042. [PMID: 33749112 PMCID: PMC11002978 DOI: 10.1002/smi.3048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/17/2021] [Accepted: 03/14/2021] [Indexed: 01/14/2023]
Abstract
Nurses may experience frequent nightmares due to stressful work environments. Nightmares may also exacerbate stress among nurses, although this has yet to be tested empirically. We examined daily bidirectional associations between stress severity and nightmares, and moderation by post-traumatic stress disorder (PTSD) symptoms. 392 nurses (92% female; 78% White) completed 14 days of sleep diaries to assess previous-day stress severity and nightmare occurrence and severity. PTSD symptoms were assessed at baseline. Multilevel models were used to examine bidirectional, within-person associations between daily stress and nightmares, and cross-level moderation by baseline PTSD symptoms. 47.2% of nurses reported at least one nightmare across the two weeks. Days with greater stress were associated with higher odds of experiencing a nightmare (OR = 1.22, p = 0.001), as well as greater nightmare severity (b = 0.09, p = 0.033). Nightmare occurrence was associated with greater next-day stress severity (b = 0.15, p < 0.001). Daily stress and nightmare associations were similar for those with and without PTSD symptoms. Nightmares and stress may occur in a bidirectional fashion. Nurses face intense occupational demands and frequent exposure to potentially traumatic events. Studies should explore whether targeting nightmares and stress may improve nurses' health and well-being.
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Affiliation(s)
- Odalis Garcia
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Jessica R Dietch
- Department of Psychology, Oregon State University, Corvallis, Oregon, USA
| | - Brett A Messman
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | | | - Patricia L Haynes
- Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Camilo Ruggero
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona, USA
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26
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Bilsky SA, Luber MJ, Cloutier RM, Dietch JR, Taylor DJ, Friedman HP. Cigarette use, anxiety, and insomnia from adolescence to early adulthood: A longitudinal indirect effects test. Addict Behav 2021; 120:106981. [PMID: 33993036 DOI: 10.1016/j.addbeh.2021.106981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cigarette use during adolescence has been linked to increased risk for insomnia symptoms, but limited work has examined factors that may account for this association. Adolescent cigarette use and anxiety symptoms characterized by physiological hyperarousal evidence bidirectional associations, as do anxiety symptoms and insomnia symptoms. This suggests that adolescent cigarette use, anxiety symptoms characterized by physiological hyperarousal, and insomnia symptoms may increase and maintain one another. The current study tests physiological hyperarousal anxiety symptoms as a potential indirect effect in the cigarette-insomnia symptoms link across adolescence and young adulthood. METHODS We examined data from adolescents and young adults from Waves 1, 2, 3 and 4 of the National Longitudinal Study of Adolescent to Adult Health (N = 2,432 with full data). Insomnia symptoms were assessed at baseline (ages 12-16 years), 1 year later (13-17 years), and 14 years after baseline (26 - 30 years) among a nationally representative sample of adolescents. Cigarette use was assessed at baseline, 1 year later, 6 years after baseline, and 14 years after baseline. Anxiety symptoms were assessed at baseline and 1 year later. RESULTS Structural equation models indicated that anxiety symptoms exerted an indirect effect on the longitudinal associations between adolescent cigarette use and adult insomnia symptoms. Anxiety symptoms and cigarette use evidenced bidirectional associations during adolescence. CONCLUSIONS These results suggest that increases in anxiety symptoms characterized by physiological hyperarousal may be one mechanism whereby cigarette use during adolescence is associated with increased insomnia symptoms during early adulthood. Prevention efforts aimed at reducing cigarette use during adolescence may have long term additional benefits for anxiety symptoms and insomnia symptoms.
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27
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Walker JL, Slavish DC, Dolan M, Dietch JR, Wardle-Pinkston S, Messman B, Ruggero CJ, Kohut M, Borwick J, Kelly K, Taylor DJ. Age-dependent associations among insomnia, depression, and inflammation in nurses. Psychol Health 2021; 36:967-984. [PMID: 32795158 PMCID: PMC7882004 DOI: 10.1080/08870446.2020.1805450] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/29/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Insomnia and depression have been inconsistently associated with inflammation. Age may be one important moderator of these associations. This study examined associations between insomnia and depression with inflammatory biomarkers in nurses and how these associations varied by age. Design: Participants were 392 nurses ages 18-65 (Mage = 39.54 years ± 11.15, 92% female) recruited from two hospitals. Main outcome measures: Participants completed surveys to assess insomnia and depression symptoms. Serum samples were obtained and analysed for inflammatory biomarkers interleukin-6 (IL-6), C-reactive protein (CRP), interleukin-1 beta (IL-1β), and tumour necrosis factor alpha (TNF-α). Results: Neither insomnia nor depression symptoms were associated with inflammatory biomarkers. Older age was associated with higher IL-1β, and age moderated the effects of depression symptoms on CRP and TNF-α: Greater depression symptoms were associated with higher CRP (b = .14, p = .017) and TNF-α (b = .008, p = .165) among older nurses only. Conclusion: Results suggest older nurses with higher depression symptoms may be at increased risk for elevated inflammation. Interventions should consider the role of age-related processes in modifying health and well-being. Given relatively low levels of depression in the current sample, future studies should replicate results in clinical and non-nurse samples.
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Affiliation(s)
- Jamie L Walker
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Megan Dolan
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Jessica R Dietch
- War Related Illness and Injury Study Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA
| | | | - Brett Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Marian Kohut
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Joshua Borwick
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
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28
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Dietch JR, Taylor DJ. Evaluation of the Consensus Sleep Diary in a community sample: comparison with single-channel electroencephalography, actigraphy, and retrospective questionnaire. J Clin Sleep Med 2021; 17:1389-1399. [PMID: 33666165 PMCID: PMC8314633 DOI: 10.5664/jcsm.9200] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 11/16/2020] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVES The Consensus Sleep Diary (CSD) was developed by experts to promote standardization of sleep diary data across the field, but studies comparing the CSD with other assessments of sleep parameters are scarce. This study compared the CSD with 3 other methods to assess sleep duration, efficiency, and timing. METHODS Participants (n = 80) were community adults (mean age = 32.65 years, 63% female) who completed the time-stamped CSD and used single-channel electroencephalography (EEG) and actigraphy for 7 days at home, then completed a retrospective sleep questionnaire. Total sleep time (TST), sleep efficiency (SE), and sleep midpoint were compared using correlations, Bland-Altman plots, and limits of agreement (adjusted for repeated measures). RESULTS Correlations between the CSD and all methods on TST were large (rs = .63-.75). Adjusted CSD average TST was 40 minutes greater than with EEG and 31 minutes greater than with actigraphy. Correlations between CSD, actigraphy, and EEG for SE were small (rs = .18), and there was a medium correlation with questionnaire (r = .42). Adjusted CSD average SE was 7% greater than EEG and 6% greater than actigraphy; both demonstrated heteroscedasticity. Sleep midpoint correlations between CSD and all methods were large (r = .92-.99). Adjusted CSD was, on average, 6 minutes later than EEG and 1 minute later than actigraphy. Questionnaire-derived sleep parameters demonstrated nonconstant bias; lesser values had positive bias and greater values had negative bias. CONCLUSIONS The time-stamped CSD led to meaningful overestimations of TST and SE as measured by objective/inferred methods. However, sleep timing was rather accurately assessed with the CSD in comparison to objective/inferred measures. Researchers should carefully consider which sleep assessment methods are best aligned with their research question and parameters of interest, as methods do not demonstrate complete agreement.
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Affiliation(s)
- Jessica R. Dietch
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona
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Affiliation(s)
- Jessica R Dietch
- School of Psychological Science, Oregon State University, Corvallis, OR
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
- Corresponding author. Jessica R. Dietch, School of Psychological Science, Oregon State University, Corvallis, OR 97331.
| | - Rachel Manber
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
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Dietch JR, Taylor DJ, Pruiksma K, Wardle-Pinkston S, Slavish DC, Messman B, Estevez R, Ruggero CJ, Kelly K. The Nightmare Disorder Index: development and initial validation in a sample of nurses. Sleep 2021; 44:6007673. [PMID: 33245781 DOI: 10.1093/sleep/zsaa254] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/28/2020] [Revised: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Nurses are a group at high risk for nightmares, yet little is known about the rate of nightmare disorder and associated psychosocial factors in this group in part attributable to the lack of a self-report questionnaire to assess DSM-5 criteria for nightmare disorder. Aims of the current study were to (1) report on development and initial validity of a self-report measure of DSM-5 nightmare disorder, and (2) examine the rate and associated factors of nightmare disorder among nurses. METHODS Nurses (N = 460) completed baseline measures online including Nightmare Disorder Index (NDI), psychosocial and demographic questionnaires. A subset (n = 400) completed 14 days of sleep diaries and actigraphy. RESULTS NDI demonstrated satisfactory psychometric characteristics as indicated by good internal consistency (α = 0.80), medium inter-item correlations (r = 0.50), medium to large item-total (r = 0.55-0.85) and convergent correlations (0.32-0.45), and small to medium discriminant correlations (-0.12-0.33). Per NDI, 48.7% of nurses reported no nightmares in the past month, 43.9% met partial/subthreshold criteria and 7.4% met full criteria for probable nightmare disorder. Nurses with nightmare disorder demonstrated significantly poorer psychosocial functioning (i.e. posttraumatic stress, depression, anxiety, stress) than those with subthreshold nightmare symptoms, who had poorer functioning than those with no nightmares. CONCLUSIONS NDI is an efficient and valid self-report assessment of nightmare disorder. Nurses have high rates of nightmares and nightmare disorder which are associated with poorer psychosocial functioning. We recommend increased nightmare screening particularly for high-risk populations such as healthcare workers.
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Affiliation(s)
- Jessica R Dietch
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA
| | | | - Kristi Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center at San Antonio, San Antonio, TX
| | | | | | - Brett Messman
- Department of Psychology, University of North Texas, Denton, TX
| | | | | | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, TX
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Wells SY, Dietch JR, Edner BJ, Glassman LH, Thorp SR, Morland LA, Aarons GA. The Development of a Brief Version of the Insomnia Severity Index (ISI-3) in Older Adult Veterans with Posttraumatic Stress Disorder. Behav Sleep Med 2021; 19:352-362. [PMID: 32475177 DOI: 10.1080/15402002.2020.1760278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective/Background: The Insomnia Severity Index (ISI) is an insomnia self-report measure used to identify individuals at risk for insomnia disorder. Although the full ISI is only seven questions, a briefer version would allow more efficient and pragmatic administration in routine practice settings. Reliable and valid brief measures can support measurement-based care. The present study was a proof-of-concept study that developed a brief version of the ISI, the ISI-3, in a sample of older adult veterans with posttraumatic stress disorder (PTSD), a group which is at increased risk for insomnia.Patients/Methods: Participants included 86 older veterans with combat- or military-related PTSD. Veterans completed a clinician-administered PTSD diagnostic interview, self-report measures of insomnia and other psychosocial questionnaires, and two neuropsychological assessments. The factor structure of the ISI was examined to reduce the measure into a brief version. The reliability and validity of the ISI-3 were examined.Results: Principal axis factoring yielded a one-factor solution, which reproduced 59% of the item variance. Item reduction procedures resulted in three items, which best represented this factor ("Insomnia Impact;" ISI-3). For the ISI-3, internal consistency was good (α =.89). Convergent validity was demonstrated via moderate to high positive correlations between the ISI-3 and other measures of sleep disturbance. Divergent validity was demonstrated via non-significant correlations between the ISI-3 and unrelated measures and moderate correlations with self-reported depression.Conclusions: The ISI-3 is a psychometrically valid brief version of the ISI. Clinicians can administer the ISI-3 to screen for insomnia and monitor changes in insomnia during treatment.
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Affiliation(s)
- Stephanie Y Wells
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California.,San Diego VA Health Care System, San Diego, California.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina.,Durham VA Health Care System, Durham, North Carolina
| | - Jessica R Dietch
- Department of Psychology, University of North Texas, Denton, Texas
| | - Benjamin J Edner
- Department of Counseling and Human Development Services, University of Georgia, Athens, Georgia
| | - Lisa H Glassman
- Veterans Medical Research Foundation, San Diego, California.,Department of Psychiatry, University of California, La Jolla, California
| | - Steven R Thorp
- California School of Professional Psychology, Alliant University, San Diego, California
| | - Leslie A Morland
- Veterans Medical Research Foundation, San Diego, California.,Department of Psychiatry, University of California, La Jolla, California.,National Center for PTSD- Pacific Islands Division, Honolulu, Hawaii
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, San Diego, California.,UCSD Dissemination and Implementation Science Center, La Jolla, California
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Taylor DJ, Dietch JR, Pruiksma K, Calhoun CD, Milanak ME, Wardle-Pinkston S, Rheingold AA, Ruggiero KJ, Bunnell BE, Wilkerson AK. Developing and Testing a Web-Based Provider Training for Cognitive Behavioral Therapy of Insomnia. Mil Med 2021; 186:230-238. [PMID: 33499510 DOI: 10.1093/milmed/usaa359] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Chronic insomnia is a common and debilitating disease that increases risk for significant morbidity and workplace difficulties. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment, but there is a critical lack of behavioral health providers trained in CBT-I because, in part, of a bottleneck in training availability and costs. The current project developed and evaluated a web-based provider training course for CBT-I: CBTIweb.org. MATERIALS AND METHODS Subject matter experts developed the content for CBTIweb.org. Then, trainees completed alpha testing (n = 24) and focus groups, and the site was improved. Next, licensed behavioral health providers and trainees completed beta testing (n = 41) and the site underwent another round of modifications. Finally, to compare CBTIweb.org to an in-person workshop, licensed behavioral health providers were randomly assigned to CBTIweb.org (n = 21) or an in-person workshop (n = 23). All participants were CBT-I naïve and completed the following assessments: Computer System Usability Questionnaire, Website Usability Satisfaction Questionnaire, Website Content Satisfaction Questionnaire, and Continuing Education knowledge acquisition questionnaires. RESULTS Alpha and beta testers of CBTIweb.org reported high levels of usability and satisfaction with the site and showed significant within-group knowledge acquisition. In the pilot comparison study, linear fixed-effects modeling on the pre-/postquestionnaires revealed a significant main effect for time, indicating a significant increase in knowledge acquisition from 69% correct at baseline to 92% correct at posttraining collapsed across in-person and CBTIweb.org groups. The interaction effect of Time by Condition was nonsignificant, indicating equivalence in knowledge gains across both groups. CONCLUSION CBTIweb.org appears to be an engaging, interactive, and concise provider training that can be easily navigated by its users and produce significant knowledge gains that are equivalent to traditional in-person workshops. CBTIweb.org will allow for worldwide dissemination of CBT-I to any English-speaking behavioral health providers. Future research will work on translating this training to other languages and extending this web-based platform to the treatment of other sleep disorders (e.g., nightmares) and populations (e.g., pediatric populations with insomnia).
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Affiliation(s)
- Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX 76203, USA.,Department of Psychology, University of Arizona, Tucson, AZ 85712, USA
| | - Jessica R Dietch
- Department of Psychology, University of North Texas, Denton, TX 76203, USA.,War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA 94304, USA
| | - Kristi Pruiksma
- Department of Psychiatry, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Casey D Calhoun
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Melissa E Milanak
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Sophie Wardle-Pinkston
- Department of Psychology, University of North Texas, Denton, TX 76203, USA.,Department of Psychology, University of Arizona, Tucson, AZ 85712, USA
| | - Alyssa A Rheingold
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kenneth J Ruggiero
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Brian E Bunnell
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.,Department of Psychiatry and Behavioral Neurosciences, University of Southern Florida, Tampa, FL 33613, USA
| | - Allison K Wilkerson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
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Lauer EE, Dietch JR, Chu TLA, Barton M, Martin SB, Petrie TA, Greenleaf CA, Taylor DJ. Insomnia, Psychosocial Well-Being, and Weight Control Behaviors Among Healthy-Weight Adolescent Females: Brief Report. Int J Behav Med 2021; 28:259-264. [PMID: 32140933 DOI: 10.1007/s12529-020-09872-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Weight control behaviors (WCBs) typically involve appearance- or health-driven behaviors that may be influenced by physiological, psychological, or social factors. Sleep disturbances like insomnia are an important area of research for adolescent populations, as early intervention may result in improvements in other physical and mental health domains. The purpose of this study was to investigate the relationship of insomnia, psychosocial well-being, and current WCBs in healthy-weight female adolescents. METHOD Female adolescents (N = 323; Mage = 12.33 ± .04) who had healthy body mass index (BMI) levels completed self-report items on insomnia, depression, self-esteem, and physical self-concept. Multivariate analysis of covariance (MANCOVA), controlling for age, was conducted to further examine differences in insomnia and psychosocial variables among the WCB groups. RESULTS Compared to those who were trying to stay the same weight or not trying to do anything about their weight, the girls who were trying to lose weight had significantly greater insomnia and depression symptoms, and lower self-esteem, with small to medium effect sizes. CONCLUSIONS Clinicians working with adolescent girls should include assessments of WCBs in addition to measures of insomnia symptoms, even for adolescent girls within a normal BMI range, as these are common and frequently co-occurring phenomena. Additional research is needed to further disentangle these complicated relationships.
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Affiliation(s)
- E Earlynn Lauer
- Western Illinois University, 1 University Cir. Brophy Hall 221G, Macomb, IL, 61455, USA.
| | - Jessica R Dietch
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94034, USA
| | - Tsz Lun Alan Chu
- University of Wisconsin-Green Bay, 2420 Nicolet Dr, Green Bay, WI, 54311, USA
| | - Mitch Barton
- Dallas Independent School District, 2909 N. Buckner Blvd, Dallas, TX, 75228, USA
| | - Scott B Martin
- University of North Texas, Physical Education Building, 1921 Chestnut St., Denton, TX, 76293, USA
| | - Trent A Petrie
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94034, USA
| | - Christy A Greenleaf
- University of Wisconsin-Milwaukee, 2200 E. Kenwood Blvd., Milwaukee, WI, 53201-0413, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, 1503 E University Blvd., Building, Tucson, AZ, 68, USA
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Messman BA, Slavish DC, Dietch JR, Jenkins BN, Ten Brink M, Taylor DJ. Associations between daily affect and sleep vary by sleep assessment type: What can ambulatory EEG add to the picture? Sleep Health 2021; 7:219-228. [PMID: 33454245 DOI: 10.1016/j.sleh.2020.11.009] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE/BACKGROUND Disrupted sleep can be a cause and a consequence of affective experiences. However, daily longitudinal studies show sleep assessed via sleep diaries is more consistently associated with positive and negative affect than sleep assessed via actigraphy. The objective of the study was to test whether sleep parameters derived from ambulatory electroencephalography (EEG) in a naturalistic setting were associated with day-to-day changes in affect. PARTICIPANTS/METHOD Eighty adults (mean age = 32.65 years, 63% female) completed 7 days of affect and sleep assessments. We examined bidirectional associations between morning positive affect and negative affect with sleep assessed via diary, actigraphy, and ambulatory EEG. RESULTS Mornings with lower positive affect than average were associated with higher diary- and actigraphy-determined sleep efficiency that night. Mornings with higher negative affect than average were associated with longer actigraphy-determined total sleep time that night. Nights with longer diary-determined total sleep time, greater sleep efficiency, and shorter sleep onset latency than average were associated with higher next-morning positive affect, and nights with lower diary-determined wake-after-sleep-onset were associated with lower next-morning negative affect. EEG-determined sleep and affect results were generally null in both directions: only higher morning negative affect was associated with longer rapid eye movement (REM) sleep that night. CONCLUSIONS Self-reported sleep and affect may occur in a bidirectional fashion for some sleep parameters. EEG-determined sleep and affect associations were inconsistent but may still be important to assess in future studies to holistically capture sleep. Single-channel EEG represents a novel, ecologically valid tool that may provide information beyond diaries and actigraphy.
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Affiliation(s)
- Brett A Messman
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA.
| | - Jessica R Dietch
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
| | - Brooke N Jenkins
- Department of Psychology, Chapman University, One University Drive, Orange, CA 92866 USA
| | - Maia Ten Brink
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Building 420, Stanford, CA 94305 USA
| | - Daniel J Taylor
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX 76203, USA
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Dietch JR, Furst AJ. Perspective: Cognitive Behavioral Therapy for Insomnia Is a Promising Intervention for Mild Traumatic Brain Injury. Front Neurol 2020; 11:530273. [PMID: 33117253 PMCID: PMC7575746 DOI: 10.3389/fneur.2020.530273] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/04/2020] [Indexed: 11/13/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a significant public health problem. Insomnia is one of the most common symptoms of TBI, occurring in 30–50% of patients with TBI, and is more frequently reported in patients with mild as opposed to moderate or severe TBI. Although insomnia may be precipitated by mTBI, it is unlikely to subside on its own without specific treatment even after symptoms of mTBI reduce or remit. Insomnia is a novel, highly modifiable treatment target in mTBI, treatment of which has the potential to make broad positive impacts on the symptoms and recovery following brain injury. Cognitive-behavioral therapy for insomnia (CBT-I) is the front-line intervention for insomnia and has demonstrated effectiveness across clinical trials; between 70 and 80% of patients with insomnia experience enduring benefit from CBT-I and about 50% experience clinical remission. Examining an existing model of the development of insomnia in the context of mTBI suggests CBT-I may be effective for insomnia initiated or exacerbated by sustaining a mTBI, but this hypothesis has yet to be tested via clinical trial. Thus, more research supporting the use of CBT-I in special populations such as mTBI is warranted. The current paper provides a background on existing evidence for using CBT-I in the context of TBI, raises key challenges, and suggests considerations for future directions including need for increased screening and assessment of sleep disorders in the context of TBI, examining efficacy of CBT-I in TBI, and exploring factors that impact dissemination and delivery of CBT-I in TBI.
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Affiliation(s)
- Jessica R Dietch
- War Related Illness and Injury Study Center (WRIISC CA), VA Palo Alto Health Care System, Palo Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Ansgar J Furst
- War Related Illness and Injury Study Center (WRIISC CA), VA Palo Alto Health Care System, Palo Alto, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States.,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, United States.,Polytrauma System of Care (PSC), VA Palo Alto Health Care System, Palo Alto, CA, United States
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Slavish DC, Taylor DJ, Dietch JR, Wardle-Pinkston S, Messman B, Ruggero CJ, Kohut M, Kelly K. Intraindividual Variability in Sleep and Levels of Systemic Inflammation in Nurses. Psychosom Med 2020; 82:678-688. [PMID: 32697443 PMCID: PMC7484081 DOI: 10.1097/psy.0000000000000843] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Disturbed sleep is common among nurses and is associated with morbidity and mortality. Inflammation may be one mechanism linking sleep and disease. However, most studies rely on retrospective questionnaires to assess sleep, which fail to account for night-to-night fluctuations in sleep across time (i.e., intraindividual variability [IIV]). We examined prospective associations between mean and IIV in sleep with inflammation markers in nurses. METHODS Participants were 392 nurses (mean age = 39.54 years, 92% female, 23% night-shift working) who completed 7 days of sleep diaries and actigraphy to assess mean and IIV in total sleep time and sleep efficiency. Blood was drawn on day 7 to assess inflammation markers C-reactive protein, interleukin (IL)-6, tumor necrosis factor α, and IL-1β. RESULTS Greater IIV in total sleep time-measured via both actigraphy and sleep diary-was associated with higher IL-6 (actigraphy: b = 0.05, p = .046, sr = 0.01; diary: b = 0.04, p = .030, sr = 0.01) and IL-1β (actigraphy: b = 0.12, p = .008, sr = 0.02; diary: b = 0.09, p = .025, sr = 0.01), but not C-reactive protein or tumor necrosis factor α. IIV in actigraphy- and sleep diary-determined sleep efficiency was not associated with inflammation biomarkers, nor were any mean sleep variables. Shift work did not moderate any associations. CONCLUSIONS Nurses with more variable sleep durations had elevated levels of inflammation, which may increase risk for development of inflammatory-related diseases. Research should investigate how sleep regularization may change levels of inflammation and improve health.
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Affiliation(s)
- Danica C Slavish
- From the Department of Psychology (Slavish, Messman, Ruggero, Kelly), University of North Texas, Denton, Texas; Department of Psychology (Taylor, Wardle-Pinkston), University of Arizona, Tucson, Arizona; War Related Illness and Injury Study Center (Dietch), Palo Alto Veterans Affairs Health Care System; Department of Psychiatry and Behavioral Sciences (Dietch), Stanford University School of Medicine, Palo Alto, California; and Department of Kinesiology (Kohut), Iowa State University, Ames, Iowa
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Roth AJ, Dietch JR. “A ruffled mind makes a restless pillow”: reducing depression incidence and severity with dCBT-I. Sleep 2020; 43:5893472. [DOI: 10.1093/sleep/zsaa153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/03/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alicia J Roth
- Sleep Disorders Center, The Cleveland Clinic, Cleveland, OH
| | - Jessica R Dietch
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
- VA Palo Alto Health Care System, War Related Illness and Injury Study Center, Palo Alto, CA
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Slavish DC, Asbee J, Veeramachaneni K, Messman BA, Scott B, Sin NL, Taylor DJ, Dietch JR. The Cycle of Daily Stress and Sleep: Sleep Measurement Matters. Ann Behav Med 2020; 55:413-423. [PMID: 32756869 DOI: 10.1093/abm/kaaa053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 01/22/2023] Open
Abstract
BACKGROUND Disturbed sleep can be a cause and a consequence of elevated stress. Yet intensive longitudinal studies have revealed that sleep assessed via diaries and actigraphy is inconsistently associated with daily stress. PURPOSE We expanded this research by examining daily associations between sleep and stress using a threefold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography (EEG). METHODS Participants were 80 adults (mean age = 32.65 years, 63% female) who completed 7 days of stressor and sleep assessments. Multilevel models were used to examine bidirectional associations between occurrence and severity of daily stress with diary-, actigraphy-, and EEG-determined sleep parameters (e.g., total sleep time [TST], sleep efficiency, and sleep onset latency, and wake after sleep onset [WASO]). RESULTS Participants reported at least one stressor 37% of days. Days with a stressor were associated with a 14.4-min reduction in actigraphy-determined TST (β = -0.24, p = 0.030), but not with other actigraphy, diary, or EEG sleep measures. Nights with greater sleep diary-determined WASO were associated with greater next-day stressor severity (β = 0.01, p = 0.026); no other diary, actigraphy, or EEG sleep measures were associated with next-day stressor occurrence or severity. CONCLUSIONS Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that the type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary-not redundant-sleep measurement approaches.
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Affiliation(s)
- Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Justin Asbee
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Kirti Veeramachaneni
- College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Brett A Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Bella Scott
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Nancy L Sin
- Department of Psychology, University of British Colombia, Vancouver, Canada
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Jessica R Dietch
- War Related Illness and Injury Study Center, Palo Alto Veterans Affairs Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
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Lunyera J, Mohottige D, Alexopoulos AS, Campbell H, Cameron CB, Sagalla N, Amrhein TJ, Crowley MJ, Dietch JR, Gordon AM, Kosinski AS, Cantrell S, Williams JW, Gierisch JM, Ear B, Goldstein KM. Risk for Nephrogenic Systemic Fibrosis After Exposure to Newer Gadolinium Agents: A Systematic Review. Ann Intern Med 2020; 173:110-119. [PMID: 32568573 PMCID: PMC7847719 DOI: 10.7326/m20-0299] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The risk for nephrogenic systemic fibrosis (NSF) after exposure to newer versus older gadolinium-based contrast agents (GBCAs) remains unclear. PURPOSE To synthesize evidence about NSF risk with newer versus older GBCAs across the spectrum of kidney function. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science for English-language references from inception to 5 March 2020. STUDY SELECTION Randomized controlled trials, cohort studies, and case-control studies that assessed NSF occurrence after GBCA exposure. DATA EXTRACTION Data were abstracted by 1 investigator and verified by a second. Investigator pairs assessed risk of bias by using validated tools. DATA SYNTHESIS Of 32 included studies, 20 allowed for assessment of NSF risk after exposure to newer GBCAs and 12 (11 cohort studies and 1 case-control study) allowed for comparison of NSF risk between newer and older GBCAs. Among 83 291 patients exposed to newer GBCAs, no NSF cases developed (exact 95% CI, 0.0001 to 0.0258 case). Among the 12 studies (n = 118 844) that allowed risk comparison between newer and older GBCAs, 37 NSF cases developed after exposure to older GBCAs (exact CI, 0.0001 to 0.0523 case) and 4 occurred (3 confounded) after exposure to newer GBCAs (exact CI, 0.0018 to 0.0204 case). Data were scant for patients with acute kidney injury or those at risk for chronic kidney disease. LIMITATIONS Study heterogeneity prevented meta-analysis. Risk of bias was high in most studies because of inadequate exposure and outcome ascertainment. CONCLUSION Although NSF occurrence after exposure to newer GBCAs is very rare, the relatively scarce data among patients with acute kidney injury and those with risk factors for chronic kidney disease limit conclusions about safety in these populations. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs. (PROSPERO: CRD42019135783).
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Affiliation(s)
- Joseph Lunyera
- Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.)
| | - Dinushika Mohottige
- Duke University School of Medicine and Duke University Medical Center, Durham, North Carolina (D.M.)
| | - Anastasia-Stefania Alexopoulos
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Hilary Campbell
- Margolis Center for Health Policy at Duke University, Durham, North Carolina (H.C.)
| | - C Blake Cameron
- Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.)
| | - Nicole Sagalla
- Durham Veterans Affairs Health Care System and Duke University School of Medicine, Durham, North Carolina (N.S.)
| | - Timothy J Amrhein
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Matthew J Crowley
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Jessica R Dietch
- Stanford University and Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.R.D.)
| | - Adelaide M Gordon
- Durham Veterans Affairs Health Care System, Durham, North Carolina (A.M.G., B.E.)
| | - Andrzej S Kosinski
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina (A.S.K.)
| | - Sarah Cantrell
- Duke University School of Medicine and Duke University Medical Center Library and Archives, Durham, North Carolina (S.C.)
| | - John W Williams
- Duke University School of Medicine and Durham Veterans Affairs Health Care System, Durham, North Carolina (J.W.W., K.M.G.)
| | - Jennifer M Gierisch
- Duke University School of Medicine, Durham Veterans Affairs Health Care System, and Duke University, Durham, North Carolina (J.M.G.)
| | - Belinda Ear
- Durham Veterans Affairs Health Care System, Durham, North Carolina (A.M.G., B.E.)
| | - Karen M Goldstein
- Duke University School of Medicine and Durham Veterans Affairs Health Care System, Durham, North Carolina (J.W.W., K.M.G.)
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Santiago BP, Messman BA, Slavish DC, Alkire C, Wardle-Pinkston S, Dietch JR, Kelly K, Ruggero CR, Taylor DJ. 0384 Do Nurses with High Blood Pressure Have More Sleep Disturbances Than Their Peers? Sleep 2020. [DOI: 10.1093/sleep/zsaa056.381] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Nurses work in stressful environments and often have rotating work schedules, which may put them at risk for disturbed sleep and health. Poor quality and short sleep duration are strong risk factors for high blood pressure (HBP). Yet few studies have examined these associations in nurses, who may be a particularly at-risk sample. To address this gap, we examined group differences in self-reported and actigraphy-assessed sleep among nurses with and without self-reported HBP.
Methods
Participants were 392 nurses (91.8% female; 77.8% white, mean age = 39.54) recruited for a parent study. Participants completed baseline questionnaires including the Pittsburgh Sleep Quality Index (PSQI), followed by 14 days of actigraphy and sleep diaries to prospectively assess 14-day mean total sleep time (TST) and sleep efficiency (SE). An independent samples t-tests was used to assess group differences in sleep variables by HBP status. Linear regression was used to further examine the association between HBP status on sleep variables when controlling for age, race, gender, ethnicity, and body mass index (BMI).
Results
Twenty-nine (7%) nurses endorsed having clinically-diagnosed HBP. Nurses with HBP had higher global PSQI scores (indicating worse sleep quality; t=2.71, p=0.007), compared to nurses who did not report HBP, with a mean difference of 1.24. When adjusting for covariates, the association between HBP and the PSQI became marginally significant (p=0.054). There were no group differences in sleep diary or actigraphy TST or SE by HBP status, nor did HBP predict these sleep variables when controlling for covariates.
Conclusion
We found that nurses who reported having clinically diagnosed HBP had poorer global sleep quality. Although limited by self-reported history of HBP diagnosis, and low endorsement of HBP in our sample, our results corroborate other findings which suggest there is a strong association between high blood pressure and disturbed sleep. Future studies should examine these associations in larger samples, assess blood pressure directly, and experimentally examine the effects of HBP treatment on sleep quality.
Support
NIH/NIAID R01AI128359-01
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Affiliation(s)
| | | | | | - C Alkire
- University of North Texas, Denton, TX
| | | | - J R Dietch
- Palo Alto Veterans Affairs Health Care System, Palo Alto, CA
| | - K Kelly
- University of North Texas, Denton, TX
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41
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Dietch JR, Slavish DC, Messman B, Wardle-Pinkston S, Kelly K, Ruggero CJ, Taylor DJ. 0225 Do Associations Between Daily Stress and Sleep Vary by Work Shift? A Within-Person Analysis in Nurses. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.223] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Longitudinal studies have shown daily stress and sleep are bidirectionally associated. Nurses are particularly likely to experience sleep disturbances and high stress due to demanding work environments. Night shift work may be a unique stressor for nurses that exacerbates associations between stress and sleep. Using a within-person design, we examined the daily bidirectional associations between stress and sleep and moderation by nightly work shift (day/off shift vs. night shift) in a large sample of nurses.
Methods
Participants were 393 nurses (91% female; 77% white, mean age = 38.4 years) recruited from two hospitals. Participants completed 14 days of sleep diaries and actigraphy to assess total sleep time (TST) and sleep efficiency (SE). They simultaneously completed assessments of stress on the previous day (0 = “not at all” to 4 = “extremely”) and daily work schedule (day/off shift vs. night shift [work between 9pm-6am]).
Results
Results indicated greater daily stress was associated with shorter diary TST (b = -9.49, p<.0001) and actigraphy TST (b = -4.48, p<.01), as well as lower diary SE (b = -0.56, p<.001). When examining reverse pathways of sleep predicting next day stress, both diary TST (b = -0.0004, p<.0001) and actigraphy TST (b = -0.0002, p = .03) predicted higher next-day stress. Lower diary SE predicted higher next-day stress (b = -0.005, p<.001). Only the association between daily stress and nightly diary SE was moderated by daily work shift: only when nurses worked a day or off shift did they have a negative association between daily stress and diary SE (b = -0.68, p<.0001).
Conclusion
Daily stress and sleep disturbances occurred in a bidirectional fashion for night- and day-shift working nurses. Most associations were similar regardless of daily type of work shift. Objective and subjective short TST and low subjective SE may contribute to a cycle of increased stress and are prime targets for a tailored sleep intervention in nurses. More research is needed to develop interventions to address the unique sleep health challenges faced by nurses.
Support
NIAID R01AI128359-01
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Affiliation(s)
- J R Dietch
- VA Palo Alto Health Care System, Palo Alto, CA
| | | | - B Messman
- University of North Texas, Denton, TX
| | | | - K Kelly
- University of North Texas, Denton, TX
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Dietch JR, Manber R, Buysse DJ, Edinger JD, Krystal A. 0533 Age and Education Level are Associated with Dropout from Cognitive-Behavioral Therapy for Insomnia in Participants with Co-Occurring Depression: A Report from the TRIAD Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.530] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Early termination (i.e., dropout) from cognitive-behavioral therapy for insomnia (CBT-I) likely attenuates benefits and may reduce motivation for future treatment. The aim of the current study was to identify characteristics of participants who dropped out of CBT-I in an RCT of combined treatment for depression and insomnia.
Methods
Participants were 148 adults with comorbid insomnia and depression diagnoses (73% female; M age = 46.6[SD = 12.6]) who were randomly assigned to receive depression pharmacotherapy plus 7 weekly sessions of CBT-I (n = 73) or a credible control therapy for insomnia (n = 75). Receiver operating characteristic curve (ROC) analyses were performed to determine which participant characteristics (i.e., demographics, baseline depression and sleep variables) predicted dropout at session 4 (i.e., minimum dose) and session 7 (i.e., full course of CBT-I).
Results
Early termination (prior to session 4) rate was 28% and ROC analyses indicated participants aged 36 or less were more likely to drop out than those older than 36 (49% vs. 22%). The model did not identify additional predictors for either of the two age categories. Overall termination (prior to session 7) rate was 45% and ROC analyses indicated participants aged 46 or less were more likely to drop out than those older than 46 (61% vs. 34%). The model further found that among participants aged 46 or less, those with less than 14y education were at greater risk for dropout than those with greater than 14y education (79% vs. 46%). No other demographic, depression, or sleep variables were significant predictors of dropout.
Conclusion
Age was associated with elevated rate of dropout from CBT-I among individuals with co-occurring depression and insomnia. It appears that the combination of younger age and lower education level is particularly detrimental to treatment engagement. Better understanding of factors that contribute to dropout from CBT-I in this vulnerable group can guide development of retention strategies.
Support
MH078924, MH078961, MH079256
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Affiliation(s)
- J R Dietch
- VA Palo Alto Health Care System, Palo Alto, CA
| | - R Manber
- Stanford University, Palo Alto, CA
| | - D J Buysse
- University of Pittsburgh, Pittsburgh, PA
| | - J D Edinger
- National Jewish Health, Denver, CO
- Duke University Medical Center, Durham, NC
| | - A Krystal
- University of California, San Francisco, San Francisco, CA
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Atwood ME, Dietch JR, Buysse DJ, Edinger JD, Krystal A, Manber R. 0540 Insomnia Symptom Trajectories During and Following Combined Treatment for Insomnia and Depression: A Report from the Triad Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.537] [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
Cognitive behavioral therapy for insomnia (CBT-I) reduces insomnia severity among individuals with insomnia and major depressive disorder (MDD). Understanding the long-term trajectories of insomnia symptom severity has the potential to inform optimization of CBT-I in this population. The objectives of this study were to examine trajectories of change in insomnia severity over a 16-week treatment phase and 2-year naturalistic follow-up, and explore correlates of symptom trajectories.
Methods
148 adults (age 46.6±12.6, 73.0% female) with insomnia and MDD were randomly assigned to receive depression pharmacotherapy plus seven sessions of either CBT-I or control insomnia therapy. Depression and insomnia severity were assessed via the Hamilton Depression Rating Scale and Insomnia Severity Index at baseline, bi-weekly during treatment, and every 4 months over follow-up. Sleep effort and beliefs about sleep were assessed at baseline, midtreatment, and posttreatment.
Results
Latent class linear mixed modeling revealed four insomnia response trajectories: 1) Early Sustained-Responders (16%) showed marked improvement early in treatment, sustained over follow-up; 2) Gradual-Responders (36.7%) achieved substantial symptom reduction by posttreatment, sustained over follow-up; 3) Initial-Responders (25.3%) had substantial symptom reduction during treatment but increased in severity over follow-up; and 4) Partial-Responders (20.7%) achieved minimal improvement over treatment, and maintained moderate symptom severity over follow-up. Chi-square analyses revealed that classes did not differ significantly on sex, ethnicity, employment, relationship status, or treatment received (all ps > .05). One-way ANOVAs with Tukey’s HSD, showed that Partial-Responders consistently endorsed higher depressive symptom severity, sleep effort, and unhelpful beliefs about sleep at baseline, throughout treatment, and follow-up (ps < .05). Early Sustained-Responders endorsed lower sleep effort by midtreatment (ps < .01).
Conclusion
Results suggest four temporal patterns of treatment response and identified clinical correlates. Future work will be needed to determine if addressing sleep effort early in the course of treatment might enhance sustained insomnia outcome.
Support
MH078924, MH078961, MH079256
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Affiliation(s)
| | - J R Dietch
- VA Palo Alto Health Care System, Palo Alto, CA
| | - D J Buysse
- University of Pittsburgh, Pittsburgh, PA
| | | | - A Krystal
- University of California, San Francisco, San Francisco, CA
| | - R Manber
- Stanford University, Palo Alto, CA
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Williams JM, Taylor DJ, Slavish DC, Gardner CE, Zimmerman MR, Patel K, Reichenberger DA, Francetich JM, Dietch JR, Estevez R. Validity of Actigraphy in Young Adults With Insomnia. Behav Sleep Med 2020; 18:91-106. [PMID: 30472879 DOI: 10.1080/15402002.2018.1545653] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective/Background: Actigraphy is an inexpensive and objective wrist-worn activity sensor that has been validated for the measurement of sleep onset latency (SOL), number of awakenings (NWAK), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE) in both middle-aged and older adults with insomnia. However, actigraphy has not been evaluated in young adults. In addition, most previous studies compared actigraphy to in-lab polysomnography (PSG), but none have compared actigraphy to more ecologically valid ambulatory polysomnography.Participants: 21 young adults (mean age = 19.90 ± 2.19 years; n = 13 women) determined to have chronic primary insomnia through structured clinical interviews.Methods: Sleep diaries, actigraphy, and ambulatory PSG data were obtained over a single night to obtain measures of SOL, NWAK, WASO, time spent in bed after final awakening in the morning (TWAK), TST, and SE.Results: Actigraphy was a valid estimate of SOL, WASO, TST, and SE, based on significant correlations (r = 0.45 to 0.87), nonsignificant mean differences between actigraphy and PSG, and inspection of actigraphy bias from Bland Altman plots (SOL α = 1.52, WASO α = 7.95, TST α = -8.60, SE α = -1.38).Conclusions: Actigraphy was a valid objective measure of SOL, WASO, TST, and SE in a young adult insomnia sample, as compared to ambulatory PSG. Actigraphy may be a valid alternative for assessing sleep in young adults with insomnia when more costly PSG measures are not feasible.
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Affiliation(s)
- Jacob M Williams
- Department of Psychology, University of North Texas, Denton, Texas
| | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, Texas
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, Texas
| | | | | | - Kruti Patel
- Department of Psychology, University of North Texas, Denton, Texas
| | | | | | - Jessica R Dietch
- Department of Psychology, University of North Texas, Denton, Texas
| | - Rosemary Estevez
- Department of Psychology, University of North Texas, Denton, Texas
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Veeramachaneni K, Slavish DC, Dietch JR, Kelly K, Taylor DJ. Intraindividual variability in sleep and perceived stress in young adults. Sleep Health 2019; 5:572-579. [PMID: 31575485 DOI: 10.1016/j.sleh.2019.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 03/19/2019] [Revised: 06/25/2019] [Accepted: 07/25/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Research suggests strong associations between habitual sleep parameters (eg, mean duration, timing, efficiency), perceived stress, and insomnia symptoms. The associations between intraindividual variability (IIV; night-to-night within-person variation) in sleep, perceived stress, and insomnia have not been explored. This study examined associations between IIV in subjectively and objectively determined sleep parameters and to perceived stress in young adults with and without insomnia. DESIGN Prospective longitudinal. SETTING AND PARTICIPANTS Participants were 149 college students (mean age = 20.2 [SD = 2.4], 59% female) either with insomnia (n = 81; 54%) or without insomnia (n = 68; 46%). MEASUREMENTS Participants completed 1 week of daily sleep diaries and actigraphy (to assess total sleep time [TST], sleep efficiency [SE], and circadian midpoint [CM]), the Perceived Stress Scale, and a diagnostic interview for determination of insomnia as part of a parent study. RESULTS Greater IIV in actigraphy-determined TST (but not SE or CM) was independently associated with greater perceived stress, regardless of insomnia status. Greater IIV in sleep diary-determined TST, SE, or CM was not associated with perceived stress. Insomnia status was the most robust predictor of elevated perceived stress. There was a significant interaction between IIV in sleep diary-determined TST and insomnia status on perceived stress: Only in those without insomnia was greater IIV in sleep diary-determined TST associated with higher perceived stress. CONCLUSION Maintaining a more consistent sleep duration may be associated with lower stress in college students. Future research is needed to clarify the directionality and implications of this association for treatment.
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Affiliation(s)
- Kirti Veeramachaneni
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203; College for Public Health and Social Justice, St Louis University, 3545 Lafayette Ave, St Louis, MO 63104
| | - Danica C Slavish
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203.
| | - Jessica R Dietch
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203
| | - Daniel J Taylor
- Department of Psychology, University of North Texas, 1155 Union Circle #311280, Denton, TX, 76203; Department of Psychology, University of Arizona, 1503 E University Blvd Bldg 68, Tucson, AZ 85721
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Dietch JR, Ruggero CJ, Schuler K, Taylor DJ, Luft BJ, Kotov R. Posttraumatic stress disorder symptoms and sleep in the daily lives of World Trade Center responders. J Occup Health Psychol 2019; 24:689-702. [PMID: 31204820 DOI: 10.1037/ocp0000158] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sleep disturbances are common in posttraumatic stress disorder (PTSD) and can have major impacts on workplace performance and functioning. Although effects between PTSD and sleep broadly have been documented, little work has tested their day-to-day temporal relationship particularly in those exposed to occupational trauma. The present study examined daily, bidirectional associations between PTSD symptoms and self-reported sleep duration and quality in World Trade Center (WTC) responders oversampled for PTSD. WTC responders (N = 202; 19.3% with current PTSD diagnosis) were recruited from the Long Island site of the WTC health program. Participants were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; SCID; First, Spitzer, Gibbon, & Williams, 1997) and completed daily assessments of PTSD symptoms, sleep duration and sleep quality for 7 days. PTSD symptoms on a given day were prospectively associated with shorter sleep duration (β = -.13) and worse sleep quality (β = -.18) later that night. Reverse effects were also significant but smaller, with reduced sleep duration (not quality) predicting increased PTSD the next day (β = -.04). Effects of PTSD on sleep duration and quality were driven by numbing symptoms, whereas effects of sleep duration on PTSD were largely based on intrusion symptoms. PTSD symptoms and sleep have bidirectional associations that occur on a daily basis, representing potential targets to disrupt maintenance of each. Improving PTSD numbing symptoms may improve sleep, and increasing sleep duration may improve intrusion symptoms in individuals with exposure to work-related traumatic events. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Roman Kotov
- Department of Psychiatry and Behavioral Sciences, Stony Brook University
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47
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Walker JL, Slavish DC, Messman B, Wardle S, Dietch JR, Kohut ML, Kelly K, Ruggero C, Taylor DJ. 0040 Effects Of Chronotype, Insomnia, Depression, And Age On Markers Of Systemic Inflammation In Nurses. Sleep 2019. [DOI: 10.1093/sleep/zsz067.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kumar RA, Slavish DC, Messman B, Wardle S, Dietch JR, Ruggero CJ, Kelly K, Taylor DJ. 0415 Associations Between Pain, Depression, Stress, and Substance Use in Nurses With and Without Insomnia. Sleep 2019. [DOI: 10.1093/sleep/zsz067.414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Riya A Kumar
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Danica C Slavish
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Brett Messman
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Sophie Wardle
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Jessica R Dietch
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Kimberly Kelly
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Daniel J Taylor
- Department of Psychology, University of North Texas, Denton, TX, USA
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Dietch JR, Taylor DJ. 0323 Validity of Survey Measures of Sleep Duration, Efficiency, and Timing. Sleep 2019. [DOI: 10.1093/sleep/zsz067.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Price SN, Doyle CY, Flores M, Taylor DJ, Dietch JR, Ahn C, Allison M, Smith TW, Smyth JW, Uchino BN, Ruiz JM. 0161 Insomnia Severity is Associated with Positive and Negative Affect: NHST and Bayesian Multilevel Approaches. Sleep 2019. [DOI: 10.1093/sleep/zsz067.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | | | | | - Chul Ahn
- UT Southwestern, Dallas, TX, USA
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