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Roberts DM, Schade MM, Master L, Honavar VG, Nahmod NG, Chang AM, Gartenberg D, Buxton OM. Corrigendum to "Performance of an open machine learning model to classify sleep/wake from actigraphy across ∼24-hour intervals without knowledge of rest timing" [Sleep Health 9 (2023) 596-610]. Sleep Health 2024:S2352-7218(23)00290-5. [PMID: 38360520 DOI: 10.1016/j.sleh.2023.11.008] [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: 02/17/2024]
Affiliation(s)
- Daniel M Roberts
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA; Proactive Life, Inc, New York, New York, USA.
| | - Margeaux M Schade
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Lindsay Master
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Vasant G Honavar
- Faculty of Data Sciences, College of Information Science and Technology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Nicole G Nahmod
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Anne-Marie Chang
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Orfeu M Buxton
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
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Ji L, Wallace ML, Master L, Schade MM, Shen Y, Derby CA, Buxton OM. Six multidimensional sleep health facets in older adults identified with factor analysis of actigraphy: Results from the Einstein Aging Study. Sleep Health 2023; 9:758-766. [PMID: 37246064 PMCID: PMC10593097 DOI: 10.1016/j.sleh.2023.03.002] [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: 09/13/2022] [Revised: 02/17/2023] [Accepted: 03/19/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The concept of multi-dimensional sleep health, originally based on self-report, was recently extended to actigraphy in older adults, yielding five components, but without a hypothesized rhythmicity factor. The current study extends prior work using a sample of older adults with a longer period of actigraphy follow-up, which may facilitate observation of the rhythmicity factor. METHODS Wrist actigraphy measures of participants (N = 289, Mage = 77.2 years, 67% females; 47% White, 40% Black, 13% Hispanic/Others) over 2 weeks were used in exploratory factor analysis to determine factor structures, followed by confirmatory factor analysis on a different subsample. The utility of this approach was demonstrated by associations with global cognitive performance (Montreal Cognitive Assessment). RESULTS Exploratory factor analysis identified six factors: Regularity: standard deviations of four sleep measures: midpoint, sleep onset time, night total sleep time (TST), and 24-hour TST; Alertness/Sleepiness (daytime): amplitude, napping (mins and #/day); Timing: sleep onset, midpoint, wake-time (of nighttime sleep); up-mesor, acrophase, down-mesor; Efficiency: sleep maintenance efficiency, wake after sleep onset; Duration: night rest interval(s), night TST, 24-hour rest interval(s), 24-hour TST; Rhythmicity (pattern across days): mesor, alpha, and minimum. Greater sleep efficiency was associated with better Montreal Cognitive Assessment performance (β [95% confidence interval] = 0.63 [0.19, 1.08]). CONCLUSIONS Actigraphic records over 2 weeks revealed that Rhythmicity may be an independent factor in sleep health. Facets of sleep health can facilitate dimension reduction, be considered predictors of health outcomes, and be potential targets for sleep interventions.
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Affiliation(s)
- Linying Ji
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lindsay Master
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Margeaux M Schade
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Yuqi Shen
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Carol A Derby
- Saul R. Korey Department of Neurology, and Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Orfeu M Buxton
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA.
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Reichenberger DA, Ness KM, Strayer SM, Mathew GM, Schade MM, Buxton OM, Chang AM. Recovery Sleep After Sleep Restriction Is Insufficient to Return Elevated Daytime Heart Rate and Systolic Blood Pressure to Baseline Levels. Psychosom Med 2023; 85:744-751. [PMID: 37363991 PMCID: PMC10543608 DOI: 10.1097/psy.0000000000001229] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Sleep restriction alters daytime cardiac activity, including elevating heart rate (HR) and blood pressure (BP). There is minimal research on the cumulative effects of sleep loss and the response after subsequent recovery sleep on HR and BP. This study examined patterns of HR and BP across baseline, sleep restriction, and recovery conditions using multiple daytime cardiac measurements. METHODS Participants (15 healthy men, mean [standard deviation] = 22.3 [2.8] years) completed an 11-day inpatient protocol with three nights of 10 hours/night baseline sleep opportunity, five sleep restriction nights (5-hour/night sleep opportunity), and two recovery nights (10-hour/night sleep opportunity). Resting HR and BP were measured every 2 hours during wake. Multilevel models with random effects for individuals examined daytime HR and BP across study conditions and days into the study. RESULTS Mean daytime HR was 1.2 (0.5) beats/min lower during sleep restriction compared with baseline ( p < .001). During recovery, HR was 5.5 (1.0) beats/min higher ( p < .001), and systolic BP (SBP) was 2.9 (1.1) mm Hg higher ( p = .009). When accounting for days into the study (irrespective of condition) and measurement timing across the day, HR increased by 7.6 beats/min and SBP increased by 3.4 mm Hg across the study period ( p < .001). CONCLUSIONS Our findings suggest that daytime HR and SBP increase after successive nights of sleep restriction, even after accounting for measurement time of day. HR and SBP did not recover to baseline levels after two recovery nights of sleep, suggesting that longer recovery sleep may be necessary to recover from multiple, consecutive nights of moderate sleep restriction.
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Affiliation(s)
| | - Kelly M. Ness
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington
| | | | - Gina Marie Mathew
- Program in Public Health; Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | | | - Orfeu M. Buxton
- Department of Biobehavioral Health, Pennsylvania State University
| | - Anne-Marie Chang
- Department of Biobehavioral Health, Pennsylvania State University
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Roberts DM, Schade MM, Master L, Honavar VG, Nahmod NG, Chang AM, Gartenberg D, Buxton OM. Performance of an open machine learning model to classify sleep/wake from actigraphy across ∼24-hour intervals without knowledge of rest timing. Sleep Health 2023; 9:596-610. [PMID: 37573208 PMCID: PMC11005467 DOI: 10.1016/j.sleh.2023.07.001] [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: 11/10/2022] [Revised: 06/05/2023] [Accepted: 07/02/2023] [Indexed: 08/14/2023]
Abstract
GOAL AND AIMS Commonly used actigraphy algorithms are designed to operate within a known in-bed interval. However, in free-living scenarios this interval is often unknown. We trained and evaluated a sleep/wake classifier that operates on actigraphy over ∼24-hour intervals, without knowledge of in-bed timing. FOCUS TECHNOLOGY Actigraphy counts from ActiWatch Spectrum devices. REFERENCE TECHNOLOGY Sleep staging derived from polysomnography, supplemented by observation of wakefulness outside of the staged interval. Classifications from the Oakley actigraphy algorithm were additionally used as performance reference. SAMPLE Adults, sleeping in either a home or laboratory environment. DESIGN Machine learning was used to train and evaluate a sleep/wake classifier in a supervised learning paradigm. The classifier is a temporal convolutional network, a form of deep neural network. CORE ANALYTICS Performance was evaluated across ∼24 hours, and additionally restricted to only in-bed intervals, both in terms of epoch-by-epoch performance, and the discrepancy of summary statistics within the intervals. ADDITIONAL ANALYTICS AND EXPLORATORY ANALYSES Performance of the trained model applied to the Multi-Ethnic Study of Atherosclerosis dataset. CORE OUTCOMES Over ∼24 hours, the temporal convolutional network classifier produced the same or better performance as the Oakley classifier on all measures tested. When restricting analysis to the in-bed interval, the temporal convolutional network remained favorable on several metrics. IMPORTANT SUPPLEMENTAL OUTCOMES Performance decreased on the Multi-Ethnic Study of Atherosclerosis dataset, especially when restricting analysis to the in-bed interval. CORE CONCLUSION A classifier using data labeled over ∼24-hour intervals allows for the continuous classification of sleep/wake without knowledge of in-bed intervals. Further development should focus on improving generalization performance.
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Affiliation(s)
- Daniel M Roberts
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA; Proactive Life, Inc, New York, New York, USA.
| | - Margeaux M Schade
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Lindsay Master
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Vasant G Honavar
- Faculty of Data Sciences, College of Information Science and Technology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Nicole G Nahmod
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Anne-Marie Chang
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Orfeu M Buxton
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania, USA
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Emert SE, Taylor DJ, Gartenberg D, Schade MM, Roberts DM, Nagy SM, Russell M, Huskey A, Mueller M, Gamaldo A, Buxton OM. A non-pharmacological multi-modal therapy to improve sleep and cognition and reduce mild cognitive impairment risk: Design and methodology of a randomized clinical trial. Contemp Clin Trials 2023; 132:107275. [PMID: 37380020 DOI: 10.1016/j.cct.2023.107275] [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: 05/03/2023] [Revised: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 06/30/2023]
Abstract
Aging populations are at increased risk of sleep deficiencies (e.g., insomnia) that are associated with a variety of chronic health risks, including Alzheimer's disease and related dementias (ADRD). Insomnia medications carry additional risk, including increased drowsiness and falls, as well as polypharmacy risks. The recommended first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBTi), but access is limited. Telehealth is one way to increase access, particularly for older adults, but to date telehealth has been typically limited to simple videoconferencing portals. While these portals have been shown to be non-inferior to in-person treatment, it is plausible that telehealth could be significantly improved. This work describes a protocol designed to evaluate whether a clinician-patient dashboard inclusive of several user-friendly features (e.g., patterns of sleep data from ambulatory devices, guided relaxation resources, and reminders to complete in-home CBTi practice) could improve CBTi outcomes for middle- to older-aged adults (N = 100). Participants were randomly assigned to one of three telehealth interventions delivered through 6-weekly sessions: (1) CBTi augmented with a clinician-patient dashboard, smartphone application, and integrated smart devices; (2) standard CBTi (i.e., active comparator); or (3) sleep hygiene education (i.e., active control). All participants were assessed at screening, pre-study evaluation, baseline, throughout treatment, and at 1-week post-treatment. The primary outcome is the Insomnia Severity Index. Secondary and exploratory outcomes span sleep diary, actiwatch and Apple watch assessed sleep parameters (e.g., efficiency, duration, timing, variability), psychosocial correlates (e.g., fatigue, depression, stress), cognitive performance, treatment adherence, and neurodegenerative and systemic inflammatory biomarkers.
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Affiliation(s)
- Sarah E Emert
- The University of Arizona, Department of Psychology, Tucson, AZ, United States
| | - Daniel J Taylor
- The University of Arizona, Department of Psychology, Tucson, AZ, United States.
| | | | - Margeaux M Schade
- The Pennsylvania State University, Department of Biobehavioral Health, University Park, PA, United States
| | - Daniel M Roberts
- Proactive Life, Inc. (DBA SleepSpace), New York, NY, United States; The Pennsylvania State University, Department of Biobehavioral Health, University Park, PA, United States
| | - Samantha M Nagy
- The University of Arizona, Department of Psychology, Tucson, AZ, United States
| | - Michael Russell
- The Pennsylvania State University, Department of Biobehavioral Health, University Park, PA, United States
| | - Alisa Huskey
- The University of Arizona, Department of Psychology, Tucson, AZ, United States
| | - Melissa Mueller
- Proactive Life, Inc. (DBA SleepSpace), New York, NY, United States
| | - Alyssa Gamaldo
- The Pennsylvania State University, Department of Biobehavioral Health, University Park, PA, United States
| | - Orfeu M Buxton
- The Pennsylvania State University, Department of Biobehavioral Health, University Park, PA, United States
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Gu Y, Han F, Sainburg LE, Schade MM, Buxton OM, Duyn JH, Liu X. An orderly sequence of autonomic and neural events at transient arousal changes. Neuroimage 2022; 264:119720. [PMID: 36332366 PMCID: PMC9772091 DOI: 10.1016/j.neuroimage.2022.119720] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/15/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022] Open
Abstract
Resting-state functional magnetic resonance imaging (rsfMRI) allows the study of functional brain connectivity based on spatially structured variations in neuronal activity. Proper evaluation of connectivity requires removal of non-neural contributions to the fMRI signal, in particular hemodynamic changes associated with autonomic variability. Regression analysis based on autonomic indicator signals has been used for this purpose, but may be inadequate if neuronal and autonomic activities covary. To investigate this potential co-variation, we performed rsfMRI experiments while concurrently acquiring electroencephalography (EEG) and autonomic indicator signals, including heart rate, respiratory depth, and peripheral vascular tone. We identified a recurrent and systematic spatiotemporal pattern of fMRI (named as fMRI cascade), which features brief signal reductions in salience and default-mode networks and the thalamus, followed by a biphasic global change with a sensory-motor dominance. This fMRI cascade, which was mostly observed during eyes-closed condition, was accompanied by large EEG and autonomic changes indicative of arousal modulations. Importantly, the removal of the fMRI cascade dynamics from rsfMRI diminished its correlations with various signals. These results suggest that the rsfMRI correlations with various physiological and neural signals are not independent but arise, at least partly, from the fMRI cascades and associated neural and physiological changes at arousal modulations.
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Affiliation(s)
- Yameng Gu
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Feng Han
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Lucas E. Sainburg
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA 16802, USA
| | - Margeaux M. Schade
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, USA
| | - Orfeu M. Buxton
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA 16802, USA
| | - Jeff H. Duyn
- Advanced MRI Section, Laboratory of Functional and Molecular Imaging, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Xiao Liu
- Department of Biomedical Engineering, The Pennsylvania State University, University Park, PA 16802, USA,Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA 16802, USA,Corresponding author at: 431 Chemical and Biomedical Engineering Building, The Pennsylvania State University, University Park, PA 16802-4400, USA. (X. Liu)
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Roberts DM, Schade MM, Chang AM, Honavar V, Gartenberg D, Buxton OM. 0102 Performance Evaluation of a 24-hour Sleep-Wake State Classifier Derived from Research-Grade Actigraphy. Sleep 2022. [DOI: 10.1093/sleep/zsac079.100] [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
Wrist-worn research-grade actigraphy devices are commonly used to identify sleep and wakefulness in freely-living people. However, common existing algorithms were developed primarily to classify sleep-wake within a defined in-bed period with PSG, and exhibit relatively high sensitivity (accuracy on sleep epochs) but relatively low specificity (accuracy on wake epochs). This classification imbalance results in the algorithms performing poorly when attempting to classify data that does not have a predefined sleep period, such as over a 24-hour interval. Here, we develop a 24-hour actigraphy classifier to overcome limitations in specificity (accuracy on wake epochs), which typically afflict in-bed focused algorithms.
Methods
Four datasets scored via either PSG or direct observation of daytime wakefulness were combined (n=52 participants of mean age 49.8yrs, age range 19 - 86; 52% male; 221 total days/nights). Actigraphy (counts) and PSG (RPSGT-staged epochs) were temporally aligned. A model was trained to transform a time-series actigraphy counts to a time series of sleep-wake classifications, using the TensorFlow library for Python. 5-fold cross-validation was used to train and evaluate the model. Classification performance was compared to the output of the Spectrum device (Philips-Respironics) using the Oakley algorithm with a wake threshold of ‘medium’.
Results
The developed classifier was compared to the Spectrum classifications across the 24-hour intervals. The developed classifier had higher accuracy (95.4% vs. 76.8%), higher specificity (95.9% vs. 68.9%) and higher balanced-accuracy (95.2% vs. 81.6%) relative to the Spectrum classifications, each assessed via paired-sample t-test. Sensitivity did not statistically differ (94.5% vs. 94.4%).
Conclusion
The model trained and evaluated on 24-hour data outperformed the existing algorithm output in terms of overall accuracy, specificity, and balanced accuracy, while sensitivity did not significantly differ. A model trained on 24-hour data may be more appropriate for analyses of freely living people, or older populations where napping is more common. Developing an accurate 24-hour sleep/wake classifier fosters new opportunities to evaluate sleep patterns in the absence of self-reports or assumptions about time in bed.
Support (If Any)
UL1TR002014, NSF#1622766, R43/44-AG056250
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Arnold CRK, Srinivasan S, Rodriguez S, Rydzak N, Herzog CM, Gontu A, Bharti N, Small M, Rogers CJ, Schade MM, Kuchipudi SV, Kapur V, Read AF, Ferrari MJ. A longitudinal study of the impact of university student return to campus on the SARS-CoV-2 seroprevalence among the community members. Sci Rep 2022; 12:8586. [PMID: 35597780 PMCID: PMC9124192 DOI: 10.1038/s41598-022-12499-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 05/04/2022] [Indexed: 12/02/2022] Open
Abstract
Returning university students represent large-scale, transient demographic shifts and a potential source of transmission to adjacent communities during the COVID-19 pandemic. In this prospective longitudinal cohort study, we tested for IgG antibodies against SARS-CoV-2 in a non-random cohort of residents living in Centre County prior to the Fall 2020 term at the Pennsylvania State University and following the conclusion of the Fall 2020 term. We also report the seroprevalence in a non-random cohort of students collected at the end of the Fall 2020 term. Of 1313 community participants, 42 (3.2%) were positive for SARS-CoV-2 IgG antibodies at their first visit between 07 August and 02 October 2020. Of 684 student participants who returned to campus for fall instruction, 208 (30.4%) were positive for SARS-CoV-2 antibodies between 26 October and 21 December. 96 (7.3%) community participants returned a positive IgG antibody result by 19 February. Only contact with known SARS-CoV-2-positive individuals and attendance at small gatherings (20-50 individuals) were significant predictors of detecting IgG antibodies among returning students (aOR, 95% CI 3.1, 2.07-4.64; 1.52, 1.03-2.24; respectively). Despite high seroprevalence observed within the student population, seroprevalence in a longitudinal cohort of community residents was low and stable from before student arrival for the Fall 2020 term to after student departure. The study implies that heterogeneity in SARS-CoV-2 transmission can occur in geographically coincident populations.
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Affiliation(s)
- Callum R K Arnold
- Department of Biology, Pennsylvania State University, University Park, PA, 16802, USA.
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA.
| | - Sreenidhi Srinivasan
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Sophie Rodriguez
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Natalie Rydzak
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Catherine M Herzog
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Abhinay Gontu
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Nita Bharti
- Department of Biology, Pennsylvania State University, University Park, PA, 16802, USA
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA
| | - Meg Small
- College of Health and Human Development, Pennsylvania State University, University Park, PA, 16802, USA
- Social Science Research Institute, Pennsylvania State University, University Park, PA, 16802, USA
| | - Connie J Rogers
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Margeaux M Schade
- College of Health and Human Development, Pennsylvania State University, University Park, PA, 16802, USA
| | - Suresh V Kuchipudi
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Vivek Kapur
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, 16802, USA
- Department of Animal Science, Pennsylvania State University, University Park, PA, 16802, USA
| | - Andrew F Read
- Department of Biology, Pennsylvania State University, University Park, PA, 16802, USA
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, 16802, USA
| | - Matthew J Ferrari
- Department of Biology, Pennsylvania State University, University Park, PA, 16802, USA.
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, 16802, USA.
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Arnold CR, Srinivasan S, Rodriguez S, Rydzak N, Herzog CM, Gontu A, Bharti N, Small M, Rogers CJ, Schade MM, Kuchipudi SV, Kapur V, Read A, Ferrari MJ. SARS-CoV-2 Seroprevalence in a University Community: A Longitudinal Study of the Impact of Student Return to Campus on Infection Risk Among Community Members. medRxiv 2021:2021.02.17.21251942. [PMID: 33619497 PMCID: PMC7899462 DOI: 10.1101/2021.02.17.21251942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Returning university students represent large-scale, transient demographic shifts and a potential source of transmission to adjacent communities during the COVID-19 pandemic. METHODS In this prospective longitudinal cohort study, we tested for IgG antibodies against SARS-CoV-2 in a non-random cohort of residents living in Centre County prior to the Fall 2020 term at the Pennsylvania State University and following the conclusion of the Fall 2020 term. We also report the seroprevalence in a non-random cohort of students collected at the end of the Fall 2020 term. RESULTS Of 1313 community participants, 42 (3.2%) were positive for SARS-CoV-2 IgG antibodies at their first visit between 07 August and 02 October 2020. Of 684 student participants who returned to campus for fall instruction, 208 (30.4%) were positive for SARS-CoV-2 antibodies between 26 October and 21 December. 96 (7.3%) community participants returned a positive IgG antibody result by 19 February. Only contact with known SARS-CoV-2-positive individuals and attendance at small gatherings (20-50 individuals) were significant predictors of detecting IgG antibodies among returning students (aOR, 95% CI: 3.1, 2.07-4.64; 1.52, 1.03-2.24; respectively). CONCLUSIONS Despite high seroprevalence observed within the student population, seroprevalence in a longitudinal cohort of community residents was low and stable from before student arrival for the Fall 2020 term to after student departure. The study implies that heterogeneity in SARS-CoV-2 transmission can occur in geographically coincident populations.
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Affiliation(s)
- Callum R.K. Arnold
- Department of Biology, Pennsylvania State University, University Park, PA, USA 16802
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA 16802
| | - Sreenidhi Srinivasan
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA 16802
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA 16802
| | - Sophie Rodriguez
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA 16802
| | - Natalie Rydzak
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, USA 16802
| | - Catherine M. Herzog
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA 16802
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA 16802
| | - Abhinay Gontu
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, USA 16802
| | - Nita Bharti
- Department of Biology, Pennsylvania State University, University Park, PA, USA 16802
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA 16802
| | - Meg Small
- College of Health and Human Development, Pennsylvania State University, University Park, PA, USA 16802
- Social Science Research Institute, Pennsylvania State University, University Park, PA, USA 16802
| | - Connie J. Rogers
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA 16802
| | - Margeaux M. Schade
- Social Science Research Institute, Pennsylvania State University, University Park, PA, USA 16802
| | - Suresh V Kuchipudi
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA 16802
- Department of Veterinary and Biomedical Sciences, Pennsylvania State University, University Park, PA, USA 16802
| | - Vivek Kapur
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA 16802
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA 16802
- Department of Animal Science, Pennsylvania State University, University Park, PA, USA 16802
| | - Andrew Read
- Department of Biology, Pennsylvania State University, University Park, PA, USA 16802
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA 16802
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA 16802
| | - Matthew J. Ferrari
- Department of Biology, Pennsylvania State University, University Park, PA, USA 16802
- Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, PA, USA 16802
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Roberts DM, Schade MM, Mathew GM, Gartenberg D, Buxton OM. Detecting sleep using heart rate and motion data from multisensor consumer-grade wearables, relative to wrist actigraphy and polysomnography. Sleep 2021; 43:5811697. [PMID: 32215550 DOI: 10.1093/sleep/zsaa045] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/19/2020] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES Multisensor wearable consumer devices allowing the collection of multiple data sources, such as heart rate and motion, for the evaluation of sleep in the home environment, are increasingly ubiquitous. However, the validity of such devices for sleep assessment has not been directly compared to alternatives such as wrist actigraphy or polysomnography (PSG). METHODS Eight participants each completed four nights in a sleep laboratory, equipped with PSG and several wearable devices. Registered polysomnographic technologist-scored PSG served as ground truth for sleep-wake state. Wearable devices providing sleep-wake classification data were compared to PSG at both an epoch-by-epoch and night level. Data from multisensor wearables (Apple Watch and Oura Ring) were compared to data available from electrocardiography and a triaxial wrist actigraph to evaluate the quality and utility of heart rate and motion data. Machine learning methods were used to train and test sleep-wake classifiers, using data from consumer wearables. The quality of classifications derived from devices was compared. RESULTS For epoch-by-epoch sleep-wake performance, research devices ranged in d' between 1.771 and 1.874, with sensitivity between 0.912 and 0.982, and specificity between 0.366 and 0.647. Data from multisensor wearables were strongly correlated at an epoch-by-epoch level with reference data sources. Classifiers developed from the multisensor wearable data ranged in d' between 1.827 and 2.347, with sensitivity between 0.883 and 0.977, and specificity between 0.407 and 0.821. CONCLUSIONS Data from multisensor consumer wearables are strongly correlated with reference devices at the epoch level and can be used to develop epoch-by-epoch models of sleep-wake rivaling existing research devices.
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Affiliation(s)
| | - Margeaux M Schade
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Gina M Mathew
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | | | - Orfeu M Buxton
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
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11
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Mathew GM, Strayer SM, Bailey DS, Buzzell K, Ness KM, Schade MM, Nahmod NG, Buxton OM, Chang AM. Changes in Subjective Motivation and Effort During Sleep Restriction Moderate Interindividual Differences in Attentional Performance in Healthy Young Men. Nat Sci Sleep 2021; 13:1117-1136. [PMID: 34285617 PMCID: PMC8286723 DOI: 10.2147/nss.s294409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/13/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The effects of sleep restriction on subjective alertness, motivation, and effort vary among individuals and may explain interindividual differences in attention during sleep restriction. We investigated whether individuals with a greater decrease in subjective alertness or motivation, or a greater increase in subjective effort (versus other participants), demonstrated poorer attention when sleep restricted. PARTICIPANTS AND METHODS Fifteen healthy men (M±SD, 22.3±2.8 years) completed a study with three nights of 10-hour time in bed (baseline), five nights of 5-hour time in bed (sleep restriction), and two nights of 10-hour time in bed (recovery). Participants completed a 10-minute psychomotor vigilance task (PVT) of sustained attention and rated alertness, motivation, and effort every two hours during wake (range: 3-9 administrations on a given day). Analyses examined performance across the study (first two days excluded) moderated by per-participant change in subjective alertness, motivation, or effort from baseline to sleep restriction. For significant interactions, we investigated the effect of study day2 (day*day) on the outcome at low (mean-1 SD) and high (mean+1 SD) levels of the moderator (N = 15, all analyses). RESULTS False starts increased across sleep restriction in participants who reported lower (mean-1 SD) but not preserved (mean+1 SD) motivation during sleep restriction. Lapses increased across sleep restriction regardless of change in subjective motivation, with a more pronounced increase in participants who reported lower versus preserved motivation. Lapses increased across sleep restriction in participants who reported higher (mean+1 SD) but not preserved (mean-1 SD) effort during sleep restriction. Change in subjective alertness did not moderate the effects of sleep restriction on attention. CONCLUSION Vigilance declines during sleep restriction regardless of change in subjective alertness or motivation, but individuals with reduced motivation exhibit poorer inhibition. Individuals with preserved subjective alertness still perform poorly during sleep restriction, while those reporting additional effort demonstrate impaired vigilance.
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Affiliation(s)
- Gina Marie Mathew
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Stephen M Strayer
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - David S Bailey
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Katherine Buzzell
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Kelly M Ness
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Margeaux M Schade
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Nicole G Nahmod
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Orfeu M Buxton
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA
| | - Anne-Marie Chang
- Department of Biobehavioral Health, College of Health and Human Development, Pennsylvania State University, University Park, PA, USA.,College of Nursing, Pennsylvania State University, University Park, PA, USA
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12
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Schade MM, Mathew GM, Roberts DM, Gartenberg D, Buxton OM. Enhancing Slow Oscillations and Increasing N3 Sleep Proportion with Supervised, Non-Phase-Locked Pink Noise and Other Non-Standard Auditory Stimulation During NREM Sleep. Nat Sci Sleep 2020; 12:411-429. [PMID: 32765139 PMCID: PMC7364346 DOI: 10.2147/nss.s243204] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/11/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE In non-rapid eye movement (NREM) stage 3 sleep (N3), phase-locked pink noise auditory stimulation can amplify slow oscillatory activity (0.5-1 Hz). Open-loop pink noise auditory stimulation can amplify slow oscillatory and delta frequency activity (0.5-4 Hz). We assessed the ability of pink noise and other sounds to elicit delta power, slow oscillatory power, and N3 sleep. PARTICIPANTS AND METHODS Participants (n = 8) underwent four consecutive inpatient nights in a within-participants design, starting with a habituation night. A registered polysomnographic technologist live-scored sleep stage and administered stimuli on randomized counterbalanced Enhancing and Disruptive nights, with a preceding Habituation night (night 1) and an intervening Sham night (night 3). A variety of non-phase-locked pink noise stimuli were used on Enhancing night during NREM; on Disruptive night, environmental sounds were used throughout sleep to induce frequent auditory-evoked arousals. RESULTS Total sleep time did not differ between conditions. Percentage of N3 was higher in the Enhancing condition, and lower in the Disruptive condition, versus Sham. Standard 0.8 Hz pink noise elicited low-frequency power more effectively than other pink noise, but was not the most effective stimulus. Both pink noise on the "Enhancing" night and sounds intended to Disrupt sleep administered on the "Disruptive" night increased momentary delta and slow-wave activity (ie, during stimulation versus the immediate pre-stimulation period). Disruptive auditory stimulation degraded sleep with frequent arousals and increased next-day vigilance lapses versus Sham despite preserved sleep duration and momentary increases in delta and slow-wave activity. CONCLUSION These findings emphasize sound features of interest in ecologically valid, translational auditory intervention to increase restorative sleep. Preserving sleep continuity should be a primary consideration if auditory stimulation is used to enhance slow-wave activity.
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Affiliation(s)
- Margeaux M Schade
- Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Gina Marie Mathew
- Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | | | | | - Orfeu M Buxton
- Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
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13
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Schade MM, Montgomery-Downs HE. Utility Encompasses Both Clinical Translation and Ecologic Validity. J Clin Sleep Med 2019; 15:1709. [PMID: 31739870 DOI: 10.5664/jcsm.8064] [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]
Affiliation(s)
- Margeaux M Schade
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania
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14
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Ness KM, Strayer SM, Nahmod NG, Schade MM, Chang AM, Shearer GC, Buxton OM. Four nights of sleep restriction suppress the postprandial lipemic response and decrease satiety. J Lipid Res 2019; 60:1935-1945. [PMID: 31484696 DOI: 10.1194/jlr.p094375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/20/2019] [Indexed: 12/16/2022] Open
Abstract
Chronic sleep restriction, or inadequate sleep, is associated with increased risk of cardiometabolic disease. Laboratory studies demonstrate that sleep restriction causes impaired whole-body insulin sensitivity and glucose disposal. Evidence suggests that inadequate sleep also impairs adipose tissue insulin sensitivity and the NEFA rebound during intravenous glucose tolerance tests, yet no studies have examined the effects of sleep restriction on high-fat meal lipemia. We assessed the effect of 5 h time in bed (TIB) per night for four consecutive nights on postprandial lipemia following a standardized high-fat dinner (HFD). Furthermore, we assessed whether one night of recovery sleep (10 h TIB) was sufficient to restore postprandial metabolism to baseline. We found that postprandial triglyceride (TG) area under the curve was suppressed by sleep restriction (P = 0.01), but returned to baseline values following one night of recovery. Sleep restriction decreased NEFAs throughout the HFD (P = 0.02) and NEFAs remained suppressed in the recovery condition (P = 0.04). Sleep restriction also decreased participant-reported fullness or satiety (P = 0.03), and decreased postprandial interleukin-6 (P < 0.01). Our findings indicate that four nights of 5 h TIB per night impair postprandial lipemia and that one night of recovery sleep may be adequate for recovery of TG metabolism, but not for markers of adipocyte function.
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Affiliation(s)
- Kelly M Ness
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802.,Departments of Biobehavioral Health Pennsylvania State University, University Park, PA 16802.,Nutritional Sciences, Pennsylvania State University, University Park, PA 16802
| | - Stephen M Strayer
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802.,Departments of Biobehavioral Health Pennsylvania State University, University Park, PA 16802
| | - Nicole G Nahmod
- Departments of Biobehavioral Health Pennsylvania State University, University Park, PA 16802
| | - Margeaux M Schade
- Departments of Biobehavioral Health Pennsylvania State University, University Park, PA 16802
| | - Anne-Marie Chang
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802.,Departments of Biobehavioral Health Pennsylvania State University, University Park, PA 16802.,College of Nursing, Pennsylvania State University, University Park, PA 16802
| | - Gregory C Shearer
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802.,Nutritional Sciences, Pennsylvania State University, University Park, PA 16802
| | - Orfeu M Buxton
- Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA 16802 .,Departments of Biobehavioral Health Pennsylvania State University, University Park, PA 16802.,Division of Sleep Medicine, Harvard Medical School, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, and Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 20115
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15
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Schade MM, Bauer CE, Murray BR, Gahan L, Doheny EP, Kilroy H, Zaffaroni A, Montgomery-Downs HE. Sleep Validity of a Non-Contact Bedside Movement and Respiration-Sensing Device. J Clin Sleep Med 2019; 15:1051-1061. [PMID: 31383243 DOI: 10.5664/jcsm.7892] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 04/01/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the sleep detection and staging validity of a non-contact, commercially available bedside bio-motion sensing device (S+, ResMed) and evaluate the impact of algorithm updates. METHODS Polysomnography data from 27 healthy adult participants was compared epoch-by-epoch to synchronized data that were recorded and staged by actigraphy and S+. An update to the S+ algorithm (common in the rapidly evolving commercial sleep tracker industry) permitted comparison of the original (S+V1) and updated (S+V2) versions. RESULTS Sleep detection accuracy by S+V1 (93.3%), S+V2 (93.8%), and actigraphy (96.0%) was high; wake detection accuracy by each (69.6%, 73.1%, and 47.9%, respectively) was low. Higher overall S+ specificity, compared to actigraphy, was driven by higher accuracy in detecting wake before sleep onset (WBSO), which differed between S+V2 (90.4%) and actigraphy (46.5%). Stage detection accuracy by the S+ did not exceed 67.6% (for stage N2 sleep, by S+V2) for any stage. Performance is compared to previously established variance in polysomnography scored by humans: a performance standard which commercial devices should ideally strive to reach. CONCLUSIONS Similar limitations in detecting wake after sleep onset (WASO) were found for the S+ as have been previously reported for actigraphy and other commercial sleep tracking devices. S+ WBSO detection was higher than actigraphy, and S+V2 algorithm further improved WASO accuracy. Researchers and clinicians should remain aware of the potential for algorithm updates to impact validity. COMMENTARY A commentary on this article appears in this issue on page 935.
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Affiliation(s)
- Margeaux M Schade
- Department of Psychology, West Virginia University, Morgantown, West Virginia.,Department of Biobehavioral Health, Pennsylvania State University, State College, Pennsylvania
| | - Christopher E Bauer
- Department of Psychology, West Virginia University, Morgantown, West Virginia.,Department of Neuroscience, University of Kentucky, Lexington, Kentucky
| | - Billie R Murray
- Department of Psychology, West Virginia University, Morgantown, West Virginia
| | - Luke Gahan
- ResMed Sensor Technologies Ltd., Dublin, Ireland
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16
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Chen TY, Lee S, Schade MM, Saito Y, Chan A, Buxton OM. Longitudinal relationship between sleep deficiency and pain symptoms among community-dwelling older adults in Japan and Singapore. Sleep 2018; 42:5174354. [DOI: 10.1093/sleep/zsy219] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 01/02/2023] Open
Affiliation(s)
- Tuo-Yu Chen
- Ageing Research Institute for Society and Education, Nanyang Technological University, Singapore
- Center for Healthy Aging, Pennsylvania State University, University Park, PA
| | - Soomi Lee
- School of Aging Studies, University of South Florida, Tampa, FL
| | - Margeaux M Schade
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
| | - Yasuhiko Saito
- Population Research Institute, Nihon University, Tokyo, Japan
| | - Angelique Chan
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Orfeu M Buxton
- Center for Healthy Aging, Pennsylvania State University, University Park, PA
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
- Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, Boston, MA
- Sleep Health Institute, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA
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Schade MM, Montgomery-Downs HE. 0427 EXPERIMENTAL FRAGMENTATION MODELING LOW-LEVEL OSA DOES NOT ALTER PERCEIVED PRESSURE-PAIN THRESHOLD OR TOLERANCE. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schade MM, Bauer CE, Murray BR, Gahan L, Doheny EP, Kilroy H, Zaffaroni A, Montgomery-Downs HE. 0784 SLEEP VALIDITY OF A NON-CONTACT BEDSIDE MOVEMENT AND RESPIRATION-SENSING DEVICE. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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