Do nurses provide a safe sleep environment for infants in the hospital setting? An integrative review.

PubMed

Patton, Carla; Stiltner, Denise; Wright, Kelly Barnhardt; Kautz, Donald D

2015-02-01

Sudden infant death syndrome (SIDS) may be the most preventable cause of death for infants 0 to 6 months of age. The American Academy of Pediatrics (AAP) first published safe sleep recommendations for parents and healthcare professionals in 1992. In 1994, new guidelines were published and they became known as the "Back to Sleep" campaign. After this, a noticeable decline occurred in infant deaths from SIDS. However, this number seems to have plateaued with no continuing significant improvements in infant deaths. The objective of this review was to determine whether nurses provide a safe sleep environment for infants in the hospital setting. Research studies that dealt with nursing behaviors and nursing knowledge in the hospital setting were included in the review. A search was conducted of Google Scholar, CINAHL, PubMed, and Cochrane, using the key words "NICU," "newborn," "SIDS," "safe sleep environment," "nurse," "education," "supine sleep," "prone sleep," "safe sleep," "special care nursery," "hospital policy for safe sleep," "research," "premature," "knowledge," "practice," "health care professionals," and "parents." The review included research reports on nursing knowledge and behaviors as well as parental knowledge obtained through education and role modeling of nursing staff. Only research studies were included to ensure that our analysis was based on rigorous research-based findings. Several international studies were included because they mirrored findings noted in the United States. All studies were published between 1999 and 2012. Healthcare professionals and parents were included in the studies. They were primarily self-report surveys, designed to determine what nurses, other healthcare professionals, and parents knew or had been taught about SIDS. Integrative review. Thirteen of the 16 studies included in the review found that some nurses and some mothers continued to use nonsupine positioning. Four of the 16 studies discussed nursing knowledge and noncompliance with AAP safe sleep recommendations. Eleven of the 16 studies found that some nurses were recommending incorrect sleep positions to mothers. Five of the 16 studies noted that some nurses and mothers gave fear of aspiration as the reason they chose to use a nonsupine sleep position. In the majority of the studies, the information was self-reported, which could impact the validity of the findings. Also, the studies used convenience sampling, which makes study findings difficult to generalize. The research indicates that there has been a plateau in safe sleeping practices in the hospital setting. Some infants continue to be placed in positions that increase the risk for SIDS. The research also shows that some nurses are not following the 2011 AAP recommendations for a safe sleep environment. Clearly, nurses need additional education on SIDS prevention and the safe sleep environment, and additional measures need to be adopted to ensure that all nurses and all families understand the research supporting the AAP recommendation that supine sleep is best. Further work is needed to promote evidence-based practice among healthcare professionals and families.

Assessment of the suitability of using a forehead EEG electrode set and chin EMG electrodes for sleep staging in polysomnography.

PubMed

Myllymaa, Sami; Muraja-Murro, Anu; Westeren-Punnonen, Susanna; Hukkanen, Taina; Lappalainen, Reijo; Mervaala, Esa; Töyräs, Juha; Sipilä, Kirsi; Myllymaa, Katja

2016-12-01

Recently, a number of portable devices designed for full polysomnography at home have appeared. However, current scalp electrodes used for electroencephalograms are not practical for patient self-application. The aim of this study was to evaluate the suitability of recently introduced forehead electroencephalogram electrode set and supplementary chin electromyogram electrodes for sleep staging. From 31 subjects (10 male, 21 female; age 31.3 ± 11.8 years), sleep was recorded simultaneously with a forehead electroencephalogram electrode set and with a standard polysomnography setup consisting of six recommended electroencephalogram channels, two electrooculogram channels and chin electromyogram. Thereafter, two experienced specialists scored each recording twice, based on either standard polysomnography or forehead recordings. Sleep variables recorded with the forehead electroencephalogram electrode set and separate chin electromyogram electrodes were highly consistent with those obtained with the standard polysomnography. There were no statistically significant differences in total sleep time, sleep efficiency or sleep latencies. However, compared with the standard polysomnography, there was a significant increase in the amount of stage N1 and N2, and a significant reduction in stage N3 and rapid eye movement sleep. Overall, epoch-by-epoch agreement between the methods was 79.5%. Inter-scorer agreement for the forehead electroencephalogram was only slightly lower than that for standard polysomnography (76.1% versus 83.2%). Forehead electroencephalogram electrode set as supplemented with chin electromyogram electrodes may serve as a reliable and simple solution for recording total sleep time, and may be adequate for measuring sleep architecture. Because this electrode concept is well suited for patient's self-application, it may offer a significant advancement in home polysomnography. © 2016 European Sleep Research Society.

The Effects of a Cluster Randomized Controlled Workplace Intervention on Sleep and Work-Family Conflict Outcomes in an Extended Care Setting

PubMed Central

Marino, Miguel; Killerby, Marie; Lee, Soomi; Klein, Laura Cousino; Moen, Phyllis; Olson, Ryan; Kossek, Ellen Ernst; King, Rosalind; Erickson, Leslie; Berkman, Lisa F.; Buxton, Orfeu M.

2016-01-01

Objectives To evaluate the effects of a workplace-based intervention on actigraphic and self-reported sleep outcomes in an extended care setting. Design Cluster randomized trial. Setting Extended-care (nursing) facilities. Participants US employees and managers at nursing homes. Nursing homes were randomly selected to intervention or control settings. Intervention The Work, Family and Health Study developed an intervention aimed at reducing work-family conflict within a 4-month work-family organizational change process. Employees participated in interactive sessions with facilitated discussions, role-playing, and games designed to increase control over work processes and work time. Managers completed training in family-supportive supervision. Measurements Primary actigraphic outcomes included: total sleep duration, wake after sleep onset, nighttime sleep, variation in nighttime sleep, nap duration, and number of naps. Secondary survey outcomes included work-to-family conflict, sleep insufficiency, insomnia symptoms and sleep quality. Measures were obtained at baseline, 6-months and 12-months post-intervention. Results A total of 1,522 employees and 184 managers provided survey data at baseline. Managers and employees in the intervention arm showed no significant difference in sleep outcomes over time compared to control participants. Sleep outcomes were not moderated by work-to-family conflict or presence of children in the household for managers or employees. Age significantly moderated an intervention effect on nighttime sleep among employees (p=0.040), where younger employees benefited more from the intervention. Conclusion In the context of an extended-care nursing home workplace, the intervention did not significantly alter sleep outcomes in either managers or employees. Moderating effects of age were identified where younger employees’ sleep outcomes benefited more from the intervention. PMID:28239635

Recovery from Fatigue.

DTIC Science & Technology

1976-06-30

block number) FATIGUE NAPPING PATTERNS SLEEP AND HYPNOSIS NAPPING CONTROL OF SLEEP PROPHYLACTIC NAPPING SLEEP NON-NAPPERS STRESS SLEEP EFFICIENCY 2-L...responsivity to hypnosis and aspects of the napping questionnaire. While there were no differences between hypnotizable and unhypnotizable napper... hypnosis to help modify sleep behavior is documented in a collaborative study. The implications of each of these sets of data, both in terms of our

Sensitivity and Specificity of Polysomnographic Criteria for Defining Insomnia

PubMed Central

Edinger, Jack D.; Ulmer, Christi S.; Means, Melanie K.

2013-01-01

Study Objectives: In recent years, polysomnography-based eligibility criteria have been increasingly used to identify candidates for insomnia research, and this has been particularly true of studies evaluating pharmacologic therapy for primary insomnia. However, the sensitivity and specificity of PSG for identifying individuals with insomnia is unknown, and there is no consensus on the criteria sets which should be used for participant selection. In the current study, an archival data set was used to test the sensitivity and specificity of PSG measures for identifying individuals with primary insomnia in both home and lab settings. We then evaluated the sensitivity and specificity of the eligibility criteria employed in a number of recent insomnia trials for identifying primary insomnia sufferers in our sample. Design: Archival data analysis. Settings: Study participants' homes and a clinical sleep laboratory. Participants: Adults: 76 with primary insomnia and 78 non-complaining normal sleepers. Measurements and Results: ROC and cross-tabs analyses were used to evaluate the sensitivity and specificity of PSG-derived total sleep time, latency to persistent sleep, wake after sleep onset, and sleep efficiency for discriminating adults with primary insomnia from normal sleepers. None of the individual criteria accurately discriminated PI from normal sleepers, and none of the criteria sets used in recent trials demonstrated acceptable sensitivity and specificity for identifying primary insomnia. Conclusions: The use of quantitative PSG-based selection criteria in insomnia research may exclude many who meet current diagnostic criteria for an insomnia disorder. Citation: Edinger JD; Ulmer CS; Means MK. Sensitivity and specificity of polysomnographic criteria for defining insomnia. J Clin Sleep Med 2013;9(5):481-491. PMID:23674940

DO HERBAL AGENTS HAVE A PLACE IN THE TREATMENT OF SLEEP PROBLEMS IN LONG-TERM CARE?

PubMed Central

Shimazaki, Mark; Martin, Jennifer L.

2007-01-01

Sleep disruption is common in the long-term care setting. This paper discusses the available literature on two herbal approaches to sleep problems in long-term care. The largest body of evidence exists for the use of the dietary/herbal supplements valerian and melatonin. While these agents appear to have a modest positive effect on sleep quality among older adults, most studies were small in size and included only subjective assessments of sleep quality. In addition, it is unclear whether these agents pose risks to long-term care residents due to potential drug interactions. Additional research is needed prior to making conclusive recommendations about the use of these interventions for sleep in the long-term care setting. PMID:17498609

Earlier parental set bedtimes as a protective factor against depression and suicidal ideation.

PubMed

Gangwisch, James E; Babiss, Lindsay A; Malaspina, Dolores; Turner, J Blake; Zammit, Gary K; Posner, Kelly

2010-01-01

To examine the relationships between parental set bedtimes, sleep duration, and depression as a quasi-experiment to explore the potentially bidirectional relationship between short sleep duration and depression. Short sleep duration has been shown to precede depression, but this could be explained as a prodromal symptom of depression. Depression in an adolescent can affect his/her chosen bedtime, but it is less likely to affect a parent's chosen set bedtime which can establish a relatively stable upper limit that can directly affect sleep duration. Multivariate cross-sectional analyses of the ADD Health using logistic regression. United States nationally representative, school-based, probability-based sample in 1994-96. Adolescents (n = 15,659) in grades 7 to 12. Adolescents with parental set bedtimes of midnight or later were 24% more likely to suffer from depression (OR = 1.24, 95% CI 1.04-1.49) and 20% more likely to have suicidal ideation (1.20, 1.01-1.41) than adolescents with parental set bedtimes of 10:00 PM or earlier, after controlling for covariates. Consistent with sleep duration and perception of getting enough sleep acting as mediators, the inclusion of these variables in the multivariate models appreciably attenuated the associations for depression (1.07, 0.88-1.30) and suicidal ideation (1.09, 0.92-1.29). The results from this study provide new evidence to strengthen the argument that short sleep duration could play a role in the etiology of depression. Earlier parental set bedtimes could therefore be protective against adolescent depression and suicidal ideation by lengthening sleep duration.

Unsupervised Online Classifier in Sleep Scoring for Sleep Deprivation Studies

PubMed Central

Libourel, Paul-Antoine; Corneyllie, Alexandra; Luppi, Pierre-Hervé; Chouvet, Guy; Gervasoni, Damien

2015-01-01

Study Objective: This study was designed to evaluate an unsupervised adaptive algorithm for real-time detection of sleep and wake states in rodents. Design: We designed a Bayesian classifier that automatically extracts electroencephalogram (EEG) and electromyogram (EMG) features and categorizes non-overlapping 5-s epochs into one of the three major sleep and wake states without any human supervision. This sleep-scoring algorithm is coupled online with a new device to perform selective paradoxical sleep deprivation (PSD). Settings: Controlled laboratory settings for chronic polygraphic sleep recordings and selective PSD. Participants: Ten adult Sprague-Dawley rats instrumented for chronic polysomnographic recordings Measurements: The performance of the algorithm is evaluated by comparison with the score obtained by a human expert reader. Online detection of PS is then validated with a PSD protocol with duration of 72 hours. Results: Our algorithm gave a high concordance with human scoring with an average κ coefficient > 70%. Notably, the specificity to detect PS reached 92%. Selective PSD using real-time detection of PS strongly reduced PS amounts, leaving only brief PS bouts necessary for the detection of PS in EEG and EMG signals (4.7 ± 0.7% over 72 h, versus 8.9 ± 0.5% in baseline), and was followed by a significant PS rebound (23.3 ± 3.3% over 150 minutes). Conclusions: Our fully unsupervised data-driven algorithm overcomes some limitations of the other automated methods such as the selection of representative descriptors or threshold settings. When used online and coupled with our sleep deprivation device, it represents a better option for selective PSD than other methods like the tedious gentle handling or the platform method. Citation: Libourel PA, Corneyllie A, Luppi PH, Chouvet G, Gervasoni D. Unsupervised online classifier in sleep scoring for sleep deprivation studies. SLEEP 2015;38(5):815–828. PMID:25325478

Patients with primary insomnia in the sleep laboratory: do they present with typical nights of sleep?

PubMed

Hirscher, Verena; Unbehaun, Thomas; Feige, Bernd; Nissen, Christoph; Riemann, Dieter; Spiegelhalder, Kai

2015-08-01

The validity of sleep laboratory investigations in patients with insomnia is important for researchers and clinicians. The objective of this study was to examine the first-night effect and the reverse first-night effect in patients with chronic primary insomnia compared with good sleeper controls. A retrospective comparison of a well-characterised sample of 50 patients with primary insomnia and 50 good sleeper controls was conducted with respect to 2 nights of polysomnography, and subjective sleep parameters in the sleep laboratory and the home setting. When comparing the first and second sleep laboratory night, a significant first-night effect was observed across both groups in the great majority of the investigated polysomnographic and subjective variables. However, patients with primary insomnia and good sleeper controls did not differ with respect to this effect. Regarding the comparison between the sleep laboratory nights and the home setting, unlike good sleeper controls, patients with primary insomnia reported an increased subjective sleep efficiency on both nights (in part due to a reduced bed time) and an increased subjective total sleep time on the second night. These results suggest that even the second sleep laboratory night does not necessarily provide clinicians and researchers with a representative insight into the sleep perception of patients with primary insomnia. Future studies should investigate whether these findings also hold for other patient populations. © 2015 European Sleep Research Society.

Preliminary study for the personal handheld device based snoring detection in ordinary sleep situation.

PubMed

Shin, Hangsik; Choi, Wangrim; Kim, Yi-gon; Cho, Jaegeol

2014-01-01

Snoring is one of the representative phenomena of the sleep disorder and detection of snoring is quite important for improving quality of daily human life. The purpose of this research is to define the noises of the ordinary sleep situation and to find its characteristics as a preliminary research of snoring detection. Differently from previous snoring researches, we use a built-in sound recording system of Smartphone for practical use in ordinary sleep condition, and recording was carried out in a general private bedroom. Especially, we designed the experimental protocol, including the various noises could be frequently occurred during sleep such as cough, music, talking, alarm, door open/close, fan, radio and footstep to make closer to the actual sleep circumstance. The sound data set was recorded during actual sleep from 10 normal subjects. Totally 44 snoring data set and 75-noise dataset is acquired and analyzed.

Sleep Environments of Children in an Urban U.S. Setting Exposed to Interpersonal Violence.

PubMed

Spilsbury, James C; Frame, Jennifer; Magtanong, Ruth; Rork, Kristine

2016-01-01

This study investigated how violence influences children's sleep environments. Sixty-five children ages 8-16 years and a parent or guardian were recruited from agencies serving families experiencing violence. At baseline (5 weeks post-violent event), 6 months, and 12 months postbaseline, study staff collected sleep-behavior information and conducted systematic, qualitative assessments of sleep environments. Child sleep problems were generally frequent and persistent. However, 9 children reported improved sleep after the violent event, mainly because perpetrators were no longer present. Sleeping environments were dynamic via changes in location and modifications to improve safety and sleep. Incongruence between children's and parents' perceptions of environmental characteristics influencing sleep was common. Families' motivation to improve children's sleep represents a foundation to build upon when working with families victimized by violence.

Naturalistic Field Studies of Sleep and Performance

DTIC Science & Technology

2010-05-01

AD_________________ Award Number: W81XWH-05-1-0099 TITLE: Naturalistic Field Studies of Sleep and...5a. CONTRACT NUMBER Naturalistic Field Studies of Sleep and Performance 5b. GRANT NUMBER W81XWH-05-1-0099 5c. PROGRAM ELEMENT NUMBER 6...Center (SPRC) conducts human and animal  studies  in laboratory and field settings in support of basic and applied sleep  research at Washington State

The use of ENT-prescribed home sleep studies for patients with suspected obstructive sleep apnea.

PubMed

Davidson, T M; Do, K L; Justus, S

1999-10-01

Sleep disordered breathing, including obstructive sleep apnea, is a common and morbid health problem. Traditionally, sleep disordered breathing is diagnosed by complex sleep studies. However, newer, easy-to-use, highly sensitive, and highly specific home sleep study equipment is now available. The present study was undertaken to determine whether an otolaryngologist could easily and effectively dispense home sleep equipment from the office. We used a portable AutoSet home sleep machine. Our experience with the first 100 consecutively presenting patients was recorded and analyzed under institutional review board approval. Ninety-nine of the 100 tests were completed successfully on the first attempt; the one failure was successful on the second attempt. Our results were consistent with those reported from in-house polysomnogram sleep studies; 71% of our patients had an apnea-hypopnea index (AHI) of 15 or higher, and 93% had an AHI at least 5. We conclude that an otolaryngologist, using state-of-the-art home sleep testing equipment, can accurately and cost-effectively prescribe home sleep studies.

Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback

PubMed Central

Whitney, Paul; Hinson, John M.; Jackson, Melinda L.; Van Dongen, Hans P.A.

2015-01-01

Study Objectives: To better understand the sometimes catastrophic effects of sleep loss on naturalistic decision making, we investigated effects of sleep deprivation on decision making in a reversal learning paradigm requiring acquisition and updating of information based on outcome feedback. Design: Subjects were randomized to a sleep deprivation or control condition, with performance testing at baseline, after 2 nights of total sleep deprivation (or rested control), and following 2 nights of recovery sleep. Subjects performed a decision task involving initial learning of go and no go response sets followed by unannounced reversal of contingencies, requiring use of outcome feedback for decisions. A working memory scanning task and psychomotor vigilance test were also administered. Setting: Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring. Subjects: Twenty-six subjects (22–40 y of age; 10 women). Interventions: Thirteen subjects were randomized to a 62-h total sleep deprivation condition; the others were controls. Results: Unlike controls, sleep deprived subjects had difficulty with initial learning of go and no go stimuli sets and had profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Working memory scanning performance was not significantly affected by sleep deprivation. And although sleep deprived subjects showed expected attentional lapses, these could not account for impairments in reversal learning decision making. Conclusions: Sleep deprivation is particularly problematic for decision making involving uncertainty and unexpected change. Blunted reactions to feedback while sleep deprived underlie failures to adapt to uncertainty and changing contingencies. Thus, an error may register, but with diminished effect because of reduced affective valence of the feedback or because the feedback is not cognitively bound with the choice. This has important implications for understanding and managing sleep loss-induced cognitive impairment in emergency response, disaster management, military operations, and other dynamic real-world settings with uncertain outcomes and imperfect information. Citation: Whitney P, Hinson JM, Jackson ML, Van Dongen HPA. Feedback blunting: total sleep deprivation impairs decision making that requires updating based on feedback. SLEEP 2015;38(5):745–754. PMID:25515105

A cross-cultural comparison of sleep duration between US And Australian adolescents: the effect of school start time, parent-set bedtimes, and extracurricular load.

PubMed

Short, Michelle A; Gradisar, Michael; Lack, Leon C; Wright, Helen R; Dewald, Julia F; Wolfson, Amy R; Carskadon, Mary A

2013-06-01

To test whether sleep duration on school nights differs between adolescents in Australia and the United States and, if so, whether this difference is explained by cultural differences in school start time, parental involvement in setting bedtimes, and extracurricular commitments. Three hundred eighty-five adolescents aged 13 to 18 years (M = 15.57, SD = 0.95; 60% male) from Australia and 302 adolescents aged 13 to 19 years (M = 16.03, SD = 1.19; 35% male) from the United States. Adolescents completed the School Sleep Habits Survey during class time, followed by an 8-day sleep diary. After controlling for age and gender, Australian adolescents obtained an average of 47 minutes more sleep per school night than those in the United States. Australian adolescents were more likely to have a parent-set bedtime (17.5% vs. 6.8%), have a later school start time (8:32 a.m. vs. 7:45 a.m.), and spend less time per day on extracurricular commitments (1 h 37 min vs. 2 h 41 min) than their U.S. peers. The mediating factors of parent-set bedtimes, later school start times, and less time spent on extracurricular activities were significantly associated with more total sleep. In addition to biological factors, extrinsic cultural factors significantly affect adolescent sleep. The present study highlights the importance of a cross-cultural, ecological approach and the impact of early school start times, lack of parental limit setting around bedtimes, and extracurricular load in limiting adolescent sleep.

Sleep Disorders Among Holocaust Survivors: A Review of Selected Publications.

PubMed

Lurie, Ido

2017-09-01

After World War II, traumatic after effects often caused persistent sleep disorders for Holocaust survivors (HSs). This is a review of studies reporting on sleep disturbances and nightmares (as primary or secondary outcomes) among HSs between 1939 and 2015, conducted in various countries and contexts (clinical settings, pension claims, community surveys, sleep laboratories). Most studies revealed various sleep disturbances among HSs. Some studies found those disturbances in the absence of clinical disorders. Both men and women reported similar frequencies of sleep disturbances, although posttraumatic stress disorder and depression were more frequent in women. Sleep laboratory studies provided the single most direct and detailed sources of information. Findings included a) long-standing changes in sleep architecture, for example, decreased rapid eye movement (REM) sleep, and b) contrasting patterns of dreaming and recall among better versus poorly adjusted survivors. These results are of importance to both HSs and their families and for medical and mental health professionals.

The Influence of Break Timing on the Sleep Quantity and Quality of Fly-in, Fly-out Shiftworkers

PubMed Central

PAECH, Gemma M.; FERGUSON, Sally A.; BANKS, Siobhan; DORRIAN, Jillian; ROACH, Gregory D.

2014-01-01

Although shift and break timing is known to affect the sleep of shiftworkers, this has not been demonstrated in Fly-in, Fly-out (FIFO) settings which, compared to residential based settings, may be favourable for sleep. This study investigated the sleep quantity and quality of shiftworkers working a FIFO operation comprising of shifts, and therefore breaks, across the 24-h day. The sleep of 24 males (50.43 ± 8.57 yr) was measured using actigraphy and sleep diaries. Morning breaks were associated with less sleep (09:00–12:00 h; 4.4 ± 1.3 h) and a poorer sleep quality (06:00–09:00 h; 3.1 ± 1.0, “average”) compared to breaks beginning between 00:00 h and 03:00 h (6.8 ± 1.7 h; 2.2 ± 0.9, “good”). Sleep efficiency remained constant regardless of break timing (85.9 ± 5.0% to 89.9 ± 3.5%). Results indicate that even in operations such as FIFO where sleeping conditions are near-optimal and the break duration is held constant, the influence of the endogenous circadian pacemaker on sleep duration is evident. PMID:25224336

Effects of Positive Airway Pressure on Patients with Obstructive Sleep Apnea during Acute Ascent to Altitude

PubMed Central

Nishida, Katsufumi; Cloward, Tom V.; Weaver, Lindell K.; Brown, Samuel M.; Bell, James E.; Grissom, Colin K.

2015-01-01

Rationale: In acute ascent to altitude, untreated obstructive sleep apnea (OSA) is often replaced with central sleep apnea (CSA). In patients with obstructive sleep apnea who travel to altitude, it is unknown whether their home positive airway pressure (PAP) settings are sufficient to treat their obstructive sleep apnea, or altitude-associated central sleep apnea. Methods: Ten participants with positive airway pressure–treated obstructive sleep apnea, who reside at 1,320 m altitude, underwent polysomnography on their home positive airway pressure settings at 1,320 m and at a simulated altitude of 2,750 m in a hypobaric chamber. Six of the participants were subsequently studied without positive airway pressure at 2,750 m. Measurements and Main Results: At 1,320 m, all participants’ sleep apnea was controlled with positive airway pressure on home settings; at 2,750, no participants’ sleep apnea was controlled. At higher altitude, the apnea–hypopnea index was higher (11 vs. 2 events/h; P < 0.01), mostly due to hypopneas (10.5 vs. 2 events/h; P < 0.01). Mean oxygen saturations were lower (88 vs. 93%; P < 0.01) and total sleep time was diminished (349 vs. 393 min; P = 0.03). Four of six participants without positive airway pressure at 2,750 m required supplemental oxygen to prevent sustained oxygen saturation (as determined by pulse oximetry) less than 80%. Positive airway pressure also was associated with reduced central sleep apnea (0 vs. 1; P = 0.03), improved sleep time (358 vs. 292 min; P = 0.06), and improved sleep efficiency (78 vs. 63%; P = 0.04). Conclusions: Acute altitude exposure in patients with obstructive sleep apnea treated with positive airway pressure is associated with hypoxemia, decreased sleep time, and increased frequency of hypopneas compared with baseline altitude. Application of positive airway pressure at altitude is associated with decreased central sleep apnea and increased sleep efficiency. PMID:25884271

Binge drinking and sleep problems among young adults.

PubMed

Popovici, Ioana; French, Michael T

2013-09-01

As most of the literature exploring the relationships between alcohol use and sleep problems is descriptive and with small sample sizes, the present study seeks to provide new information on the topic by employing a large, nationally representative dataset with several waves of data and a broad set of measures for binge drinking and sleep problems. We use data from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative survey of adolescents and young adults. The analysis sample consists of all Wave 4 observations without missing values for the sleep problems variables (N=14,089, 53% females). We estimate gender-specific multivariate probit models with a rich set of socioeconomic, demographic, physical, and mental health variables to control for confounding factors. Our results confirm that alcohol use, and specifically binge drinking, is positively and significantly associated with various types of sleep problems. The detrimental effects on sleep increase in magnitude with frequency of binge drinking, suggesting a dose-response relationship. Moreover, binge drinking is associated with sleep problems independent of psychiatric conditions. The statistically strong association between sleep problems and binge drinking found in this study is a first step in understanding these relationships. Future research is needed to determine the causal links between alcohol misuse and sleep problems to inform appropriate clinical and policy responses. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Effects of a Cluster Randomized Controlled Workplace Intervention on Sleep and Work-Family Conflict Outcomes in an Extended Care Setting.

PubMed

Marino, Miguel; Killerby, Marie; Lee, Soomi; Klein, Laura Cousino; Moen, Phyllis; Olson, Ryan; Kossek, Ellen Ernst; King, Rosalind; Erickson, Leslie; Berkman, Lisa F; Buxton, Orfeu M

2016-12-01

To evaluate the effects of a workplace-based intervention on actigraphic and self-reported sleep outcomes in an extended care setting. Cluster randomized trial. Extended-care (nursing) facilities. US employees and managers at nursing homes. Nursing homes were randomly selected to intervention or control settings. The Work, Family and Health Study developed an intervention aimed at reducing work-family conflict within a 4-month work-family organizational change process. Employees participated in interactive sessions with facilitated discussions, role-playing, and games designed to increase control over work processes and work time. Managers completed training in family-supportive supervision. Primary actigraphic outcomes included: total sleep duration, wake after sleep onset, nighttime sleep, variation in nighttime sleep, nap duration, and number of naps. Secondary survey outcomes included work-to-family conflict, sleep insufficiency, insomnia symptoms and sleep quality. Measures were obtained at baseline, 6-months and 12-months post-intervention. A total of 1,522 employees and 184 managers provided survey data at baseline. Managers and employees in the intervention arm showed no significant difference in sleep outcomes over time compared to control participants. Sleep outcomes were not moderated by work-to-family conflict or presence of children in the household for managers or employees. Age significantly moderated an intervention effect on nighttime sleep among employees (p=0.040), where younger employees benefited more from the intervention. In the context of an extended-care nursing home workplace, the intervention did not significantly alter sleep outcomes in either managers or employees. Moderating effects of age were identified where younger employees' sleep outcomes benefited more from the intervention.

Sleep complaints affecting school performance at different educational levels.

PubMed

Pagel, James F; Kwiatkowski, Carol F

2010-01-01

The clear association between reports of sleep disturbance and poor school performance has been documented for sleepy adolescents. This study extends that research to students outside the adolescent age grouping in an associated school setting (98 middle school students, 67 high school students, and 64 college students). Reported restless legs and periodic limb movements are significantly associated with lower GPA's in junior high students. Consistent with previous studies, daytime sleepiness was the sleep variable most likely to negatively affects high school students. Sleep onset and maintenance insomnia were the reported sleep variables significantly correlated with poorer school performance in college students. This study indicates that different sleep disorder variables negatively affect performance at different age and educational levels.

The Orexin Antagonist SB-649868 Promotes and Maintains Sleep in Men with Primary Insomnia

PubMed Central

Bettica, Paolo; Squassante, Lisa; Zamuner, Stefano; Nucci, Gianluca; Danker-Hopfe, Heidi; Ratti, Emiliangelo

2012-01-01

Study Objectives: To assess the acute effects of SB-649868 in male subjects with Primary Insomnia with regard to (1) objective and subjective sleep parameters, (2) safety and tolerability, (3) next-day residual effects. Design: Multicenter, randomized, double-blind, placebo-controlled crossover study using a complete set of Williams orthogonal Latin Squares Setting: 9 sleep centers in Germany Patients: 52 male subjects with a diagnosis of primary insomnia (difficulty in sleep initiation and maintenance) confirmed by polysomnography Interventions: SB-649868 (10, 30, 60 mg) and placebo administered after dinner 90 minutes before bedtime Measurements and Results: Sleep effects assessed by polysomnography during 2 consecutive nights and by sleep questionnaires completed by subjects after each night at the sleep laboratory. Safety and tolerability were assessed by adverse events collection, electrocardiogram (ECG), vital signs, laboratory tests. Next-day residual effects were assessed by Digit Symbol Substitution Test, and modified Verbal Learning Memory Test administered at “lights on” after night 2. SB-649868 significantly reduced latency to persistent sleep, wake after sleep onset (WASO), and increased total sleep time (TST) compared to placebo. A dose-dependent effect was observed. A dose-dependent increase in absolute and percent REM sleep and reduction in REM sleep latency was observed mainly at the 60-mg dose. SB-649868 was well tolerated with inconsistent next day residual effects. SB-649868 sleep effects were correlated with SB-649868 circulating levels. Conclusion: The data demonstrate the sleep-promoting properties of the orexin antagonist SB-649868 in male patients with insomnia. Clinical Trials Information: This study was registered on ClinicalTrials.gov with the following identifier: NCT00426816. URL: http://www.clinicaltrial.gov/ct2/show/NCT00426816?term=649868&rank=5. Citation: Bettica P; Squassante L; Zamuner S; Nucci G; Danker-Hopfe H; Ratti E. The orexin antagonist SB-649868 promotes and maintains sleep in men with primary insomnia. SLEEP 2012;35(8):1097-1104. PMID:22851805

Sleep Shelters Verbal Memory from Different Kinds of Interference

PubMed Central

Sheth, Bhavin R.; Varghese, Reni; Truong, Thuy

2012-01-01

Study Objectives: Studies have shown that sleep shelters old verbal memories from associative interference arising from new, more recently acquired memories. Our objective is to extend the forms of interference for which sleep provides a sheltering benefit to non-associative and prospective interference, and to examine experimental conditions and memory strengths for which sleep before or after learning particularly affects verbal memory consolidation. Design: Acquiring paired word associates, retention across intervening sleep and wake, training on new, interfering word associates, and test recall of both sets. Setting: University laboratory. Participants: Healthy volunteers. Interventions: N/A. Measurements and Results: Comparing recall before and after intervening periods of sleep versus wake, we found that: (i) Sleep preferentially shields weakly encoded verbal memories from retroactive interference. (ii) Sleep immediately following learning helps shelter memory from associative and non-associative forms of retroactive interference. (iii) Sleep protects new verbal memories from prospective interference. (iv) Word associations acquired for the first time in the evening after a day spent in the wake state are encoded more strongly than word associations acquired in the morning following a night of sleep. Conclusions: The findings extend the known sleep protection from interference to non-associative as well as prospective interference, and limit the protection to weakly encoded word associations. Combined, our results suggest that sleep immediately after verbal learning isolates newly formed memory traces and renders them inaccessible, except by specific contextual cues. Memory isolation in sleep is a passive mechanism that can reasonably account for several experimental findings. Citation: Sheth BR; Varghese R; Truong T. Sleep shelters verbal memory from different kinds of interference. SLEEP 2012;35(7):985-996. PMID:22754045

Actigraphy scoring for sleep outcome measures in chronic obstructive pulmonary disease.

PubMed

Kapella, Mary C; Vispute, Sachin; Zhu, Bingqian; Herdegen, James J

2017-09-01

Actigraphy is commonly used to measure sleep outcomes so that sleep can be measured conveniently at home over multiple nights. Actigraphy has been validated in people with sleep disturbances; however, the validity of scoring settings in people with chronic medical illnesses such as chronic obstructive pulmonary disease remains unclear. The purpose of this secondary analysis was to compare actigraphy-customized scoring settings with polysomnography (PSG) for the measurement of sleep outcomes in people with chronic obstructive pulmonary disease who have insomnia. Participants underwent overnight sleep assessment simultaneously by PSG and actigraphy at the University of Illinois of Chicago Sleep Science Center. Fifty participants (35 men and 15 women) with mild-to-severe chronic obstructive pulmonary disease and co-existing insomnia were included in the analysis. Sleep onset latency, total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE) were calculated independently from data derived from PSG and actigraphy. Actigraphy sleep outcome scores obtained at the default setting and several customized actigraphy settings were compared to the scored PSG results. Although no single setting was optimal for all sleep outcomes, the combination of 10 consecutive immobile minutes for sleep onset or end and an activity threshold of 10 worked well. Actigraphy overestimated TST and SE and underestimated WASO, but there was no difference in variance between PSG and actigraphy in TST and SE when the 10 × 10 combination was used. As the average TST and SE increased, the agreement between PSG and actigraphy appeared to increase, and as the average WASO decreased, the agreement between PSG and actigraphy appeared to increase. Results support the conclusion that the default actigraphy settings may not be optimal for people with chronic obstructive pulmonary disease and co-existing insomnia. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

The addition of entropy-based regularity parameters improves sleep stage classification based on heart rate variability.

PubMed

Aktaruzzaman, M; Migliorini, M; Tenhunen, M; Himanen, S L; Bianchi, A M; Sassi, R

2015-05-01

The work considers automatic sleep stage classification, based on heart rate variability (HRV) analysis, with a focus on the distinction of wakefulness (WAKE) from sleep and rapid eye movement (REM) from non-REM (NREM) sleep. A set of 20 automatically annotated one-night polysomnographic recordings was considered, and artificial neural networks were selected for classification. For each inter-heartbeat (RR) series, beside features previously presented in literature, we introduced a set of four parameters related to signal regularity. RR series of three different lengths were considered (corresponding to 2, 6, and 10 successive epochs, 30 s each, in the same sleep stage). Two sets of only four features captured 99 % of the data variance in each classification problem, and both of them contained one of the new regularity features proposed. The accuracy of classification for REM versus NREM (68.4 %, 2 epochs; 83.8 %, 10 epochs) was higher than when distinguishing WAKE versus SLEEP (67.6 %, 2 epochs; 71.3 %, 10 epochs). Also, the reliability parameter (Cohens's Kappa) was higher (0.68 and 0.45, respectively). Sleep staging classification based on HRV was still less precise than other staging methods, employing a larger variety of signals collected during polysomnographic studies. However, cheap and unobtrusive HRV-only sleep classification proved sufficiently precise for a wide range of applications.

Unearthing the Phylogenetic Roots of Sleep

PubMed Central

Allada, Ravi; Siegel, Jerome M.

2010-01-01

Why we sleep remains one of the enduring unanswered questions in biology. At its core, sleep can be defined behaviorally as a homeostatically regulated state of reduced movement and sensory responsiveness. The cornerstone of sleep studies in terrestrial mammals, including humans, has been the measurement of coordinated changes in brain activity during sleep measured using the electroencephalogram (EEG). Yet among a diverse set of animals, these EEG sleep traits can vary widely and, in some cases, are absent, raising questions as to whether they define a universal, or even essential, feature of sleep. Over the past decade, behaviorally defined sleep-like states have been identified in a series of genetic model organisms, including fish, flies and worms. Genetic analyses in these systems are revealing a remarkable conservation in the underlying mechanisms controlling sleep behavior. Taken together, these studies suggest an ancient origin for sleep and raise the possibility that model organism genetics may reveal the molecular mechanisms that guide sleep and wake. PMID:18682212

Classifying vulnerability to sleep deprivation using baseline measures of psychomotor vigilance.

PubMed

Patanaik, Amiya; Kwoh, Chee Keong; Chua, Eric C P; Gooley, Joshua J; Chee, Michael W L

2015-05-01

To identify measures derived from baseline psychomotor vigilance task (PVT) performance that can reliably predict vulnerability to sleep deprivation. Subjects underwent total sleep deprivation and completed a 10-min PVT every 1-2 h in a controlled laboratory setting. Participants were categorized as vulnerable or resistant to sleep deprivation, based on a median split of lapses that occurred following sleep deprivation. Standard reaction time, drift diffusion model (DDM), and wavelet metrics were derived from PVT response times collected at baseline. A support vector machine model that incorporated maximum relevance and minimum redundancy feature selection and wrapper-based heuristics was used to classify subjects as vulnerable or resistant using rested data. Two academic sleep laboratories. Independent samples of 135 (69 women, age 18 to 25 y), and 45 (3 women, age 22 to 32 y) healthy adults. In both datasets, DDM measures, number of consecutive reaction times that differ by more than 250 ms, and two wavelet features were selected by the model as features predictive of vulnerability to sleep deprivation. Using the best set of features selected in each dataset, classification accuracy was 77% and 82% using fivefold stratified cross-validation, respectively. In both datasets, DDM measures, number of consecutive reaction times that differ by more than 250 ms, and two wavelet features were selected by the model as features predictive of vulnerability to sleep deprivation. Using the best set of features selected in each dataset, classification accuracy was 77% and 82% using fivefold stratified cross-validation, respectively. Despite differences in experimental conditions across studies, drift diffusion model parameters associated reliably with individual differences in performance during total sleep deprivation. These results demonstrate the utility of drift diffusion modeling of baseline performance in estimating vulnerability to psychomotor vigilance decline following sleep deprivation. © 2015 Associated Professional Sleep Societies, LLC.

Effectiveness of a sleep education program for pediatricians.

PubMed

Ersu, Refika; Boran, Perran; Akın, Yasemin; Bozaykut, Abdülkadir; Ay, Pınar; Yazar, Ahmet Sami

2017-03-01

The high prevalence of sleep problems in children and long-term consequences point to the need for early effective interventions, but health-care providers have limited training in pediatric sleep medicine. The aims of this study were therefore to assess the effectiveness of a sleep health-care education program and to develop a Turkish acronym for brief sleep history taking for pediatric primary caregivers in the ambulatory setting. This was a quasi-experimental study. Four centers were randomly selected from eight training and research hospitals as the intervention group. The control group was recruited during training in subjects other than sleep. Education was provided to the intervention group. Knowledge and attitudes were evaluated in the short and long term. The intervention and the control groups consisted of 132 and 78 pediatricians, respectively. The intervention group scored significantly higher both in the short and the long term. The Turkish acronym (UYKU) was reported to be easy to remember and effective in prompting the correct questions to ask about sleep issues. The Turkish acronym would be useful in the primary care setting to increase the frequency of screening of sleep problems in children. Although education significantly improved knowledge on sleep issues in children, the percentage of participants who lacked confidence in the management of sleep problems in children was still very high, even in the intervention group. We suggest that a broader educational program, carried out more than once, would be more beneficial. © 2016 Japan Pediatric Society.

Integrative literature review: sleep patterns in infants attending nurseries.

PubMed

Cerqueira, Ana Carolina Dantas Rocha; Cardoso, Maria Vera Lúcia Moreira Leitão; Viana, Tamires Rebeca Forte; Lopes, Márcia Maria Coelho Oliveira

2018-01-01

To identify evidence available in the literature about sleep patterns of infants attending nurseries. An integrative review of studies published in Portuguese, English or Spanish available in full text on LILACS, CINAHL, and PubMed databases. The following descriptors sono, lactente and creches or berçários (in Portuguese) and sleep, infant and childcare or nurseries were used for LILACS, CINAHL and Pubmed, respectively. Nine studies were selected and analyzed. The main component explored in the studies about sleep pattern is the sleep position of the infants, due to its association with sudden infant death syndrome. The results pointed to the need to promote and develop written guidelines regarding behavioral practices to reduce the risk of this phenomenon. Evidence has identified sleep issues, mainly regarding the sleep position of the infant and the environment where the infant sleeps, showing that it is critical to set routines and interventions to improve the quality of sleep care of infants attending nurseries.

Sleep Duration and Quality in Pregnant Women: A Cross-Sectional Survey in China.

PubMed

Xu, Xianglong; Liu, Dengyuan; Zhang, Zhangyi; Sharma, Manoj; Zhao, Yong

2017-07-20

Objectives: Good maternal health and fetal development require sufficient and good quality of sleep during pregnancy. This study investigated sleep duration and quality in pregnant women, assessing factors with possibly influence on sleep. Method: A cross-sectional survey was conducted on pregnant women between June and August in 2015 in 16 hospitals in five provinces in China. A total of 2345 pregnant women aged 18 years and older were surveyed. Insufficient sleeping duration was defined as sleeping of less than 7 h per day. Excessive sleep duration was defined as sleeping of more than 9 h per day. Results: A total of 561 (23.9%) participants reported insufficient sleeping duration, whereas 485 (20.9%) claimed excessive sleep duration. A total of 358 (15.2%) of pregnant women reported problems regarding sleep quality. Compared to pregnant women with sufficient sleeping duration, those with insufficient sleeping duration were prone to have poor sleep quality, whereas those with excessive sleeping duration featured low possibility of poor sleep quality. High-risk groups of insufficient sleep duration include women of Han nationality, with siblings, in their first trimester of pregnancy, receiving care in low-capacity/quality hospital settings, and with daily or 1-3 days of secondhand smoke exposure. High-risk groups of excessive sleep duration include women living in rural areas, unemployed, in their third trimester of pregnancy, and receiving care in medium-capacity/quality hospital settings. High-risk groups of poor sleep quality include women of non-Han nationality, low income level, in their third trimester of pregnancy, and with insufficient sleep duration. Conclusions: Insufficient/excessive sleep duration and poor sleep quality commonly occur during pregnancy in China. Findings provide a better understanding of the influencing factors of insufficient/excessive sleep duration and poor quality of sleep. These findings have some implications for future interventions on sleep among pregnant women.

Sleep Duration and Quality in Pregnant Women: A Cross-Sectional Survey in China

PubMed Central

Liu, Dengyuan; Zhang, Zhangyi; Zhao, Yong

2017-01-01

Objectives: Good maternal health and fetal development require sufficient and good quality of sleep during pregnancy. This study investigated sleep duration and quality in pregnant women, assessing factors with possibly influence on sleep. Method: A cross-sectional survey was conducted on pregnant women between June and August in 2015 in 16 hospitals in five provinces in China. A total of 2345 pregnant women aged 18 years and older were surveyed. Insufficient sleeping duration was defined as sleeping of less than 7 h per day. Excessive sleep duration was defined as sleeping of more than 9 h per day. Results: A total of 561 (23.9%) participants reported insufficient sleeping duration, whereas 485 (20.9%) claimed excessive sleep duration. A total of 358 (15.2%) of pregnant women reported problems regarding sleep quality. Compared to pregnant women with sufficient sleeping duration, those with insufficient sleeping duration were prone to have poor sleep quality, whereas those with excessive sleeping duration featured low possibility of poor sleep quality. High-risk groups of insufficient sleep duration include women of Han nationality, with siblings, in their first trimester of pregnancy, receiving care in low-capacity/quality hospital settings, and with daily or 1–3 days of secondhand smoke exposure. High-risk groups of excessive sleep duration include women living in rural areas, unemployed, in their third trimester of pregnancy, and receiving care in medium-capacity/quality hospital settings. High-risk groups of poor sleep quality include women of non-Han nationality, low income level, in their third trimester of pregnancy, and with insufficient sleep duration. Conclusions: Insufficient/excessive sleep duration and poor sleep quality commonly occur during pregnancy in China. Findings provide a better understanding of the influencing factors of insufficient/excessive sleep duration and poor quality of sleep. These findings have some implications for future interventions on sleep among pregnant women. PMID:28726747

SleepSense: A Noncontact and Cost-Effective Sleep Monitoring System.

PubMed

Lin, Feng; Zhuang, Yan; Song, Chen; Wang, Aosen; Li, Yiran; Gu, Changzhan; Li, Changzhi; Xu, Wenyao

2017-02-01

Quality of sleep is an important indicator of health and well being. Recent developments in the field of in-home sleep monitoring have the potential to enhance a person's sleeping experience and contribute to an overall sense of well being. Existing in-home sleep monitoring devices either fail to provide adequate sleep information or are obtrusive to use. To overcome these obstacles, a noncontact and cost-effective sleep monitoring system, named SleepSense, is proposed for continuous recognition of the sleep status, including on-bed movement, bed exit, and breathing section. SleepSense consists of three parts: a Doppler radar-based sensor, a robust automated radar demodulation module, and a sleep status recognition framework. Herein, several time-domain and frequency-domain features are extracted for the sleep recognition framework. A prototype of SleepSense is presented and evaluated using two sets of experiments. In the short-term controlled experiment, the SleepSense achieves an overall 95.1% accuracy rate in identifying various sleep status. In the 75-minute sleep study, SleepSense demonstrates wide usability in real life. The error rate for breathing rate extraction in this study is only 6.65%. These experimental results indicate that SleepSense is an effective and promising solution for in-home sleep monitoring.

Self-perceived health status and sleep quality of older adults living in community after elastic band exercises.

PubMed

Chan, Shu-Ya; Chen, Kuei-Min

2017-07-01

To test the effectiveness of a six-month senior elastic band exercise programme on the self-perceived health status and sleep quality of older adults living in community settings. Health issues common among older adults living in community settings include poor physical and mental health conditions and sleep quality. Engagement in appropriate exercise programmes facilitates alleviating these health issues among older adults. A quasi-experimental design was applied. A convenience sample of older adults was drawn from six senior-citizen activity centres in southern Taiwan. Participants were assigned to either an experimental group (three centres, n = 97) or a control group (three centres, n = 102) based on the senior-citizen activity centres they attended. The participants in the experimental group carried out the Senior Elastic Band exercise programme for six months (three times per week and 40 minutes per session) in addition to their daily activities. The participants in the control group maintained their daily activities. The participants' self-perceived health status and sleep quality were examined at the baseline, three-month interval and six-month interval. In total, 169 participants completed the six-month study: 84 constituted the experimental group and 85 constituted the control group. At the three-month interval, the participants in the experimental group had greater improvements in self-perceived physical health, overall sleep quality, sleep latency and sleep duration compared with those in the control group; these significant changes continued throughout the six-month study. The Senior Elastic Band exercise programme showed promising effects in improving the self-perceived physical health and sleep quality of older adults living in community settings. Healthcare professionals can incorporate the Senior Elastic Band exercise programme as one of the health promotion activities for older adults living in community settings. © 2016 John Wiley & Sons Ltd.

Comparison between a Single-Channel Nasal Airflow Device and Oximetry for the Diagnosis of Obstructive Sleep Apnea

PubMed Central

Rofail, Lydia Makarie; Wong, Keith K.H.; Unger, Gunnar; Marks, Guy B.; Grunstein, Ronald R.

2010-01-01

Rationale: The most common single channel devices used for obstructive sleep apnea (OSA) screening are nasal airflow and oximetry. No studies have directly compared their role in diagnosing OSA at home. Study Objectives: To prospectively compare the diagnostic utility of home-based nasal airflow and oximetry to attended polysomnography (PSG) and to assess the diagnostic value of adding oximetry to nasal airflow for OSA. Design: Cross-sectional study Setting: Laboratory and home Participants: Sleep clinic patients with suspected OSA. Interventions: All patients had laboratory PSG and 2 sets of 3 consecutive nights on each device; nasal airflow (Flow Wizard, DiagnoseIT, Australia) and oximetry (Radical Set, Masimo, USA) at home in random order. Results: Ninety-eight of the 105 patients enrolled completed home monitoring. The accuracy of nasal airflow respiratory disturbance index (NF RDI) was not different from oximetry (ODI 3%) for diagnosing OSA (area under the ROC curve (AUC) difference, 0.04; 95% CI of difference −0.05 to 0.12; P = 0.43) over 3 nights of at-home recording. The accuracy of NF RDI was higher after 3 nights compared to one night (AUC difference, 0.05; 95% CI of difference, 0.01 to 0.08; P = 0.04). Addition of oximetry to nasal airflow did not increase the accuracy for predicting OSA compared to nasal airflow alone (P > 0.1). Conclusions: Nasal flow and oximetry have equivalent accuracy for diagnosing OSA in the home setting. Choice of device for home screening of sleep apnea may depend on logistical and service delivery issues. Citation: Makarie Rofail L; Wong KKH; Unger G; Marks GB; Grunstein RR. Comparison between a single-channel nasal airflow device and oximetry for the diagnosis of obstructive sleep apnea. SLEEP 2010;33(8):1106-1114. PMID:20815194

Respiratory Cycle-Related Electroencephalographic Changes during Sleep in Healthy Children and in Children with Sleep Disordered Breathing

PubMed Central

Immanuel, Sarah A.; Pamula, Yvonne; Kohler, Mark; Martin, James; Kennedy, Declan; Saint, David A.; Baumert, Mathias

2014-01-01

Study Objective: To investigate respiratory cycle-related electroencephalographic changes (RCREC) in healthy children and in children with sleep disordered breathing (SDB) during scored event-free (SEF) breathing periods of sleep. Design: Interventional case-control repeated measurements design. Setting: Paediatric sleep laboratory in a hospital setting. Participants: Forty children with SDB and 40 healthy, age- and sex-matched children. Interventions: Adenotonsillectomy in children with SDB and no intervention in controls. Measurements and Results: Overnight polysomnography; electroencephalography (EEG) power variations within SEF respiratory cycles in the overall and frequency band-specific EEG within stage 2 nonrapid eye movement (NREM) sleep, slow wave sleep (SWS), and rapid eye movement (REM) sleep. Within both groups there was a decrease in EEG power during inspiration compared to expiration across all sleep stages. Compared to controls, RCREC in children with SDB in the overall EEG were significantly higher during REM and frequency band specific RCRECs were higher in the theta band of stage 2 and REM sleep, alpha band of SWS and REM sleep, and sigma band of REM sleep. This between-group difference was not significant postadenotonsillectomy. Conclusion: The presence of nonrandom respiratory cycle-related electroencephalographic changes (RCREC) in both healthy children and in children with sleep disordered breathing (SDB) during NREM and REM sleep has been demonstrated. The RCREC values were higher in children with SDB, predominantly in REM sleep and this difference reduced after adenotonsillectomy. Citation: Immanuel SA, Pamula Y, Kohler M, Martin J, Kennedy D, Saint DA, Baumert M. Respiratory cycle-related electroencephalographic changes during sleep in healthy children and in children with sleep disordered breathing. SLEEP 2014;37(8):1353-1361. PMID:25083016

Sleep duration is associated with sperm chromatin integrity among young men in Chongqing, China.

PubMed

Wang, Xiaogang; Chen, Qing; Zou, Peng; Liu, Taixiu; Mo, Min; Yang, Huan; Zhou, Niya; Sun, Lei; Chen, Hongqiang; Ling, Xi; Peng, Kaige; Ao, Lin; Yang, Huifang; Cao, Jia; Cui, Zhihong

2017-10-09

This study explores whether sleep duration is associated with sperm chromatin integrity. To do so, we conducted a three-phase panel study of 796 male volunteers from colleges in Chongqing (China) from 2013 to 2015. Sleep duration was measured using a modified Munich Chronotype Questionnaire. Sperm DNA integrity was examined via Sperm Chromatin Structure Assay and Comet assay. Setting 7-7.5 h day -1 of sleep duration as a reference, either longer or shorter sleep duration was associated negatively with high DNA stainability (HDS) (P = 0.009), which reflected the immaturity of sperm chromatin. The volunteers with > 9.0 h day -1 sleep and those with ≤ 6.5 h day -1 sleep had 40.7 and 30.3% lower HDS than did volunteers with 7-7.5 h day -1 sleep. No association was found between sleep duration and DNA fragmentation index or Comet assay parameters. This study suggests that sleep duration is associated with sperm chromatin integrity. Further studies are required to validate these findings and investigate the mechanism underlying this association. © 2017 European Sleep Research Society.

Time Alignment as a Necessary Step in the Analysis of Sleep Probabilistic Curves

NASA Astrophysics Data System (ADS)

Rošt'áková, Zuzana; Rosipal, Roman

2018-02-01

Sleep can be characterised as a dynamic process that has a finite set of sleep stages during the night. The standard Rechtschaffen and Kales sleep model produces discrete representation of sleep and does not take into account its dynamic structure. In contrast, the continuous sleep representation provided by the probabilistic sleep model accounts for the dynamics of the sleep process. However, analysis of the sleep probabilistic curves is problematic when time misalignment is present. In this study, we highlight the necessity of curve synchronisation before further analysis. Original and in time aligned sleep probabilistic curves were transformed into a finite dimensional vector space, and their ability to predict subjects' age or daily measures is evaluated. We conclude that curve alignment significantly improves the prediction of the daily measures, especially in the case of the S2-related sleep states or slow wave sleep.

Quality of Sleep Among Intensive Care Unit Patients: A Literature Review.

PubMed

Bani Younis, Mohammad; Hayajneh, Ferial A

Investigating sleep disturbances among intensive care unit (ICU) patients and its serious consequences is considered a crucial issue for nurses. The need of sleep increases during hospitalization time to preserve energy for the healing process. Previous studies have demonstrated that sleep disturbance is one of the most common complaints of patients in the ICUs, with a prevalence of more than 50%. Although the total sleep time might be normal, the patients' sleep is fragmented and light in the intensive care settings. The main purpose of this review is to generate a clear view of what is known about sleep disturbances among ICU patients as well as to identify the gap in knowledge regarding this issue. This was done by describing, summarizing, clarifying, and evaluating well-selected previous studies about this topic. In addition, this concise review has focused on the prevalence of sleep disturbances in the ICU, factors contributing to poor quality of sleep among ICU patients, and the physiological effects of poor sleep on the patients' prognosis.

Association between Sleep and Breast Cancer Incidence among Postmenopausal Women in the Women's Health Initiative

PubMed Central

Vogtmann, Emily; Levitan, Emily B.; Hale, Lauren; Shikany, James M.; Shah, Neomi A.; Endeshaw, Yohannes; Lewis, Cora E.; Manson, JoAnn E.; Chlebowski, Rowan T.

2013-01-01

Study Objectives: To determine whether the duration of sleep, sleep quality, insomnia, or sleep disturbance was associated with incident breast cancer in the Women's Health Initiative (WHI). Design: Prospective cohort study. Setting: Women enrolled in one of the Clinical Trial (CT) arms or the Observational Study (OS) from the WHI conducted in the United States. Participants: This study included 110,011 women age 50 to 79 years with no history of cancer. Measurements and Results: Typical sleep duration, sleep quality, and other self-reported sleep measures over the past 4 weeks were assessed during the screening visits for both the CT and OS participants. The presence of insomnia and level of sleep disturbance was calculated from an index of the WHI Insomnia Rating Scale. The outcome for this study was primary, invasive breast cancer. A total of 5,149 incident cases of breast cancer were identified in this study. No statistically significant associations were found between sleep duration, sleep quality, insomnia, or level of sleep disturbance with the risk of breast cancer after multivariable adjustment. A positive trend was observed for increasing sleeping duration with the risk of estrogen receptor positive breast cancer, but the association estimates for each sleep duration category were weak and nonsignificant. Conclusions: This study does not provide strong support for an association between self-reported sleep duration, sleep quality, insomnia, or sleep disturbance with the risk of breast cancer. Citation: Vogtmann E; Levitan EB; Hale L; Shikany JM; Shah NA; Endeshaw Y; Lewis CE; Manson JE; Chlebowski RT. Association between sleep and breast cancer incidence among postmenopausal women in the Women's Health Initiative. SLEEP 2013;36(10):1437-1444. PMID:24082303

The state of the art of predicting noise-induced sleep disturbance in field settings.

PubMed

Fidell, Sanford; Tabachnick, Barbara; Pearsons, Karl S

2010-01-01

Several relationships between intruding noises (largely aircraft) and sleep disturbance have been inferred from the findings of a handful of field studies. Comparisons of sleep disturbance rates predicted by the various relationships are complicated by inconsistent data collection methods and definitions of predictor variables and predicted quantities. None of the relationships is grounded in theory-based understanding, and some depend on questionable statistical assumptions and analysis procedures. The credibility, generalizability, and utility of sleep disturbance predictions are also limited by small and nonrepresentative samples of test participants, and by restricted (airport-specific and relatively short duration) circumstances of exposure. Although expedient relationships may be the best available, their predictions are of only limited utility for policy analysis and regulatory purposes, because they account for very little variance in the association between environmental noise and sleep disturbance, have characteristically shallow slopes, have not been well validated in field settings, are highly context-dependent, and do not squarely address the roles and relative importance of nonacoustic factors in sleep disturbance. Such relationships offer the appearance more than the substance of precision and objectivity. Truly useful, population-level prediction and genuine understanding of noise-induced sleep disturbance will remain beyond reach for the foreseeable future, until the findings of field studies of broader scope and more sophisticated design become available.

Sleep Reduces False Memory in Healthy Older Adults

PubMed Central

Lo, June C.; Sim, Sam K. Y.; Chee, Michael W. L.

2014-01-01

Study Objectives: To investigate the effects of post-learning sleep and sleep architecture on false memory in healthy older adults. Design: Balanced, crossover design. False memory was induced using the Deese-Roediger-McDermott (DRM) paradigm and assessed following nocturnal sleep and following a period of daytime wakefulness. Post-learning sleep structure was evaluated using polysomnography (PSG). Setting: Sleep research laboratory. Participants: Fourteen healthy older adults from the Singapore-Longitudinal Aging Brain Study (mean age ± standard deviation = 66.6 ± 4.1 y; 7 males). Measurements and Results: At encoding, participants studied lists of words that were semantically related to non-presented critical lures. At retrieval, they made “remember”/“know” and “new” judgments. Compared to wakefulness, post-learning sleep was associated with reduced “remember” responses, but not “know” responses to critical lures. In contrast, there were no significant differences in the veridical recognition of studied words, false recognition of unrelated distractors, discriminability, or response bias between the sleep and the wake conditions. More post-learning slow wave sleep was associated with greater reduction in false memory. Conclusions: In healthy older adults, sleep facilitates the reduction in false memory without affecting veridical memory. This benefit correlates with the amount of slow wave sleep in the post-learning sleep episode. Citation: Lo JC; Sim SK; Chee MW. Sleep reduces false memory in healthy older adults. SLEEP 2014;37(4):665-671. PMID:24744453

Good quality sleep is associated with better academic performance among university students in Ethiopia.

PubMed

Lemma, Seblewengel; Berhane, Yemane; Worku, Alemayehu; Gelaye, Bizu; Williams, Michelle A

2014-05-01

This study assessed the association of sleep quality with academic performance among university students in Ethiopia. This cross-sectional study of 2,173 college students (471 female and 1,672 male) was conducted in two universities in Ethiopia. Students were selected into the study using a multistage sampling procedure, and data were collected through a self-administered questionnaire. Sleep quality was assessed using Pittsburgh Sleep Quality Index, and academic performance was based on self-reported cumulative grade point average. The Student's "t" test, analysis of variance, and multiple linear regression were used to evaluate associations. We found that students with better sleep quality score achieved better on their academic performance (P value = 0.001), while sleep duration was not associated with academic performance in the final model. Our study underscores the importance of sleep quality on better academic performance. Future studies need to identify the possible factors which influence sleep quality other than the academic environment repeatedly reported by other literature. It is imperative to design and implement appropriate interventions to improve sleep quality in light of the current body of evidence to enhance academic success in the study setting.

The Relative Contributions of the Homeostatic and Circadian Processes to Sleep Regulation under Conditions of Severe Sleep Restriction

PubMed Central

Paech, Gemma M.; Ferguson, Sally A.; Sargent, Charli; Kennaway, David J.; Roach, Gregory D.

2012-01-01

Study Objectives: To investigate the relative contributions of the homeostatic and circadian processes on sleep regulation under conditions of severe sleep restriction. Design: The 13-day laboratory based study consisted of 3 × 24-h baseline days (8 h sleep opportunity, 16 h wake) followed by 7 × 28-h forced desynchrony days (4.7 h sleep opportunity, 23.3 h wake). Setting: The study was conducted in a time isolation unit at the Centre for Sleep Research, University of South Australia. Participants: Fourteen healthy, nonsmoking males, aged 21.8 ± 3.8 (mean ± SD) years participated in the study. Interventions: N/A Measurements: Sleep was measured using standard polysomnography. Core body temperature (CBT) was recorded continuously using a rectal thermistor. Each epoch of sleep was assigned a circadian phase based on the CBT data (6 × 60-degree bins) and an elapsed time into sleep episode (2 × 140-min intervals). Results: The percentage of SWS decreased with elapsed time into the sleep episode. However, no change in the percentage of REM sleep was observed with sleep progression. Whilst there was a circadian modulation of REM sleep, the amplitude of the circadian variation was smaller than expected. Sleep efficiency remained high throughout the sleep episode and across all circadian phases. Conclusions: Previous forced desynchrony studies have demonstrated a strong circadian influence on sleep, in the absence of sleep restriction. The current study suggests that in the presence of high homeostatic pressure, the circadian modulation of sleep, in particular sleep efficiency and to a lesser extent, REM sleep, are reduced. Citation: Paech GM; Ferguson SA; Sargent C; Kennaway DJ; Roach GD. The relative contributions of the homeostatic and circadian processes to sleep regulation under conditions of severe sleep restriction. SLEEP 2012;35(7):941-948. PMID:22754040

Technologically sensed social exposure related to slow-wave sleep in healthy adults.

PubMed

Butt, Maryam; Ouarda, Taha B M J; Quan, Stuart F; Pentland, Alex Sandy; Khayal, Inas

2015-03-01

The aim of this study is to understand the relationship between automatically captured social exposure and detailed sleep parameters of healthy young adults. This study was conducted in a real-world setting in a graduate-student housing community at a US university. Social exposure was measured using Bluetooth proximity sensing technology in mobile devices. Sleep was monitored in a naturalistic setting using a headband sleep monitoring device over a period of 2 weeks. The analysis included a total of 11 subjects (6 males and 5 females) aged 24-35 (149 subject nights). Slow-wave sleep showed a significant positive correlation (Spearman's rho = 0.51, p < 0.0001) with social exposure, whereas light non-REM (N1 + N2) sleep and wake time were found to be negatively correlated (rho = -0.25, p < 0.01; rho = -0.21, p < 0.01, respectively). The correlation of median slow-wave sleep with median social exposure per subject showed a strong positive significance (rho = 0.88, p < 0.001). On average, within subjects, following day's social exposure was higher when (slow-wave NREM + REM) percentage was high (Wilcoxon sign-ranked test, p < 0.05). Subjects with higher social exposure spent more time in slow-wave sleep. Following day's social exposure was found to be positively affected by previous night's (slow-wave NREM + REM) percentage. This suggests that sleep affects following day's social exposure and not vice versa. Capturing an individual's dynamic social behavior and sleep from their natural environment can provide novel insights into these relationships.

Bench Test Evaluation of Adaptive Servoventilation Devices for Sleep Apnea Treatment

PubMed Central

Zhu, Kaixian; Kharboutly, Haissam; Ma, Jianting; Bouzit, Mourad; Escourrou, Pierre

2013-01-01

Rationale: Adaptive servoventilation devices are marketed to overcome sleep disordered breathing with apneas and hypopneas of both central and obstructive mechanisms often experienced by patients with chronic heart failure. The clinical efficacy of these devices is still questioned. Study Objectives: This study challenged the detection and treatment capabilities of the three commercially available adaptive servoventilation devices in response to sleep disordered breathing events reproduced on an innovative bench test. Methods: The bench test consisted of a computer-controlled piston and a Starling resistor. The three devices were subjected to a flow sequence composed of central and obstructive apneas and hypopneas including Cheyne-Stokes respiration derived from a patient. The responses of the devices were separately evaluated with the maximum and the clinical settings (titrated expiratory positive airway pressure), and the detected events were compared to the bench-scored values. Results: The three devices responded similarly to central events, by increasing pressure support to raise airflow. All central apneas were eliminated, whereas hypopneas remained. The three devices responded differently to the obstructive events with the maximum settings. These obstructive events could be normalized with clinical settings. The residual events of all the devices were scored lower than bench test values with the maximum settings, but were in agreement with the clinical settings. However, their mechanisms were misclassified. Conclusion: The tested devices reacted as expected to the disordered breathing events, but not sufficiently to normalize the breathing flow. The device-scored results should be used with caution to judge efficacy, as their validity depends upon the initial settings. Citation: Zhu K; Kharboutly H; Ma J; Bouzit M; Escourrou P. Bench test evaluation of adaptive servoventilation devices for sleep apnea treatment. J Clin Sleep Med 2013;9(9):861-871. PMID:23997698

Sleep Onset Problems in Two Children with Mild Intellectual Disability and Epilepsy: Assessment and Treatment in the Home Setting

ERIC Educational Resources Information Center

Maas, A. P. H. M.; Didden, R.; de Moor, J. M. H.; Renier, W. O.; Curfs, L. M. G.

2005-01-01

Sleep problems such as bedtime difficulties, frequent night waking and excessive daytime sleepiness are prevalent in children with epilepsy. In the present study, functional assessment of sleep onset problems in two young children with epilepsy was performed. Effects of bedtime fading and antipsychotic medication (pipamperon) in a 6-year-old boy,…

The Association of Sleep Duration and Depressive Symptoms in Rural Communities of Missouri, Tennessee, and Arkansas

ERIC Educational Resources Information Center

Chang, Jen Jen; Salas, Joanne; Habicht, Katherine; Pien, Grace W.; Stamatakis, Katherine A.; Brownson, Ross C.

2012-01-01

Purpose: To determine the association between sleep duration and depressive symptoms in a rural setting. Methods: We conducted a cross-sectional study using data from Wave 3 of the Walk the Ozarks to Wellness Project including 12 rural communities in Missouri, Arkansas, and Tennessee (N = 1,204). Sleep duration was defined based on average…

Cerebral correlates of delta waves during non-REM sleep revisited.

PubMed

Dang-Vu, Thien Thanh; Desseilles, Martin; Laureys, Steven; Degueldre, Christian; Perrin, Fabien; Phillips, Christophe; Maquet, Pierre; Peigneux, Philippe

2005-10-15

We aimed at characterizing the neural correlates of delta activity during Non Rapid Eye Movement (NREM) sleep in non-sleep-deprived normal young adults, based on the statistical analysis of a positron emission tomography (PET) sleep data set. One hundred fifteen PET scans were obtained using H(2)(15)O under continuous polygraphic monitoring during stages 2-4 of NREM sleep. Correlations between regional cerebral blood flow (rCBF) and delta power (1.5-4 Hz) spectral density were analyzed using statistical parametric mapping (SPM2). Delta power values obtained at central scalp locations negatively correlated during NREM sleep with rCBF in the ventromedial prefrontal cortex, the basal forebrain, the striatum, the anterior insula, and the precuneus. These regions embrace the set of brain areas in which rCBF decreases during slow wave sleep (SWS) as compared to Rapid Eye Movement (REM) sleep and wakefulness (Maquet, P., Degueldre, C., Delfiore, G., Aerts, J., Peters, J.M., Luxen, A., Franck, G., 1997. Functional neuroanatomy of human slow wave sleep. J. Neurosci. 17, 2807-S2812), supporting the notion that delta activity is a valuable prominent feature of NREM sleep. A strong association was observed between rCBF in the ventromedial prefrontal regions and delta power, in agreement with electrophysiological studies. In contrast to the results of a previous PET study investigating the brain correlates of delta activity (Hofle, N., Paus, T., Reutens, D., Fiset, P., Gotman, J., Evans, A.C., Jones, B.E., 1997. Regional cerebral blood flow changes as a function of delta and spindle activity during slow wave sleep in humans. J. Neurosci. 17, 4800-4808), in which waking scans were mixed with NREM sleep scans, no correlation was found with thalamus activity. This latter result stresses the importance of an extra-thalamic delta rhythm among the synchronous NREM sleep oscillations. Consequently, this rCBF distribution might preferentially reflect a particular modulation of the cellular processes involved in the generation of cortical delta waves during NREM sleep.

A role for clock genes in sleep homeostasis.

PubMed

Franken, Paul

2013-10-01

The timing and quality of both sleep and wakefulness are thought to be regulated by the interaction of two processes. One of these two processes keeps track of the prior sleep-wake history and controls the homeostatic need for sleep while the other sets the time-of-day that sleep preferably occurs. The molecular pathways underlying the latter, circadian process have been studied in detail and their key role in physiological time-keeping has been well established. Analyses of sleep in mice and flies lacking core circadian clock gene proteins have demonstrated, however, that besides disrupting circadian rhythms, also sleep homeostatic processes were affected. Subsequent studies revealed that sleep loss alters both the mRNA levels and the specific DNA-binding of the key circadian transcriptional regulators to their target sequences in the mouse brain. The fact that sleep loss impinges on the very core of the molecular circadian circuitry might explain why both inadequate sleep and disrupted circadian rhythms can similarly lead to metabolic pathology. The evidence for a role for clock genes in sleep homeostasis will be reviewed here. Copyright © 2013 Elsevier Ltd. All rights reserved.

Development and validation of an algorithm for the study of sleep using a biometric shirt in young healthy adults.

PubMed

Pion-Massicotte, Joëlle; Godbout, Roger; Savard, Pierre; Roy, Jean-François

2018-02-23

Portable polysomnography is often too complex and encumbering for recording sleep at home. We recorded sleep using a biometric shirt (electrocardiogram sensors, respiratory inductance plethysmography bands and an accelerometer) in 21 healthy young adults recorded in a sleep laboratory for two consecutive nights, together with standard polysomnography. Polysomnographic recordings were scored using standard methods. An algorithm was developed to classify the biometric shirt recordings into rapid eye movement sleep, non-rapid eye movement sleep and wake. The algorithm was based on breathing rate and heart rate variability, body movement, and included a correction for sleep onset and offset. The overall mean percentage of agreement between the two sets of recordings was 77.4%; when non-rapid eye movement and rapid eye movement sleep epochs were grouped together, it increased to 90.8%. The overall kappa coefficient was 0.53. Five of the seven sleep variables were significantly correlated. The findings of this pilot study indicate that this simple portable system could be used to estimate the general sleep pattern of young healthy adults. © 2018 European Sleep Research Society.

A Cross-Cultural Comparison of Sleep Duration between U.S. and Australian Adolescents: The Effect of School Start Time, Parent-Set Bedtimes, and Extracurricular Load

ERIC Educational Resources Information Center

Short, Michelle A.; Gradisar, Michael; Lack, Leon C.; Wright, Helen R.; Dewald, Julia F.; Wolfson, Amy R.; Carskadon, Mary A.

2013-01-01

Study Objective. To test whether sleep duration on school nights differs between adolescents in Australia and the United States and, if so, whether this difference is explained by cultural differences in school start time, parental involvement in setting bedtimes, and extracurricular commitments. Participants. Three hundred eighty-five adolescents…

Noise and sleep on board vessels in the Royal Norwegian Navy

PubMed Central

Sunde, Erlend; Bråtveit, Magne; Pallesen, Ståle; Moen, Bente Elisabeth

2016-01-01

Previous research indicates that exposure to noise during sleep can cause sleep disturbance. Seamen on board vessels are frequently exposed to noise also during sleep periods, and studies have reported sleep disturbance in this occupational group. However, studies of noise and sleep in maritime settings are few. This study's aim was to examine the associations between noise exposure during sleep, and sleep variables derived from actigraphy among seamen on board vessels in the Royal Norwegian Navy (RNoN). Data were collected on board 21 RNoN vessels, where navy seamen participated by wearing an actiwatch (actigraph), and by completing a questionnaire comprising information on gender, age, coffee drinking, nicotine use, use of medication, and workload. Noise dose meters were used to assess noise exposure inside the seamen's cabin during sleep. Eighty-three sleep periods from 68 seamen were included in the statistical analysis. Linear mixed-effects models were used to examine the association between noise exposure and the sleep variables percentage mobility during sleep and sleep efficiency, respectively. Noise exposure variables, coffee drinking status, nicotine use status, and sleeping hours explained 24.9% of the total variance in percentage mobility during sleep, and noise exposure variables explained 12.0% of the total variance in sleep efficiency. Equivalent noise level and number of noise events per hour were both associated with increased percentage mobility during sleep, and the number of noise events was associated with decreased sleep efficiency. PMID:26960785

Daytime Sleepiness and Driving Performance in Patients with Obstructive Sleep Apnea: Comparison of the MSLT, the MWT, and a Simulated Driving Task

PubMed Central

Pizza, Fabio; Contardi, Sara; Mondini, Susanna; Trentin, Lino; Cirignotta, Fabio

2009-01-01

Study Objectives: To test the reliability of a driving-simulation test for the objective measurement of daytime alertness compared with the Multiple Sleep Latency Test (MSLT) and with the Maintenance of Wakefulness Test (MWT), and to test the ability to drive safely, in comparison with on-road history, in the clinical setting of untreated severe obstructive sleep apnea. Design: N/A. Setting: Sleep laboratory. Patients or Participants: Twenty-four patients with severe obstructive sleep apnea and reported daytime sleepiness varying in severity (as measured by the Epworth Sleepiness Scale). Interventions: N/A. Measurements and Results: Patients underwent MSLT and MWT coupled with 4 sessions of driving-simulation test on 2 different days randomly distributed 1 week apart. Simulated-driving performance (in terms of lane-position variability and crash occurrence) was correlated with sleep latency on the MSLT and more significantly on the MWT, showing a predictive validity toward the detection of sleepy versus alert patients with obstructive sleep apnea. In addition, patients reporting excessive daytime sleepiness or a history of car crashes showed poorer performances on the driving simulator. Conclusions: A simulated driving test is a suitable tool for objective measurement of daytime alertness in patients with obstructive sleep apnea. Further studies are needed to clarify the association between simulated-driving performance and on-road crash risk of patients with sleep disordered breathing. Citation: Pizza F; Contardi S; Mondini S; Trentin L; Cirignotta F. Daytime sleepiness and driving performance in patients with obstructive sleep apnea: comparison of the MSLT, the MWT, and a simulated driving task. SLEEP 2009;32(3):382-391. PMID:19294958

Monitoring healthy and disturbed sleep through smartphone applications: a review of experimental evidence.

PubMed

Fino, Edita; Mazzetti, Michela

2018-04-23

Smartphone applications are considered as the prime candidate for the purposes of large-scale, low-cost and long-term sleep monitoring. How reliable and scientifically grounded is smartphone-based assessment of healthy and disturbed sleep remains a key issue in this direction. Here we offer a review of validation studies of sleep applications to the aim of providing some guidance in terms of their reliability to assess sleep in healthy and clinical populations, and stimulating further examination of their potential for clinical use and improved sleep hygiene. Electronic literature review was conducted on Pubmed. Eleven validation studies published since 2012 were identified, evaluating smartphone applications' performance compared to standard methods of sleep assessment in healthy and clinical samples. Studies with healthy populations show that most sleep applications meet or exceed accuracy levels of wrist-based actigraphy in sleep-wake cycle discrimination, whereas performance levels drop in individuals with low sleep efficiency (SE) and in clinical populations, mirroring actigraphy results. Poor correlation with polysomnography (PSG) sleep sub-stages is reported by most accelerometer-based apps. However, multiple parameter-based applications (i.e., EarlySense, SleepAp) showed good capability in detection of sleep-wake stages and sleep-related breathing disorders (SRBD) like obstructive sleep apnea (OSA) respectively with values similar to PSG. While the reviewed evidence suggests a potential role of smartphone sleep applications in pre-screening of SRBD, more experimental studies are warranted to assess their reliability in sleep-wake detection particularly. Apps' utility in post treatment follow-up at home or as an adjunct to the sleep diary in clinical setting is also stressed.

Companionable sleep: Social regulation of sleep and co-sleeping in Egyptian families

PubMed Central

Worthman, Carol M.; Brown, Ryan A.

2013-01-01

This exploratory study examines family sleep patterns and quality in a setting of normative napping and co-sleeping. Participants comprised 78 members of 16 families from two locales in Egypt, Cairo and village. Each family member provided a history of sleeping arrangements, one week of continuous activity records, and details of each sleep event. Sleep records documented late-onset and dispersed sleep patterns with extensive co-sleeping. Of recorded sleep events, 69% involved co-sleeping, 24% included more than one co-sleeper, and only 21% were solitary. Mid-late afternoon napping occurred on 31% of days and night sleep onsets averaged after midnight. Age and gender structured sleep arrangements and together with locale, extensively explained sleep behavior (onset, duration, total) and quality. Co-sleepers had fewer night arousals, shorter and less variable night sleep duration, and less total sleep. Increased solitary sleep in adolescents and young adults was associated with increased sleep dysregulation, including exaggerated phase shifts in males and more nighttime arousals in females. Where normative, co-sleeping may provide psychosensory stimuli that moderate arousal and stabilize sleep. Such moderating features may address important self-regulatory developmental needs during adolescence. PMID:17371117

Evaluation of a Piezoelectric System as an Alternative to Electroencephalogram/ Electromyogram Recordings in Mouse Sleep Studies

PubMed Central

Mang, Géraldine M.; Nicod, Jérôme; Emmenegger, Yann; Donohue, Kevin D.; O'Hara, Bruce F.; Franken, Paul

2014-01-01

Study Objectives: Traditionally, sleep studies in mammals are performed using electroencephalogram/electromyogram (EEG/EMG) recordings to determine sleep-wake state. In laboratory animals, this requires surgery and recovery time and causes discomfort to the animal. In this study, we evaluated the performance of an alternative, noninvasive approach utilizing piezoelectric films to determine sleep and wakefulness in mice by simultaneous EEG/EMG recordings. The piezoelectric films detect the animal's movements with high sensitivity and the regularity of the piezo output signal, related to the regular breathing movements characteristic of sleep, serves to automatically determine sleep. Although the system is commercially available (Signal Solutions LLC, Lexington, KY), this is the first statistical validation of various aspects of sleep. Design: EEG/EMG and piezo signals were recorded simultaneously during 48 h. Setting: Mouse sleep laboratory. Participants: Nine male and nine female CFW outbred mice. Interventions: EEG/EMG surgery. Measurements and Results: The results showed a high correspondence between EEG/EMG-determined and piezo-determined total sleep time and the distribution of sleep over a 48-h baseline recording with 18 mice. Moreover, the piezo system was capable of assessing sleep quality (i.e., sleep consolidation) and interesting observations at transitions to and from rapid eye movement sleep were made that could be exploited in the future to also distinguish the two sleep states. Conclusions: The piezo system proved to be a reliable alternative to electroencephalogram/electromyogram recording in the mouse and will be useful for first-pass, large-scale sleep screens for genetic or pharmacological studies. Citation: Mang GM, Nicod J, Emmenegger Y, Donohue KD, O'Hara BF, Franken P. Evaluation of a piezoelectric system as an alternative to electroencephalogram/electromyogram recordings in mouse sleep studies. SLEEP 2014;37(8):1383-1392. PMID:25083019

Effects of Night Work, Sleep Loss and Time on Task on Simulated Threat Detection Performance

PubMed Central

Basner, Mathias; Rubinstein, Joshua; Fomberstein, Kenneth M.; Coble, Matthew C.; Ecker, Adrian; Avinash, Deepa; Dinges, David F.

2008-01-01

Study Objectives: To investigate the effects of night work and sleep loss on a simulated luggage screening task (SLST) that mimicked the x-ray system used by airport luggage screeners. Design: We developed more than 5,800 unique simulated x-ray images of luggage organized into 31 stimulus sets of 200 bags each. 25% of each set contained either a gun or a knife with low or high target difficulty. The 200-bag stimuli sets were then run on software that simulates an x-ray screening system (SLST). Signal detection analysis was used to obtain measures of hit rate (HR), false alarm rate (FAR), threat detection accuracy (A′), and response bias (B″D). Setting: Experimental laboratory study Participants: 24 healthy nonprofessional volunteers (13 women, mean age ± SD = 29.9 ± 6.5 years). Interventions: Subjects performed the SLST every 2 h during a 5-day period that included a 35 h period of wakefulness that extended to night work and then another day work period after the night without sleep. Results: Threat detection accuracy A′ decreased significantly (P < 0.001) while FAR increased significantly (P < 0.001) during night work, while both A′ (P = 0.001) and HR decreased (P = 0.008) during day work following sleep loss. There were prominent time-on-task effects on response bias B″D (P = 0.002) and response latency (P = 0.004), but accuracy A′ was unaffected. Both HR and FAR increased significantly with increasing study duration (both P < 0.001), while response latency decreased significantly (P < 0.001). Conclusions: This study provides the first systematic evidence that night work and sleep loss adversely affect the accuracy of detecting complex real world objects among high levels of background clutter. If the results can be replicated in professional screeners and real work environments, fatigue in luggage screening personnel may pose a threat for air traffic safety unless countermeasures for fatigue are deployed. Citation: Basner M; Rubinstein J; Fomberstein KM; Coble MC; Avinash D; Dinges DF. Effects of Night Work, Sleep Loss and Time on Task on Simulated Threat Detection Performance. SLEEP 2008;31(9):1251-1259. PMID:18788650

Child temperament, parenting discipline style, and daytime behavior in childhood sleep disorders.

PubMed

Owens-Stively, J; Frank, N; Smith, A; Hagino, O; Spirito, A; Arrigan, M; Alario, A J

1997-10-01

Fifty-two children without significant sleep disturbance seen at a primary care clinic for well-child care were compared on measures of temperament, parenting style, daytime behavior, and overall sleep disturbance to three diagnostic subgroups identified in a pediatric sleep clinic: children with obstructive sleep apnea (n = 33), parasomnias (night terrors, sleepwalking, etc.) (n = 16), and behavioral sleep disorders (limit-setting disorder, etc.) (n = 31). The mean age of the entire sample was 5.7 years. Temperamental emotionality in the behavioral sleep disorders group was associated with a higher level of sleep disturbance (p < .001); parenting laxness was associated with sleep disturbance in the general pediatric population (p < .01); and intense and negative temperament characteristics seemed to be associated with clinically significant behavioral sleep disturbances. Ineffective parenting styles and daytime disruptive behaviors were more likely to be associated with the milder sleep disturbances found in children in a primary care setting.

Periodic limb movements and insomnia, a common but under-recognized association

PubMed Central

Varadharajulu, Saravanan; Chandrasekaran, Baskaran

2015-01-01

Periodic limb movements unlike restless leg syndrome is under diagnosed and unrecognized in medical arena. While robust Western trials have elucidated the association between periodic limb movements and sleep disturbances, it is not well received and recognized in India even in well sophisticated tertiary care hospital. We report a chronic insomnia patient who had sleep disturbances for past 30 years due to periodic limb movements alone. This was diagnosed through polysomnography. This case emphasizes monitoring leg movements during sleep study. This report may open new horizons in improving monitoring in sleep study in clinical setting. PMID:26124530

The Effects of Sleep Continuity Disruption on Positive Mood and Sleep Architecture in Healthy Adults.

PubMed

Finan, Patrick H; Quartana, Phillip J; Smith, Michael T

2015-11-01

The purpose of this study was to test an experimental model of the effects of sleep continuity disturbance on sleep architecture and positive mood in order to better understand the mechanisms linking insomnia and depression. Participants were randomized to receive 3 consecutive nights of sleep continuity disruption via forced nocturnal awakenings (FA, n = 21), or one of two control conditions: restricted sleep opportunity (RSO, n = 17) or uninterrupted sleep (US, n = 24). The study was set in an inpatient clinical research suite. Healthy, good-sleeping men and women were included. Polysomnography was used to measure sleep architecture, and mood was assessed via self-report each day. Compared to restricted sleep opportunity controls, forced awakenings subjects had significantly less slow wave sleep (P < 0.05) after the first night of sleep deprivation, and significantly lower positive mood (P < 0.05) after the second night of sleep deprivation. The differential change in slow wave sleep statistically mediated the observed group differences in positive mood (P = 0.002). To our knowledge, this is the first human experimental study to demonstrate that, despite comparable reductions in total sleep time, partial sleep loss from sleep continuity disruption is more detrimental to positive mood than partial sleep loss from delaying bedtime, even when controlling for concomitant increases in negative mood. With these findings, we provide temporal evidence in support of a putative biologic mechanism (slow wave sleep deficit) that could help explain the strong comorbidity between insomnia and depression. © 2015 Associated Professional Sleep Societies, LLC.

Long-Term Nightly Treatment with Indiplon in Adults with Primary Insomnia: Results of a Double-Blind, Placebo-Controlled, 3-Month Study

PubMed Central

Scharf, Martin B.; Black, Jed; Hull, Steven; Landin, Rick; Farber, Robert

2007-01-01

Objectives: To evaluate the efficacy and safety of indiplon in primary insomnia. Design: Randomized, double-blind, placebo-controlled, 3-month study. Setting: Multi-center outpatient setting. Patients: N=702 (61% female; mean age 46 years) who met DSM-IV criteria for primary insomnia of at least 3 months' duration. Interventions: Indiplon 10 mg (n=236), indiplon 20 mg (n=233), or placebo (n=233). Measurements: Subjective assessment of each of the following: latency to sleep onset (sLSO), total sleep time (sTST), number of awakenings after sleep onset (sNAASO), wake time after sleep onset (sWASO), sleep quality, Insomnia Severity Index (ISI), and global improvement. Results: Treatment with indiplon resulted in significant improvement relative to placebo at all time points for the primary endpoint, sLSO. Mean sLSO at Month 1 for each treatment group was: 10 mg (34.0 ± 1.3 mins), 20 mg (33.0 ± 1.3 mins), and placebo (48.7 ± 1.9 mins; P <0.0001 for both comparisons); efficacy was sustained through Month 3. Both doses of indiplon resulted in significant improvement in sleep maintenance and duration endpoints, sTST and sWASO, as well as sleep quality, ISI, and global improvement at all assessment time points. Conclusions: In patients with chronic insomnia, long-term nightly treatment with 10 mg and 20 mg doses of indiplon resulted in significant and sustained efficacy in sleep onset, maintenance, and duration, and significant associated improvement in both daytime functioning and quality of life. Citation: Scharf MB; Black J; Hull S et al. Long-term nightly treatment with indiplon in adults with primary insomnia: Results of a double-blind, placebo-controlled, 3-month study. SLEEP 2007;30(6):743-752. PMID:17580596

Pilot study on the effects of a 1-day sleep education program: influence on sleep of stopping alcohol intake at bedtime.

PubMed

Morita, Emi; Miyazaki, Soichiro; Okawa, Masako

2012-08-01

The aim of this pilot study was to evaluate whether sleep was improved by a 1-day sleep education program in an occupational setting and whether stopping alcohol intake at bedtime might influence sleep. Subjects were 40 high school employees. The sleep education program lasted 4.5 hours and consisted of sleep science information, and sleep hygiene education including the risk of sleep related breathing disorder resulting from alcohol intake. Sleep conditions were evaluated by self-administered questionnaires at baseline and approximately 1 month later. The mean the Epworth Sleepiness Scale (ESS) score was significantly decreased by 1.2 points (P = 0.04), while the mean sleep duration was significantly decreased by 10 minutes (P = 0.02). Shortened sleep duration coincided with a decrease in sleepiness. This may indicate an improvement in sleep quality. The percentage of habitual alcohol intake at bedtime was significantly decreased (from 38.5% (15/39) to 20.5% (8/39), P = 0.04). Subjects who stopped alcohol intake at bedtime (n = 8) received the most benefit, with decreased scores of ESS and Insomnia Severity Index (ISI), although the reductions were not significant. This education program offers the possibility of improving sleep conditions among the general population, especially in those who cease habitual alcohol intake at bedtime. Further larger, randomized, controlled studies are warranted.

Blood-Gene Expression Reveals Reduced Circadian Rhythmicity in Individuals Resistant to Sleep Deprivation

PubMed Central

Arnardottir, Erna S.; Nikonova, Elena V.; Shockley, Keith R.; Podtelezhnikov, Alexei A.; Anafi, Ron C.; Tanis, Keith Q.; Maislin, Greg; Stone, David J.; Renger, John J.; Winrow, Christopher J.; Pack, Allan I.

2014-01-01

Study Objectives: To address whether changes in gene expression in blood cells with sleep loss are different in individuals resistant and sensitive to sleep deprivation. Design: Blood draws every 4 h during a 3-day study: 24-h normal baseline, 38 h of continuous wakefulness and subsequent recovery sleep, for a total of 19 time-points per subject, with every 2-h psychomotor vigilance task (PVT) assessment when awake. Setting: Sleep laboratory. Participants: Fourteen subjects who were previously identified as behaviorally resistant (n = 7) or sensitive (n = 7) to sleep deprivation by PVT. Intervention: Thirty-eight hours of continuous wakefulness. Measurements and Results: We found 4,481 unique genes with a significant 24-h diurnal rhythm during a normal sleep-wake cycle in blood (false discovery rate [FDR] < 5%). Biological pathways were enriched for biosynthetic processes during sleep. After accounting for circadian effects, two genes (SREBF1 and CPT1A, both involved in lipid metabolism) exhibited small, but significant, linear changes in expression with the duration of sleep deprivation (FDR < 5%). The main change with sleep deprivation was a reduction in the amplitude of the diurnal rhythm of expression of normally cycling probe sets. This reduction was noticeably higher in behaviorally resistant subjects than sensitive subjects, at any given P value. Furthermore, blood cell type enrichment analysis showed that the expression pattern difference between sensitive and resistant subjects is mainly found in cells of myeloid origin, such as monocytes. Conclusion: Individual differences in behavioral effects of sleep deprivation are associated with differences in diurnal amplitude of gene expression for genes that show circadian rhythmicity. Citation: Arnardottir ES, Nikonova EV, Shockley KR, Podtelezhnikov AA, Anafi RC, Tanis KQ, Maislin G, Stone DJ, Renger JJ, Winrow CJ, Pack AI. Blood-gene expression reveals reduced circadian rhythmicity in individuals resistant to sleep deprivation. SLEEP 2014;37(10):1589-1600. PMID:25197809

Accommodating Adolescent Sleep-Wake Patterns: The Effects of Shifting the Timing of Sleep on Training Effectiveness

PubMed Central

Miller, Nita Lewis; Tvaryanas, Anthony P.; Shattuck, Lawrence G.

2012-01-01

Study Objective: This study evaluated the effect of accommodating adolescent sleep-wake patterns by altering the timing of the major sleep period of US Army recruits. Design: The quasi-experimental study compared recruits assigned to one of two training companies: one with a customary sleep regimen (20:30 to 04:30) while the other employed a phase-delayed sleep regimen (23:00 to 07:00), the latter aligning better with biologically driven sleep-wake patterns of adolescents. Setting: The study was conducted during Basic Combat Training (BCT) at Fort Leonard Wood, Missouri. Trainees: The study included 392 trainees: 209 received the intervention, while 183 composed the Comparison group. Measurements and Results: Demographic and psychophysiological measures were collected on all trainees. Weekly assessments of subjective fatigue and mood, periodic physical fitness, marksmanship scores, and attrition rates from BCT were studied. Actigraphy was collected on approximately 24% of trainees. Based on actigraphy, trainees on the phase-delayed sleep schedule obtained 31 m more sleep/night than trainees on the customary sleep schedule. The Intervention group reported less total mood disturbance relative to baseline. Improvements in marksmanship correlated positively with average nightly sleep during the preceding week when basic marksmanship skills were taught. No differences were seen in physical fitness or attrition rates. In contrast to the Intervention group, the Comparison group was 2.3 times more likely to experience occupationally significant fatigue and 5.5 times more likely to report poor sleep quality. Conclusions: Accommodating adolescent sleep patterns significantly improves mental health and performance in the training environment. Citation: Miller NL; Tvaryanas AP; Shattuck LG. Accommodating adolescent sleep-wake patterns: the effects of shifting the timing of sleep on training effectiveness. SLEEP 2012;35(8):1123-1136. PMID:22851808

Perspectives on Sleep, Sleep Problems, and Their Treatment, in People with Serious Mental Illnesses: A Systematic Review

PubMed Central

Bee, Penny

2016-01-01

Sleep problems are common in people with serious mental illness, and impact negatively on functioning and wellbeing. To understand the development of sleep problems, their maintenance, and their treatment, an in depth understanding of patient perspectives is crucial. A systematic literature review was conducted using Medline, AMED, PsychInfo, Embase and CINAHL. Qualitative and quantitative studies were included if they explored or measured patient perspectives on sleep, sleep problems or sleep treatments in people with serious mental illness. Of the 2,067 hits, only 22 met review inclusion criteria, and high quality evidence was sparse. The limited findings suggested sleep was seen as highly interlinked with mental health. Evaluations of treatments varied, however perceived efficacy and personalisation of treatments were valued. Some evidence suggested patient priorities and conceptualisations regarding sleep may diverge from those of validated screening tools developed in general population and sleep medicine samples. More rigorous research is needed to support adaptation and development of interventions and outcome measures for use in specialist mental health settings. Qualitative studies exploring the experience of sleep disturbance in particular diagnostic groups and contexts are urgently required, as are patient perspectives on sleep interventions. PMID:27657927

Sleeping while disabled, disabled while sleeping.

PubMed

Reiss, Benjamin

2016-09-01

This essay considers areas in which the study of sleep and sleep disorders might profit from the perspective of disability studies, as practiced in the humanities and social sciences. This interdisciplinary perspective considers the social and cultural dimensions of bodily and mental states and conditions that a particular society deems abnormal or impaired, as well as the lived consequences of those determinations. Some sleep disorders are considered disabilities, but almost all disabilities entail some disruption from normal sleeping patterns--whether because of physical pain, exhaustion, and emotional stress of facing obstacles in work and other areas of waking life, or challenging sleeping environments in which many disabled people live. Despite these disruptions, finding adequate nighttime care is often difficult for people with disabilities, and consequently, night is often when social isolation and vulnerability are most profound. In addition, caretakers themselves often find their own sleep profoundly disrupted, whether this occurs in a family setting or an institutional space. Finally, the essay suggests that a disability studies perspective can help us to see that disordered sleep--whether primary or secondary to a disabling condition--can both impact and be shaped by social relationships. Copyright © 2016 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Clinical efficacy of dim light melatonin onset testing in diagnosing delayed sleep phase syndrome.

PubMed

Rahman, Shadab A; Kayumov, Leonid; Tchmoutina, Ekaterina A; Shapiro, Colin M

2009-05-01

Delayed Sleep Phase Syndrome (DSPS) arises from biological clock desynchrony and accounts for 10% of chronic insomnia patients. Currently DSPS is diagnosed based on sleep/wake cycle disruptions rather than examining the underlying biological clock alterations. The objective of the study was to determine the sensitivity and specificity of the Dim Light Melatonin Onset (DLMO) Test in diagnosing DSPS in a clinical setting. Fifty-six patients (mean age 28 years) symptomatic of DSPS participated in the study. Following an initial assessment of DSPS using sleep diaries, participants underwent two consecutive nights of polysomnography (PSG), with an imposed sleep period on the second night to demonstrate the delay in the timing of habitual sleep period and to thereby confirm DSPS. Circadian phase delays were also measured using melatonin secretion profiles, and the efficacy of diagnosing DSPS using DLMO was compared to using sleep diaries and PSG. Melatonin secretion was assayed for each individual by ELISA using saliva samples. Main outcome measures included the time of melatonin secretion onset, clinical sensitivity and specificity of the DLMO test. The time of melatonin secretion onset was significantly delayed in DSPS patients. Clinical sensitivity and specificity of the DLMO test in diagnosing DSPS were 90.3% and 84.0%, respectively. The DLMO test is an accurate tool for differentiating between sleep disorder patients with or without underlying circadian rhythm disruption. It is effective for phase typing DSPS patients in a clinical setting.

Sleep health education in pediatric community settings: rationale and practical suggestions for incorporating healthy sleep education into pediatric practice.

PubMed

Gruber, Reut; Cassoff, Jamie; Knäuper, Bärbel

2011-06-01

This article offers practical ways to incorporate healthy sleep education into pediatric practice and discusses key questions, barriers, and strategies associated with such efforts. The rationale for incorporating healthy sleep education in pediatric practice settings is presented, and desirable features of sleep education programs that may be implemented in pediatric practice are identified. Potential barriers are reviewed and strategies offered to overcome these barriers, such as developing resources applicable to healthy sleep education and practical information for pediatricians. Key factors regarding effectiveness of such interventional programs and key points relevant to successful healthy sleep education in pediatric practice are highlighted. Copyright © 2011. Published by Elsevier Inc.

Never enough sleep: a brief history of sleep recommendations for children.

PubMed

Matricciani, Lisa Anne; Olds, Tim S; Blunden, Sarah; Rigney, Gabrielle; Williams, Marie T

2012-03-01

There is a common belief that children are not getting enough sleep and that children's total sleep time has been declining. Over the century, many authors have proposed sleep recommendations. The aim of this study was to describe historical trends in recommended and actual sleep durations for children and adolescents, and to explore the rationale of sleep recommendations. A systematic literature review was conducted to identify recommendations for children's sleep requirements and data reporting children's actual total sleep time. For each recommendation identified, children's actual sleep time was determined by identifying studies reporting the sleep duration of children of the same age, gender, and country in the same years. Historical trends in age-adjusted recommended sleep times and trends in children's actual sleep time were calculated. A thematic analysis was conducted to determine the rationale and evidence-base for recommendations. Thirty-two sets of recommendations were located dating from 1897 to 2009. On average, age-specific recommended sleep decreased at the rate of -0.71 minute per year. This rate of decline was almost identical to the decline in the actual sleep duration of children (-0.73 minute per year). Recommended sleep was consistently ∼37 minutes greater than actual sleep, although both declined over time. A lack of empirical evidence for sleep recommendations was universally acknowledged. Inadequate sleep was seen as a consequence of "modern life," associated with technologies of the time. No matter how much sleep children are getting, it has always been assumed that they need more.

Chronic Stress is Prospectively Associated with Sleep in Midlife Women: The SWAN Sleep Study

PubMed Central

Hall, Martica H.; Casement, Melynda D.; Troxel, Wendy M.; Matthews, Karen A.; Bromberger, Joyce T.; Kravitz, Howard M.; Krafty, Robert T.; Buysse, Daniel J.

2015-01-01

Study Objectives: Evaluate whether levels of upsetting life events measured over a 9-y period prospectively predict subjective and objective sleep outcomes in midlife women. Design: Prospective cohort study. Setting: Four sites across the United States. Participants: 330 women (46–57 y of age) enrolled in the Study of Women's Health Across the Nation (SWAN) Sleep Study. Interventions: N/A. Measurements and Results: Upsetting life events were assessed annually for up to 9 y. Trajectory analysis applied to life events data quantitatively identified three distinct chronic stress groups: low stress, moderate stress, and high stress. Sleep was assessed by self-report and in-home polysomnography (PSG) during the ninth year of the study. Multivariate analyses tested the prospective association between chronic stress group and sleep, adjusting for race, baseline sleep complaints, marital status, body mass index, symptoms of depression, and acute life events at the time of the Sleep Study. Women characterized by high chronic stress had lower subjective sleep quality, were more likely to report insomnia, and exhibited increased PSG-assessed wake after sleep onset (WASO) relative to women with low to moderate chronic stress profiles. The effect of chronic stress group on WASO persisted in the subsample of participants without baseline sleep complaints. Conclusions: Chronic stress is prospectively associated with sleep disturbance in midlife women, even after adjusting for acute stressors at the time of the sleep study and other factors known to disrupt sleep. These results are consistent with current models of stress that emphasize the cumulative effect of stressors on health over time. Citation: Hall MH, Casement MD, Troxel WM, Matthews KA, Bromberger JT, Kravitz HM, Krafty RT, Buysse DJ. Chronic stress is prospectively associated with sleep in midlife women: the SWAN Sleep Study. SLEEP 2015;38(10):1645–1654. PMID:26039965

The Effects of Caffeine Use on Driving Safety Among Truck Drivers Who Are Habitual Caffeine Users.

PubMed

Heaton, Karen; Griffin, Russell

2015-08-01

The purpose of this study was to describe caffeine use among a group of habitual caffeine users, truck drivers, and to explore the associations between caffeine use and critical safety events by age in the naturalistic work setting. A secondary analysis of existing data from the Naturalistic Truck Driving Study was conducted. Analyses focused on the association between sleep and caffeine consumption by duty status, comparisons of sleep and caffeine use by age, and the associations between caffeine use and safety-critical events (SCEs). Findings indicated differences in caffeine use by duty status. However, no difference in sleep time by duty status, or between sleep time and caffeine use was found regardless of when the caffeine was consumed during the 5 hours prior to sleep. Sleep time did not vary significantly by age, although increasing age was associated with decreased caffeine use. Overall, a 6% reduction in the rate of SCEs per eight ounces of caffeinated beverage consumed was found. This study makes a unique scientific contribution because it uses real-time observations of truckers in the naturalistic work setting. It also does not involve caffeine withdrawal but rather an investigation of the effects of the naturalistic consumption of caffeine on sleep and driving performance. Findings suggest that caffeine use among habitual users offers a protective effect for safety-critical driving events. Occupational health nurses may use this information to counsel workers in the use of caffeine to enhance driving safety. © 2015 The Author(s).

Sleep Dependent Memory Consolidation in Children with Autism Spectrum Disorder

PubMed Central

Maski, Kiran; Holbrook, Hannah; Manoach, Dara; Hanson, Ellen; Kapur, Kush; Stickgold, Robert

2015-01-01

Study Objectives: Examine the role of sleep in the consolidation of declarative memory in children with autism spectrum disorder (ASD). Design: Case-control study. Setting: Home-based study with sleep and wake conditions. Participants: Twenty-two participants with ASD and 20 control participants between 9 and 16 y of age. Measurements and Results: Participants were trained to criterion on a spatial declarative memory task and then given a cued recall test. Retest occurred after a period of daytime wake (Wake) or a night of sleep (Sleep) with home-based polysomnography; Wake and Sleep conditions were counterbalanced. Children with ASD had poorer sleep efficiency than controls, but other sleep macroarchitectural and microarchitectural measures were comparable after controlling for age and medication use. Both groups demonstrated better memory consolidation across Sleep than Wake, although participants with ASD had poorer overall memory consolidation than controls. There was no interaction between group and condition. The change in performance across sleep, independent of medication and age, showed no significant relationships with any specific sleep parameters other than total sleep time and showed a trend toward less forgetting in the control group. Conclusion: This study shows that despite their more disturbed sleep quality, children with autism spectrum disorder (ASD) still demonstrate more stable memory consolidation across sleep than in wake conditions. The findings support the importance of sleep for stabilizing memory in children with and without neurodevelopmental disabilities. Our results suggest that improving sleep quality in children with ASD could have direct benefits to improving their overall cognitive functioning. Citation: Maski K, Holbrook H, Manoach D, Hanson E, Kapur K, Stickgold R. Sleep dependent memory consolidation in children with autism spectrum disorder. SLEEP 2015;38(12):1955–1963. PMID:26194566

Feasibility and Emotional Impact of Experimentally Extending Sleep in Short-Sleeping Adolescents.

PubMed

Van Dyk, Tori R; Zhang, Nanhua; Catlin, Perry A; Cornist, Kaylin; McAlister, Shealan; Whitacre, Catharine; Beebe, Dean W

2017-09-01

Published experimental sleep manipulation protocols for adolescents have been limited to the summer, limiting causal conclusions about how short sleep affects them on school nights, when they are most likely to restrict their sleep. This study assesses the feasibility and emotional impact of a school-night sleep manipulation protocol to test the effects of lengthening sleep in habitually short-sleeping adolescents. High school students aged 14-18 years who habitually slept 5-7 hours on school nights participated in a 5-week experimental sleep manipulation protocol. Participants completed a baseline week followed in randomized counterbalanced order by two experimental conditions lasting 2 weeks each: prescribed habitual sleep (HAB; sleep time set to match baseline) and sleep extension (EXT; 1.5-hour increase in time in bed from HAB). All sleep was obtained at home, monitored with actigraphy. Data on adherence, protocol acceptability, mood and behavior were collected at the end of each condition. Seventy-six adolescents enrolled in the study, with 54 retained through all 5 weeks. Compared to HAB, during EXT, participants averaged an additional 72.6 minutes/night of sleep (p < .001) and had reduced symptoms of sleepiness, anger, vigor, fatigue, and confusion (p < .05). The large majority of parents (98%) and adolescents (100%) said they would "maybe" or "definitely" recommend the study to another family. An experimental, school-night sleep manipulation protocol can be feasibly implemented which directly tests the potential protective effects of lengthening sleep. Many short-sleeping adolescents would benefit emotionally from sleeping longer, supporting public health efforts to promote adolescent sleep on school nights. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Sleep disparity, race/ethnicity, and socioeconomic position

PubMed Central

Grandner, Michael A.; Williams, Natasha J.; Knutson, Kristen L.; Roberts, Dorothy; Jean-Louis, Girardin

2015-01-01

Sleep represents a set of biological functions necessary for the maintenance of life. Performing these functions, though, requires that an individual engage in behaviors, which are affected by social and environmental factors. Race/ethnicity and socioeconomic position represent categories of factors that likely play a role in the experience of sleep in the community. Previous studies have suggested that racial/ethnic minorities and the socioeconomically disadvantaged may be more likely to experience sleep patterns that are associated with adverse health outcomes. It is possible that disparities in sleep represent a pathway by which larger disparities in health emerge. This review (1) contextualizes the concept of race/ethnicity in biomedical research, (2) summarizes previous studies that describe patterns of sleep attainment across race/ethnicity groups, (3) discusses several pathways by which race/ethnicity may be associated with sleep, (4) introduces the potential role of socioeconomic position in the patterning of sleep, and (5) proposes future research directions to address this issue. PMID:26431755

Association Between Stress-Related Sleep Reactivity and Metacognitive Beliefs About Sleep in Insomnia Disorder: Preliminary Results.

PubMed

Palagini, Laura; Bruno, Rosa Maria; Paolo, Toti; Caccavale, Lisa; Gronchi, Alessia; Mauri, Mauro; Riemann, Dieter; Drake, Christopher L

2016-01-01

To evaluate the relation between stress-related sleep reactivity and metacognitive beliefs about sleep in subjects with insomnia disorder (93) and in a group of healthy controls (30) a set of variables, including Ford Insomnia Response to Stress Test (FIRST) and Metacognition Questionnaire-Insomnia (MCQ-I), have been used. Internal consistency of the Italian version of FIRST was studied. Univariate correlation, regression analysis, and principal component analysis were also performed. The Italian version of FIRST showed good internal consistency and discriminant validity. Sleep reactivity was higher in women (p < .05) and correlates positively in both genders with metacognitive beliefs about sleep (p < .01) in insomnia. In insomnia, metacognitive beliefs may play a key role in modulating sleep reactivity. Therapeutic strategies acting selectively on metacognition to reduce stress-related sleep reactivity in insomnia may be useful.

Sleep Tips: 7 Steps to Better Sleep

MedlinePlus

... turn every night. Consider simple tips for better sleep, from setting a sleep schedule to including physical activity in your daily ... factors that can interfere with a good night's sleep — from work stress and family responsibilities to unexpected ...

Does Elite Sport Degrade Sleep Quality? A Systematic Review.

PubMed

Gupta, Luke; Morgan, Kevin; Gilchrist, Sarah

2017-07-01

Information on sleep quality and insomnia symptomatology among elite athletes remains poorly systematised in the sports science and medicine literature. The extent to which performance in elite sport represents a risk for chronic insomnia is unknown. The purpose of this systematic review was to profile the objective and experienced characteristics of sleep among elite athletes, and to consider relationships between elite sport and insomnia symptomatology. Studies relating to sleep involving participants described on a pre-defined continuum of 'eliteness' were located through a systematic search of four research databases: SPORTDiscus, PubMed, Science Direct and Google Scholar, up to April 2016. Once extracted, studies were categorised as (1) those mainly describing sleep structure/patterns, (2) those mainly describing sleep quality and insomnia symptomatology and (3) those exploring associations between aspects of elite sport and sleep outcomes. The search returned 1676 records. Following screening against set criteria, a total of 37 studies were identified. The quality of evidence reviewed was generally low. Pooled sleep quality data revealed high levels of sleep complaints in elite athletes. Three risk factors for sleep disturbance were broadly identified: (1) training, (2) travel and (3) competition. While acknowledging the limited number of high-quality evidence reviewed, athletes show a high overall prevalence of insomnia symptoms characterised by longer sleep latencies, greater sleep fragmentation, non-restorative sleep, and excessive daytime fatigue. These symptoms show marked inter-sport differences. Two underlying mechanisms are implicated in the mediation of sport-related insomnia symptoms: pre-sleep cognitive arousal and sleep restriction.

Diurnal rhythms in the human urine metabolome during sleep and total sleep deprivation.

PubMed

Giskeødegård, Guro F; Davies, Sarah K; Revell, Victoria L; Keun, Hector; Skene, Debra J

2015-10-09

Understanding how metabolite levels change over the 24 hour day is of crucial importance for clinical and epidemiological studies. Additionally, the association between sleep deprivation and metabolic disorders such as diabetes and obesity requires investigation into the links between sleep and metabolism. Here, we characterise time-of-day variation and the effects of sleep deprivation on urinary metabolite profiles. Healthy male participants (n = 15) completed an in-laboratory study comprising one 24 h sleep/wake cycle prior to 24 h of continual wakefulness under highly controlled environmental conditions. Urine samples were collected over set 2-8 h intervals and analysed by (1)H NMR spectroscopy. Significant changes were observed with respect to both time of day and sleep deprivation. Of 32 identified metabolites, 7 (22%) exhibited cosine rhythmicity over at least one 24 h period; 5 exhibiting a cosine rhythm on both days. Eight metabolites significantly increased during sleep deprivation compared with sleep (taurine, formate, citrate, 3-indoxyl sulfate, carnitine, 3-hydroxyisobutyrate, TMAO and acetate) and 8 significantly decreased (dimethylamine, 4-DTA, creatinine, ascorbate, 2-hydroxyisobutyrate, allantoin, 4-DEA, 4-hydroxyphenylacetate). These data indicate that sampling time, the presence or absence of sleep and the response to sleep deprivation are highly relevant when identifying biomarkers in urinary metabolic profiling studies.

Utility of Sleep Stage Transitions in Assessing Sleep Continuity

PubMed Central

Laffan, Alison; Caffo, Brian; Swihart, Bruce J.; Punjabi, Naresh M.

2010-01-01

Study Objectives: Sleep continuity is commonly assessed with polysomnographic measures such as sleep efficiency, sleep stage percentages, and the arousal index. The aim of this study was to examine whether the transition rate between different sleep stages could be used as an index of sleep continuity to predict self-reported sleep quality independent of other commonly used metrics. Design and Setting: Analysis of the Sleep Heart Health Study polysomnographic data. Participants: A community cohort. Measurements and Results: Sleep recordings on 5,684 participants were deemed to be of sufficient quality to allow visual scoring of NREM and REM sleep. For each participant, we tabulated the frequency of transitions between wake, NREM sleep, and REM sleep. An overall transition rate was determined as the number of all transitions per hour sleep. Stage-specific transition rates between wake, NREM sleep, and REM sleep were also determined. A 5-point Likert scale was used to assess the subjective experience of restless and light sleep the morning after the sleep study. Multivariable regression models showed that a high overall sleep stage transition rate was associated with restless and light sleep independent of several covariates including total sleep time, percentages of sleep stages, wake time after sleep onset, and the arousal index. Compared to the lowest quartile of the overall transition rate (< 7.76 events/h), the odds ratios for restless sleep were 1.27, 1.42, and 1.38, for the second (7.77–10.10 events/h), third (10.11–13.34 events/h), and fourth (≥ 13.35 events/h) quartiles, respectively. Analysis of stage-specific transition rates showed that transitions between wake and NREM sleep were also independently associated with restless and light sleep. Conclusions: Assessing overall and stage-specific transition rates provides a complementary approach for assessing sleep continuity. Incorporating such measures, along with conventional metrics, could yield useful insights into the significance of sleep continuity for clinical outcomes. Citation: Laffan A; Caffo B; Swihart BJ; Punjabi NM. Utility of sleep stage transitions in assessing sleep continuity. SLEEP 2010;33(12):1681-1686. PMID:21120130

Social and Health Correlates of Sleep Duration in a US Hispanic Population: Results from the Hispanic Community Health Study/Study of Latinos

PubMed Central

Patel, Sanjay R.; Sotres-Alvarez, Daniela; Castañeda, Sheila F.; Dudley, Katherine A.; Gallo, Linda C.; Hernandez, Rosalba; Medeiros, Elizabeth A.; Penedo, Frank J.; Mossavar-Rahmani, Yasmin; Ramos, Alberto R.; Redline, Susan; Reid, Kathryn J.; Zee, Phyllis C.

2015-01-01

Study Objectives: To define the prevalence of poor sleep patterns in the US Hispanic/Latino population, identify sociodemographic and psychosocial predictors of short and long sleep duration, and the association between sleep and cardiometabolic outcomes. Design: Cross-sectional analysis. Setting: Community-based study. Participants: Adults age 18–74 y free of sleep disorders (n = 11,860) from the Hispanic Community Health Study/Study of Latinos baseline examination (2008–2011). Interventions: N/A. Measurements and Results: The mean self-reported sleep duration was 8.0 h per night with 18.6% sleeping less than 7 h and 20.1% sleeping more than 9 h in age- and sex-adjusted analyses. Short sleep was most common in individuals of Puerto Rican heritage (25.6%) and the Other Hispanic group (27.4%). Full-time employment, low level of education, and depressive symptoms were independent predictors of short sleep, whereas unemployment, low household income, low level of education, and being born in the mainland US were independent predictors of long sleep. After accounting for sociodemographic differences, short sleep remained significantly associated with obesity with an odds ratio of 1.29 [95% confidence interval 1.12–1.49] but not with diabetes, hypertension, or heart disease. In contrast, long sleep was not associated with any of these conditions. Conclusions: Sleep duration is highly variable among US Hispanic/Latinos, varying by Hispanic/Latino heritage as well as socioeconomic status. These differences may have health consequences given associations between sleep duration and cardiometabolic disease, particularly obesity. Citation: Patel SR, Sotres-Alvarez D, Castañeda SF, Dudley KA, Gallo LC, Hernandez R, Medeiros EA, Penedo FJ, Mossavar-Rahmani Y, Ramos AR, Redline S, Reid KJ, Zee PC. Social and health correlates of sleep duration in a US Hispanic population: results from the Hispanic Community Health Study/Study of Latinos. SLEEP 2015;38(10):1515–1522. PMID:26085298

Neural Correlates of Dream Lucidity Obtained from Contrasting Lucid versus Non-Lucid REM Sleep: A Combined EEG/fMRI Case Study

PubMed Central

Dresler, Martin; Wehrle, Renate; Spoormaker, Victor I.; Koch, Stefan P.; Holsboer, Florian; Steiger, Axel; Obrig, Hellmuth; Sämann, Philipp G.; Czisch, Michael

2012-01-01

Study Objectives: To investigate the neural correlates of lucid dreaming. Design: Parallel EEG/fMRI recordings of night sleep. Setting: Sleep laboratory and fMRI facilities. Participants: Four experienced lucid dreamers. Interventions: N/A. Measurements and Results: Out of 4 participants, one subject had 2 episodes of verified lucid REM sleep of sufficient length to be analyzed by fMRI. During lucid dreaming the bilateral precuneus, cuneus, parietal lobules, and prefrontal and occipito-temporal cortices activated strongly as compared with non-lucid REM sleep. Conclusions: In line with recent EEG data, lucid dreaming was associated with a reactivation of areas which are normally deactivated during REM sleep. This pattern of activity can explain the recovery of reflective cognitive capabilities that are the hallmark of lucid dreaming. Citation: Dresler M; Wehrle R; Spoormaker VI; Koch SP; Holsboer F; Steiger A; Obrig H; Sämann PG; Czisch M. Neural correlates of dream lucidity obtained from contrasting lucid versus non-lucid REM sleep: a combined EEG/fMRI case study. SLEEP 2012;35(7):1017–1020. PMID:22754049

How the design of a sleeping bag can support counter-measuring fatigue

NASA Astrophysics Data System (ADS)

Imhof, Barbara; Hoheneder, Waltraut; Vogel, Kaspar; Drudi, Laura

2013-10-01

The paper discusses six case studies of sleeping bag design, one used by astronauts onboard the Space Shuttle and another currently being used on the ISS, which was developed by a Russian company. Two inflatable designs, one by Wubbo Ockels for ESA and one by the University of Technology in Munich in cooperation with NASA are chosen as case studies as well. Two recent designs set a new paradigm and option of sleeping in zero-g. The cut of the sleeping bag of these two design case studies allows the person to relax and sleep in the neutral body position. They were developed by Toshiroh Ikegami from Kyoto City University of Arts and astronaut Chiaki Mukai for JAXA, and by the Vienna based team LIQUIFER Systems Group in cooperation with ESA-astronaut Gerhard Thiele. Currently there is an increased interest in astronauts' and cosmonauts' sleep quality and related comfort because analysis of their sleep quality showed that sleep during long exposure to microgravity does not always ensure good recovery of cognitive and functional capabilities. Present research in the area of sleep and performance preservation include studies by the Institute of Biomedical Problems (IBMP) in Moscow and the NASA-JSC study from the Behavioral Health and Performance Element Human Research Program about improving sleep quality on ISS. In the context of the paper the operational medical challenges of sleep quality will be described in order to establish the relevance of effective sleeping bag designs to support spaceflight crewmembers' well-being.

Effects of Sleep after Experimental Trauma on Intrusive Emotional Memories

PubMed Central

Kleim, Birgit; Wysokowsky, Julia; Schmid, Nuria; Seifritz, Erich; Rasch, Björn

2016-01-01

Study Objectives: To investigate sleep's effect in the immediate aftermath of experiencing an analog trauma in the laboratory on reducing intrusive emotional memory formation. Methods: Sixty-five healthy women were exposed to an experimental laboratory trauma. They viewed a neutral and a trauma film in the laboratory and were randomly allocated to either a group that slept following film viewing or a group that remained awake. Sleep was recorded with electroencephalogram in a subgroup of participants in the sleep group. All participants recorded intrusive memories in the week following the film. Results: The sleep group experienced fewer and less distressing intrusive trauma memories compared to the wake group. These effects were particularly evident toward the end of the week. Duration spent in stage N2 as opposed to light N1 sleep, a higher number of fast parietal sleep spindles and a lower rapid eye movement sleep density predicted intrusion frequency. Conclusions: Our results have clinical implications and set the ground for early-intervention sleep studies following trauma and prevention of chronic posttrauma disorders. Citation: Kleim B, Wysokowsky J, Schmid N, Seifritz E, Rasch B. Effects of sleep after experimental trauma on intrusive emotional memories. SLEEP 2016;39(12):2125–2132. PMID:27748249

Persistent Insomnia: the Role of Objective Short Sleep Duration and Mental Health

PubMed Central

Vgontzas, Alexandros N.; Fernandez-Mendoza, Julio; Bixler, Edward O.; Singareddy, Ravi; Shaffer, Michele L.; Calhoun, Susan L.; Liao, Duanping; Basta, Maria; Chrousos, George P.

2012-01-01

Study Objectives: Few population-based, longitudinal studies have examined risk factors for persistent insomnia, and the results are inconsistent. Furthermore, none of these studies have examined the role of polysomnographic (PSG) variables such as sleep duration or sleep apnea on the persistence of insomnia. Design: Representative longitudinal study. Setting: Sleep laboratory. Participants: From a random, general population sample of 1741 individuals of the adult Penn State Cohort, 1395 were followed-up after 7.5 years. Measurements: Individuals underwent one-night PSG and full medical evaluation at baseline and a telephone interview at follow-up. PSG sleep duration was analyzed as a continuous variable and as a categorical variable: < 6 h sleep (short sleep duration) and ≥ 6 h sleep (longer sleep duration). Results: The rates of insomnia persistence, partial remission, and full remission were 44.0%, 30.0%, and 26.0%, respectively. Objective short sleep duration significantly increased the odds of persistent insomnia as compared to normal sleep (OR = 3.19) and to fully remitted insomnia (OR = 4.92). Mental health problems at baseline were strongly associated with persistent insomnia as compared to normal sleep (OR = 9.67) and to a lesser degree compared to fully remitted insomnia (OR = 3.68). Smoking, caffeine, and alcohol consumption and sleep apnea did not predict persistent insomnia. Conclusions: Objective short sleep duration and mental health problems are the strongest predictors of persistent insomnia. These data further support the validity and clinical utility of objective short sleep duration as a novel marker of the biological severity of insomnia. Citation: Vgontzas AN; Fernandez-Mendoza J; Bixler EO; Singareddy R; Shaffer ML; Calhoun SL; Liao D; Basta M; Chrousos GP. Persistent insomnia: the role of objective short sleep duration and mental health. SLEEP 2012;35(1):61-68. PMID:22215919

Predictability of Sleep in Patients with Insomnia

PubMed Central

Vallières, Annie; Ivers, Hans; Beaulieu-Bonneau, Simon; Morin, Charles M.

2011-01-01

Study Objectives: To evaluate whether the night-to-night variability in insomnia follows specific predictable patterns and to characterize sleep patterns using objective sleep and clinical variables. Design: Prospective observational study. Setting: University-affiliated sleep disorders center. Participants: 146 participants suffering from chronic and primary insomnia. Measurements and Results: Daily sleep diaries were completed for an average of 48 days and self-reported questionnaires once. Three nights were spent in the sleep laboratory for polysomnographic (PSG) assessment. Sleep efficiency, sleep onset latency, wake after sleep onset, and total sleep time were derived from sleep diaries and PSG. Time-series diary data were used to compute conditional probabilities of having an insomnia night after 1, 2, or 3 consecutive insomnia night(s). Conditional probabilities were submitted to a k-means cluster analysis. A 3-cluster solution was retained. One cluster included 38 participants exhibiting an unpredictable insomnia pattern. Another included 30 participants with a low and decreasing probability to have an insomnia night. The last cluster included 49 participants exhibiting a high probability to have insomnia every night. Clusters differed on age, insomnia severity, and mental fatigue, and on subjective sleep variables, but not on PSG sleep variables. Conclusion: These findings replicate our previous study and provide additional evidence that unpredictability is a less prevalent feature of insomnia than suggested previously in the literature. The presence of the 3 clusters is discussed in term of sleep perception and sleep homeostasis dysregulation. Citation: Vallières A; Ivers H; Beaulieu-Bonneau S; Morin CM. Predictability of sleep in patients with insomnia. SLEEP 2011;34(5):609-617. PMID:21532954

Promoting sleep by nursing interventions in health care settings: a systematic review.

PubMed

Hellström, Amanda; Willman, Ania

2011-09-01

Sleep disturbances are common problems among individuals in hospitals and institutions. Although several studies have explored this phenomenon, there is still a lack of knowledge about the effectiveness of sleep-promoting nursing interventions. This systematic review aims to describe and evaluate the effectiveness of sleep-promoting nursing interventions in health care settings. A systematic review was performed. In June 2009, a literature search was carried out in the following databases: Academic Search Elite, CINAHL, the Cochrane Library and MedLine/PubMed. Fifty-two references were identified and after critical appraisal, nine studies were selected. A compilation of the results and the outcomes of the interventions were carried out. Furthermore, the evidence strength of the interventions was assessed. Little evidence for the nursing interventions, sleep hygiene, music, natural sound and vision, stimulation of acupoints, relaxation, massage and aromatherapy is found. However, large effect size of interventions were found when using massage, acupuncture and music, natural sounds or music videos. The use of sleep hygiene and relaxation, on the other hand, produced only small effects. The lack of high evidence strength for the nursing interventions together with the uncertainty about their effects calls for more research before implementing these interventions into clinical practice. Copyright ©2010 Sigma Theta Tau International.

Association between Sleep Duration and 24-Hour Urine Free Cortisol in the MrOS Sleep Study

PubMed Central

Rao, Madhu N.; Blackwell, Terri; Redline, Susan; Punjabi, Naresh M.; Barrett-Connor, Elizabeth; Neylan, Thomas C.; Stone, Katie L.

2013-01-01

Context Short sleep duration is associated with adverse health outcomes, but the mechanisms involved are unknown. It has been postulated that short sleep duration may elevate cortisol levels, but studies have had conflicting results. It is unclear whether these differing findings may be due to methodological issues, such as assessment of sleep duration. Specifically, objective versus subjective methods of measuring habitual sleep duration may account for the conflicting results found in epidemiological studies. Objective Our goal was to determine whether habitual sleep duration, measured objectively (by actigraphy) and subjectively (by self-report), was associated with 24-hour urine free cortisol (UFC), a measure of integrated cortisol secretion. Our secondary goal was to determine whether slow wave sleep (SWS, determined by polysomnography) was associated with 24-hour UFC. Design/Setting Cross sectional study of community dwelling older men. Patients/Participants 325 men (mean age = 76.6 years, SD = 5.5) from the Portland site of the MrOS Sleep Study, who underwent 24-hour urine collection, polysomnography, actigraphy and sleep questionnaire. Primary Outcome 24-hour UFC. Results In this study of community dwelling older men, self-reported sleep duration was inversely related to 24-hour UFC levels. Participants reporting <5 hours of habitual sleep had an adjusted mean 24-hour UFC of 29.8 ug, compared to 28.0 ug in participants reporting >5 to <8 hours of sleep 25.5 ug in those reporting >8 hours of habitual sleep. However, sleep duration determined by actigraphy was not associated with 24-hour UFC in either univariable or multivariable regression models. SWS was not associated with 24-hour UFC. Conclusion Objectively measured (i.e., actigraphic) sleep duration is not associated with 24-hour UFC in these community dwelling older men. This finding, together with prior studies, suggests that elevated levels of integrated cortisol secretion is not the mechanisms by which short sleep duration leads to adverse health outcomes. PMID:24228086

"My child has a sleep problem": a cross-cultural comparison of parental definitions.

PubMed

Sadeh, Avi; Mindell, Jodi; Rivera, Luis

2011-05-01

Sleep problems are highly prevalent in early childhood. In many cases, parents seek professional help when they suspect their child suffers from a sleep problem. The aim of this study was to explore sleep, demographic and cultural factors associated with parental definition of child sleep problem in a large-scale, cross cultural study. Parents (or caregivers) of 29,287 infants and toddlers (aged 0-3 years) from 17 countries completed a questionnaire on their child's sleep patterns, sleep setting, and demographic variables. The results indicated that, in comparison to parents from predominantly Caucasian (PC) countries, parents from predominantly Asian (PA) countries were significantly more likely to identify a sleep problem in their children (26% vs 52% overall; 2% vs 17% "severe" sleep problem). Furthermore, whereas infant sleep variables were strong predictors of a sleep problem definition in PC countries, they were significantly less predictive in PA countries where demographic variables played a significant role. These results highlight the need to further explore the role of demographic and cultural variables in determining parental perception of a sleep problem, a perception that relates to help seeking professional treatment for infant sleep problems. Our findings also emphasize the need to educate parents about infant and toddler sleep and to provide parents information and screening tools to help them identify sleep problems in a more evidence-based approach. Copyright © 2011 Elsevier B.V. All rights reserved.

Is Passive Smoking Associated With Sleep Disturbance Among Pregnant Women?

PubMed Central

Ohida, Takashi; Kaneita, Yoshitaka; Osaki, Yoneatsu; Harano, Satoru; Tanihata, Takeo; Takemura, Shinji; Wada, Kiyoshi; Kanda, Hideyuki; Hayashi, Kenji; Uchiyama, Makoto

2007-01-01

Study Objective: Pregnant women suffer from sleep disturbance, which may be aggravated by passive smoking. In this study we investigated the effects of passive smoking on sleep disturbance during pregnancy. Design: Two cross-sectional questionnaire surveys conducted in 2002 and 2006. Setting: Clinical institutions specializing in obstetrics and gynecology that participated in the nationwide surveys: 260 in the 2002 survey and 344 in the 2006 survey. Participants: 16,396 and 19,386 pregnant women in Japan surveyed in 2002 and 2006, respectively. Intervention: N/A. Measurements and Results: Pregnant women exposed to passive smoking were likely to have sleep disturbances, such as subjective insufficient sleep, difficulty in initiating sleep, short sleep duration, and snoring loudly/breathing uncomfortably. Smoking pregnant women had the same sleep disturbances and also experienced excessive daytime sleepiness and early morning awakening. The prevalence of 5 types of sleep disturbance (insufficient sleep, difficulty in initiating sleep, short sleep duration, excessive daytime sleepiness, and snoring loudly/breathing uncomfortably) among nonsmokers with environmental tobacco smoke showed a mean value intermediate between that of active smokers and that of nonsmokers without environmental tobacco smoke. Conclusion: Passive smoking is independently associated with increased sleep disturbance during pregnancy. Citation: Ohida T; Kaneita Y; Osaki Y; Harano S; Tanihata T; Takemura S; Wada K; Kanda H; Hayashi K; Uchiyama M. Is passive smoking associated with sleep disturbance among pregnant women? SLEEP 2007;30(9):1155-1161. PMID:17910387

Sleep and use of electronic devices in adolescence: results from a large population-based study

PubMed Central

Hysing, Mari; Pallesen, Ståle; Stormark, Kjell Morten; Jakobsen, Reidar; Lundervold, Astri J; Sivertsen, Børge

2015-01-01

Objectives Adolescents spend increasingly more time on electronic devices, and sleep deficiency rising in adolescents constitutes a major public health concern. The aim of the present study was to investigate daytime screen use and use of electronic devices before bedtime in relation to sleep. Design A large cross-sectional population-based survey study from 2012, the youth@hordaland study, in Hordaland County in Norway. Setting Cross-sectional general community-based study. Participants 9846 adolescents from three age cohorts aged 16–19. The main independent variables were type and frequency of electronic devices at bedtime and hours of screen-time during leisure time. Outcomes Sleep variables calculated based on self-report including bedtime, rise time, time in bed, sleep duration, sleep onset latency and wake after sleep onset. Results Adolescents spent a large amount of time during the day and at bedtime using electronic devices. Daytime and bedtime use of electronic devices were both related to sleep measures, with an increased risk of short sleep duration, long sleep onset latency and increased sleep deficiency. A dose–response relationship emerged between sleep duration and use of electronic devices, exemplified by the association between PC use and risk of less than 5 h of sleep (OR=2.70, 95% CI 2.14 to 3.39), and comparable lower odds for 7–8 h of sleep (OR=1.64, 95% CI 1.38 to 1.96). Conclusions Use of electronic devices is frequent in adolescence, during the day as well as at bedtime. The results demonstrate a negative relation between use of technology and sleep, suggesting that recommendations on healthy media use could include restrictions on electronic devices. PMID:25643702

Sleep and Depression in Postpartum Women: A Population-Based Study

PubMed Central

Dørheim, Signe Karen; Bondevik, Gunnar Tschudi; Eberhard-Gran, Malin; Bjorvatn, Bjørn

2009-01-01

Study Objectives: (1) To describe the prevalence of and risk factors for postpartum maternal sleep problems and depressive symptoms simultaneously, (2) identify factors independently associated with either condition, and (3) explore associations between specific postpartum sleep components and depression. Design: Cross-sectional. Setting: Population-based. Participants: All women (n = 4191) who had delivered at Stavanger University Hospital from October 2005 to September 2006 were mailed a questionnaire seven weeks postpartum. The response rate was 68% (n = 2830). Interventions: None. Measurements and results: Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI), and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). The prevalence of sleep problems, defined as PSQI > 5, was 57.7%, and the prevalence of depression, defined as EPDS ≥ 10, was 16.5%. The mean self-reported nightly sleep duration was 6.5 hours and sleep efficiency 73%. Depression, previous sleep problems, being primiparous, not exclusively breastfeeding, or having a younger or male infant were factors associated with poor postpartum sleep quality. Poor sleep was also associated with depression when adjusted for other significant risk factors for depression, such as poor partner relationship, previous depression, depression during pregnancy and stressful life events. Sleep disturbances and subjective sleep quality were the aspects of sleep most strongly associated with depression. Conclusions: Poor sleep was associated with depression independently of other risk factors. Poor sleep may increase the risk of depression in some women, but as previously known risk factors were also associated, mothers diagnosed with postpartum depression are not merely reporting symptoms of chronic sleep deprivation. Citation: Dørheim SK; Bondevik GT; Eberhard-Gran M; Bjorvatn B. Sleep and depression in postpartum women: a population-based study. SLEEP 2009;32(7):847-855. PMID:19639747

Sleep among bereaved caregivers of patients admitted to hospice: a 1-year longitudinal pilot study

PubMed Central

Slåtten, Kari; Saghaug, Elisabeth; Grov, Ellen Karine; Normann, Are Peder; Lee, Kathryn A; Bjorvatn, Bjørn; Gay, Caryl L

2016-01-01

Objectives This pilot study aimed to describe the sleep of partners and other family caregivers prior to and in the first year after a hospice patient's death. The study also evaluated the feasibility of the study protocol and determined the effect sizes in preparation for a full-scale study. Design The pilot study used a longitudinal, descriptive and comparative design. Setting and participants Participants included primary family caregivers of patients admitted to a hospice in Oslo, Norway. Primary outcome Caregiver sleep was measured subjectively with the Pittsburgh Sleep Quality Index (PSQI) and objectively using wrist actigraphy for 4 nights and 3 days at three different times: during the hospice stay, and at 6 and 12 months after the patient's death. Results 16 family caregivers (10 partners and 6 other family members) completed the 1-year study protocol. Overall, sleep quality and quantity were stable over time and at each assessment, approximately half of the sample had poor sleep quality, both by self-report and objective measures. However, the sleep trajectories differed significantly over time, with older caregivers (≥65 years) having significantly longer sleep durations than younger caregivers (<65 years). Furthermore, sleep quality also differed over time depending on the caregiver's relationship to the patient, with partner caregivers having significantly worse sleep quality than other family caregivers. Conclusions Caring for a dying family member is known to interfere with sleep, yet little is known about bereaved caregivers. The results of this pilot study demonstrate the feasibility of the longitudinal study protocol and indicate that sleep problems are common for caregivers and continue into the bereavement period, particularly for partner caregivers. The caregiver's relationship to the patient may be an important factor to consider in future studies. PMID:26729383

No Associations between Interindividual Differences in Sleep Parameters and Episodic Memory Consolidation

PubMed Central

Ackermann, Sandra; Hartmann, Francina; Papassotiropoulos, Andreas; de Quervain, Dominique J.F.; Rasch, Björn

2015-01-01

Study Objectives: Sleep and memory are stable and heritable traits that strongly differ between individuals. Sleep benefits memory consolidation, and the amount of slow wave sleep, sleep spindles, and rapid eye movement sleep have been repeatedly identified as reliable predictors for the amount of declarative and/or emotional memories retrieved after a consolidation period filled with sleep. These studies typically encompass small sample sizes, increasing the probability of overestimating the real association strength. In a large sample we tested whether individual differences in sleep are predictive for individual differences in memory for emotional and neutral pictures. Design: Between-subject design. Setting: Cognitive testing took place at the University of Basel, Switzerland. Sleep was recorded at participants' homes, using portable electroencephalograph-recording devices. Participants: Nine hundred-twenty-nine healthy young participants (mean age 22.48 ± 3.60 y standard deviation). Interventions: None. Measurements and results: In striking contrast to our expectations as well as numerous previous findings, we did not find any significant correlations between sleep and memory consolidation for pictorial stimuli. Conclusions: Our results indicate that individual differences in sleep are much less predictive for pictorial memory processes than previously assumed and suggest that previous studies using small sample sizes might have overestimated the association strength between sleep stage duration and pictorial memory performance. Future studies need to determine whether intraindividual differences rather than interindividual differences in sleep stage duration might be more predictive for the consolidation of emotional and neutral pictures during sleep. Citation: Ackermann S, Hartmann F, Papassotiropoulos A, de Quervain DJF, Rasch B. No associations between interindividual differences in sleep parameters and episodic memory consolidation. SLEEP 2015;38(6):951–959. PMID:25325488

Predictors of CPAP compliance in different clinical settings: primary care versus sleep unit.

PubMed

Nadal, Núria; de Batlle, Jordi; Barbé, Ferran; Marsal, Josep Ramon; Sánchez-de-la-Torre, Alicia; Tarraubella, Nuria; Lavega, Merce; Sánchez-de-la-Torre, Manuel

2018-03-01

Good adherence to continuous positive airway pressure (CPAP) treatment improves the patient's quality of life and decreases the risk of cardiovascular disease. Previous studies that have analyzed the adherence to CPAP were performed in a sleep unit (SU) setting. The involvement of primary care (PC) in the management of obstructive sleep apnea (OSA) patients receiving CPAP treatment could introduce factors related to the adherence to treatment. The objective was to compare the baseline predictors of CPAP compliance in SU and PC settings. OSA patients treated with CPAP were followed for 6 months in SU or PC setting. We included baseline clinical and anthropometrical variables, the Epworth Sleep Scale (ESS) score, the quality of life index, and the Charlson index. A logistic regression was performed for each group to determine the CPAP compliance predictors. Discrimination and calibration were performed using the area under the curve and Hosmer-Lemeshow tests. We included 191 patients: 91 in the PC group and 100 in the SU group. In 74.9% of the patients, the compliance was ≥ 4 h per day, with 80% compliance in the SU setting and 69.2% compliance in the PC setting (p = 0.087). The predictors of CPAP compliance were different between SU and PC settings. Body mass index, ESS, and CPAP pressure were predictors in the SU setting, and ESS, gender, and waist circumference were predictors in the PC setting. The predictors of adequate CPAP compliance vary between SU and PC settings. Detecting compliance predictors could help in the planning of early interventions to improve CPAP adherence.

The Case for Addressing Operator Fatigue

PubMed Central

Duffy, Jeanne F.; Zitting, Kirsi-Marja; Czeisler, Charles A.

2015-01-01

Sleep deficiency, which can be caused by acute sleep deprivation, chronic insufficient sleep, untreated sleep disorders, disruption of circadian timing, and other factors, is endemic in the U.S., including among professional and non-professional drivers and operators. Vigilance and attention are critical for safe transportation operations, but fatigue and sleepiness compromise vigilance and attention by slowing reaction times and impairing judgment and decision-making abilities. Research studies, polls, and accident investigations indicate that many Americans drive a motor vehicle or operate an aircraft, train or marine vessel while drowsy, putting themselves and others at risk for error and accident. In this chapter, we will outline some of the factors that contribute to sleepiness, present evidence from laboratory and field studies demonstrating how sleepiness impacts transportation safety, review how sleepiness is measured in laboratory and field settings, describe what is known about interventions for sleepiness in transportation settings, and summarize what we believe are important gaps in our knowledge of sleepiness and transportation safety. PMID:26056516

Sleep restores loss of generalized but not rote learning of synthetic speech.

PubMed

Fenn, Kimberly M; Margoliash, Daniel; Nusbaum, Howard C

2013-09-01

Sleep-dependent consolidation has been demonstrated for declarative and procedural memory but few theories of consolidation distinguish between rote and generalized learning, suggesting similar consolidation should occur for both. However, studies using rote and generalized learning have suggested different patterns of consolidation may occur, although different tasks have been used across studies. Here we directly compared consolidation of rote and generalized learning using a single speech identification task. Training on a large set of novel stimuli resulted in substantial generalized learning, and sleep restored performance that had degraded after 12 waking hours. Training on a small set of repeated stimuli primarily resulted in rote learning and performance also degraded after 12 waking hours but was not restored by sleep. Moreover performance was significantly worse 24-h after rote training. Our results suggest a functional dissociation between the mechanisms of consolidation for rote and generalized learning which has broad implications for memory models. Copyright © 2013 Elsevier B.V. All rights reserved.

Mixed effect Poisson log-linear models for clinical and epidemiological sleep hypnogram data

PubMed Central

Swihart, Bruce J.; Caffo, Brian S.; Crainiceanu, Ciprian; Punjabi, Naresh M.

2013-01-01

Bayesian Poisson log-linear multilevel models scalable to epidemiological studies are proposed to investigate population variability in sleep state transition rates. Hierarchical random effects are used to account for pairings of subjects and repeated measures within those subjects, as comparing diseased to non-diseased subjects while minimizing bias is of importance. Essentially, non-parametric piecewise constant hazards are estimated and smoothed, allowing for time-varying covariates and segment of the night comparisons. The Bayesian Poisson regression is justified through a re-derivation of a classical algebraic likelihood equivalence of Poisson regression with a log(time) offset and survival regression assuming exponentially distributed survival times. Such re-derivation allows synthesis of two methods currently used to analyze sleep transition phenomena: stratified multi-state proportional hazards models and log-linear models with GEE for transition counts. An example data set from the Sleep Heart Health Study is analyzed. Supplementary material includes the analyzed data set as well as the code for a reproducible analysis. PMID:22241689

Validation of a Wireless, Self-Application, Ambulatory Electroencephalographic Sleep Monitoring Device in Healthy Volunteers.

PubMed

Finan, Patrick H; Richards, Jessica M; Gamaldo, Charlene E; Han, Dingfen; Leoutsakos, Jeannie Marie; Salas, Rachel; Irwin, Michael R; Smith, Michael T

2016-11-15

To evaluate the validity of an ambulatory electroencephalographic (EEG) monitor for the estimation of sleep continuity and architecture in healthy adults. Healthy, good sleeping participants (n = 14) were fit with both an ambulatory EEG monitor (Sleep Profiler) and a full polysomnography (PSG) montage. EEG recordings were gathered from both devices on the same night, during which sleep was permitted uninterrupted for eight hours. The study was set in an inpatient clinical research suite. PSG and Sleep Profiler records were scored by a neurologist board certified in sleep medicine, blinded to record identification. Agreement between the scored PSG record, the physician-scored Sleep Profiler record, and the Sleep Profiler record scored by an automatic algorithm was evaluated for each sleep stage, with the PSG record serving as the reference. Results indicated strong percent agreement across stages. Kappa was strongest for Stage N3 and REM. Specificity was high for all stages; sensitivity was low for Wake and Stage N1, and high for Stage N2, Stage N3, and REM. Agreement indices improved for the manually scored Sleep Profiler record relative to the autoscore record. Overall, the Sleep Profiler yields an EEG record with comparable sleep architecture estimates to PSG. Future studies should evaluate agreement between devices with a clinical sample that has greater periods of wake in order to better understand utility of this device for estimating sleep continuity indices, such as sleep onset latency and wake after sleep onset. © 2016 American Academy of Sleep Medicine

Wrist Actigraphy

PubMed Central

Hakim, Alex D.

2011-01-01

To record sleep, actigraph devices are worn on the wrist and record movements that can be used to estimate sleep parameters with specialized algorithms in computer software programs. With the recent establishment of a Current Procedural Terminology code for wrist actigraphy, this technology is being used increasingly in clinical settings as actigraphy has the advantage of providing objective information on sleep habits in the patient’s natural sleep environment. Actigraphy has been well validated for the estimation of nighttime sleep parameters across age groups, but the validity of the estimation of sleep-onset latency and daytime sleeping is limited. Clinical guidelines and research suggest that wrist actigraphy is particularly useful in the documentation of sleep patterns prior to a multiple sleep latency test, in the evaluation of circadian rhythm sleep disorders, to evaluate treatment outcomes, and as an adjunct to home monitoring of sleep-disordered breathing. Actigraphy has also been well studied in the evaluation of sleep in the context of depression and dementia. Although actigraphy should not be viewed as a substitute for clinical interviews, sleep diaries, or overnight polysomnography when indicated, it can provide useful information about sleep in the natural sleep environment and/or when extended monitoring is clinically indicated. PMID:21652563

Heterogeneity of sleep quality in relation to circadian preferences and depressive symptomatology among major depressive patients.

PubMed

Selvi, Yavuz; Boysan, Murat; Kandeger, Ali; Uygur, Omer F; Sayin, Ayca A; Akbaba, Nursel; Koc, Basak

2018-08-01

The current study aimed at investigating the latent dimensional structure of sleep quality as indexed by the seven components of the Pittsburgh Sleep Quality Index (PSQI), as well as latent covariance structure between sleep quality, circadian preferences and depressive symptoms. Two hundred twenty-five patients with major depressive disorder (MDD), with an average age of 29.92 ± 10.49 years (aged between 17 and 63), participated in the study. The PSQI, Morningness-Eveningness Questionnaire (MEQ) and Beck Depression Inventory (BDI) were administered to participants. Four sets of latent class analyses were subsequently run to obtain optimal number of latent classes best fit to the data. Mixture models revealed that sleep quality is multifaceted in MDD. The data best fit to four-latent-class model: Poor Habitual Sleep Quality (PHSQ), Poor Subjective Sleep Quality (PSSQ), Intermediate Sleep Quality (ISQ), and Good Sleep Quality (GSQ). MDD patients classified into GSQ latent class (23.6%) reported the lowest depressive symptoms and were more prone to morningness diurnal preferences compared to other three homogenous sub-groups. Finally, the significant association between eveningness diurnal preferences and depressive symptomatology was significantly mediated by poor sleep quality. The cross-sectional nature of the study and the lack of an objective measurement of sleep such as polysomnography recordings was the most striking limitation of the study. We concluded sleep quality in relation to circadian preferences and depressive symptoms has a heterogeneous nature in MDD. Copyright © 2018. Published by Elsevier B.V.

Childhood Sleep Duration and Quality in Relation to Leptin Concentration in Two Cohort Studies

PubMed Central

Boeke, Caroline E.; Storfer-Isser, Amy; Redline, Susan; Taveras, Elsie M.

2014-01-01

Study Objectives: Poor sleep in childhood is associated with increased obesity risk, possibly by affecting appetite-regulating hormones such as leptin. We examined short- and long-term sleep duration and quality in relation to leptin in two US pediatric cohorts. Design: Analysis of data from two prospective cohort studies. Setting: Population-based. Adolescent polysomnography assessments performed in a clinical research unit. Patients or Participants: Children in Project Viva (n = 655) and adolescents in the Cleveland Children's Sleep & Health Study (n = 502). Interventions: N/A. Measurements and Results: In Project Viva, mothers reported average child sleep duration annually from infancy through age 7, and we measured leptin at ages 3 and 7. In the Cleveland Children's Sleep & Health Study, we collected self-reported sleep duration, polysomnography-derived measures of sleep quality, and fasting leptin at ages 16-19. In sex-stratified linear regression analyses adjusted for sociodemographic characteristics and adiposity, chronic curtailed sleep was associated with lower leptin at age 7 in girls; a one-unit decrease in sleep score was associated with a 0.08 decrease in log leptin (95%CI: 0.01,0.15). The association was stronger in girls with greater adiposity (P = 0.01). Among adolescents, shorter sleep was associated with lower leptin in males; each one-hour decrease in sleep duration was associated with a 0.06 decrease in log leptin (95%CI: 0.00, 0.11). Sleep duration was not associated with leptin at other ages. Sleep quality indices were not associated with leptin. Conclusions: Our results suggest possible age-specific sexual dimorphism in the influence of sleep on leptin, which may partly explain inconsistencies in the literature. Citation: Boeke CE; Storfer-Isser A; Redline S; Taveras EM. Childhood sleep duration and quality in relation to leptin concentration in two cohort studies. SLEEP 2014;37(3):613-620. PMID:24587585

School-based sleep education program improves sleep and academic performance of school-age children.

PubMed

Gruber, Reut; Somerville, Gail; Bergmame, Lana; Fontil, Laura; Paquin, Soukaina

2016-05-01

The objective of this study was to develop and evaluate the effectiveness of a school-based sleep education program aimed at improving the sleep and academic performance of school-age children. Using a community-based participatory research approach, we created a school-based sleep education program, "Sleep for Success"™ (SFS), composed of four distinct modules that addressed the children, their family and community, the school staff, and decision makers within the school setting. Implementation was carried out in three elementary schools. Seventy-one students participated in the evaluation of the program. The effectiveness of the SFS program was evaluated using non-randomized controlled before-and-after study groups (intervention and control) assessed over two time points (pre- and post-program implementation). Before (baseline) and after implementation, sleep and academic performance were measured using actigraphy and report card marks, respectively. In the intervention group, true sleep was extended by 18.2 min per night, sleep efficiency improved by 2.3%, and sleep latency was shortened by 2.3 min, and report card grades in mathematics and English improved significantly. No changes were noted in the control group. Participation in the sleep education program was associated with significant improvements in children's sleep and academic performance. Copyright © 2016 Elsevier B.V. All rights reserved.

To Assess Sleep Quality among Pakistani Junior Physicians (House Officers): A Cross-sectional Study.

PubMed

Surani, A A; Surani, A; Zahid, S; Ali, S; Farhan, R; Surani, S

2015-01-01

Sleep deprivation among junior physicians (house officers) is of growing concern. In developed countries, duty hours are now mandated, but in developing countries, junior physicians are highly susceptible to develop sleep impairment due to long working hours, on-call duties and shift work schedule. We undertook the study to assess sleep quality among Pakistani junior physicians. A cross-sectional study was conducted at private and public hospitals in Karachi, Pakistan, from June 2012 to January 2013. The study population comprised of junior doctors (house physicians and house surgeons). A consecutive sample of 350 physicians was drawn from the above-mentioned study setting. The subject underwent two validated self-administered questionnaires, that is, Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). A total of 334 physicians completely filled out the questionnaire with a response rate of 95.4% (334/350). Of 334 physicians, 36.8% (123/334) were classified as "poor sleepers" (global PSQI score > 5). Poor sleep quality was associated with female gender (P = 0.01), excessive daytime sleepiness (P < 0.01), lower total sleep time (P < 0.001), increased sleep onset latency (P < 0.001), and increased frequency of sleep disturbances (P < 0.001). Abnormal ESS scores (ESS > 10) were more prevalent among poor sleepers (P < 0.01) signifying increased level of daytime hypersomnolence. Sleep quality among Pakistani junior physicians is significantly poor. Efforts must be directed towards proper sleep hygiene education. Regulations regarding duty hour limitations need to be considered.

Sleep to Implement an Intention

PubMed Central

Diekelmann, Susanne; Wilhelm, Ines; Wagner, Ullrich; Born, Jan

2013-01-01

Study Objectives: Sleep supports the consolidation of new memories. However, this effect has mainly been shown for memories of past events. Here we investigated the role of sleep for the implementation of intentions for the future. Design: Subjects were instructed on a plan that had to be executed after a delay of 2 days. After plan instruction, subjects were either allowed to sleep or stayed awake for one night (Exp. 1) or had a 3-h sleep period either during the early night (SWS-rich sleep) or late night (REM-rich sleep; Exp. 2). In both experiments, retesting took place 2 days later after one recovery night. Setting: Sleep laboratory. Patients or Participants: A total of 56 healthy young adults participated in the study. Interventions: N/A. Measurements and Results: All of the subjects who were allowed to sleep after plan instruction executed the intention 2 days later, whereas only 61% of wake subjects did so (P = 0.004; Exp. 1). Also after early SWS-rich sleep all of the subjects remembered to execute the intention, but only 55% did so after late REM-rich sleep (P = 0.015; Exp. 2). Conclusions: Sleep, especially SWS, plays an important role for the successful implementation of delayed intentions. Citation: Diekelmann S; Wilhelm I; Wagner U; Born J. Sleep to implement an intention. SLEEP 2013;36(1):149-153. PMID:23288982

Identification of Genes Associated with Resilience/Vulnerability to Sleep Deprivation and Starvation in Drosophila

PubMed Central

Thimgan, Matthew S.; Seugnet, Laurent; Turk, John; Shaw, Paul J.

2015-01-01

Background and Study Objectives: Flies mutant for the canonical clock protein cycle (cyc01) exhibit a sleep rebound that is ∼10 times larger than wild-type flies and die after only 10 h of sleep deprivation. Surprisingly, when starved, cyc01 mutants can remain awake for 28 h without demonstrating negative outcomes. Thus, we hypothesized that identifying transcripts that are differentially regulated between waking induced by sleep deprivation and waking induced by starvation would identify genes that underlie the deleterious effects of sleep deprivation and/or protect flies from the negative consequences of waking. Design: We used partial complementary DNA microarrays to identify transcripts that are differentially expressed between cyc01 mutants that had been sleep deprived or starved for 7 h. We then used genetics to determine whether disrupting genes involved in lipid metabolism would exhibit alterations in their response to sleep deprivation. Setting: Laboratory. Patients or Participants: Drosophila melanogaster. Interventions: Sleep deprivation and starvation. Measurements and Results: We identified 84 genes with transcript levels that were differentially modulated by 7 h of sleep deprivation and starvation in cyc01 mutants and were confirmed in independent samples using quantitative polymerase chain reaction. Several of these genes were predicted to be lipid metabolism genes, including bubblegum, cueball, and CG4500, which based on our data we have renamed heimdall (hll). Using lipidomics we confirmed that knockdown of hll using RNA interference significantly decreased lipid stores. Importantly, genetically modifying bubblegum, cueball, or hll resulted in sleep rebound alterations following sleep deprivation compared to genetic background controls. Conclusions: We have identified a set of genes that may confer resilience/vulnerability to sleep deprivation and demonstrate that genes involved in lipid metabolism modulate sleep homeostasis. Citation: Thimgan MS, Seugnet L, Turk J, Shaw PJ. Identification of genes associated with resilience/vulnerability to sleep deprivation and starvation in Drosophila. SLEEP 2015;38(5):801–814. PMID:25409104

Deciphering the Temporal Link between Pain and Sleep in a Heterogeneous Chronic Pain Patient Sample: A Multilevel Daily Process Study

PubMed Central

Tang, Nicole K.Y.; Goodchild, Claire E.; Sanborn, Adam N.; Howard, Jonathan; Salkovskis, Paul M.

2012-01-01

Objectives: Because insomnia is a common comorbidity of chronic pain, scientific and clinical interest in the relationship of pain and sleep has surged in recent years. Although experimental studies suggest a sleep-interfering property of pain and a pain-enhancing effect of sleep deprivation/fragmentation, the temporal association between pain and sleep as experienced by patients is less understood. The current study was conducted to examine the influence of presleep pain on subsequent sleep and sleep on pain reports the next day, taking into consideration other related psychophysiologic variables such as mood and arousal. Design: A daily process study, involving participants to monitor their pain, sleep, mood, and presleep arousal for 1 wk. Multilevel modeling was used to analyze the data. Setting: In the patients' natural living and sleeping environment. Patients: One hundred nineteen patients (73.9% female, mean age = 46 years) with chronic pain and concomitant insomnia. Measurement: An electronic diary was used to record patients' self-reported sleep quality/efficiency and ratings of pain, mood, and arousal at different times of the day; actigraphy was also used to provide estimates of sleep efficiency. Results: Results indicated that presleep pain was not a reliable predictor of subsequent sleep. Instead, sleep was better predicted by presleep cognitive arousal. Although sleep quality was a consistent predictor of pain the next day, the pain-relieving effect of sleep was only evident during the first half of the day. Conclusions: These findings challenge the often-assumed reciprocal relationship between pain and sleep and call for a diversification in thinking of the daily interaction of these 2 processes. Citation: Tang NKY; Goodchild CE; Sanborn AN; Howard J; Salkovskis PM. Deciphering the temporal link between pain and sleep in a heterogeneous chronic pain patient sample: a multilevel daily process study. SLEEP 2012;35(5):675-687. PMID:22547894

Sleep problems: an emerging global epidemic? Findings from the INDEPTH WHO-SAGE study among more than 40,000 older adults from 8 countries across Africa and Asia.

PubMed

Stranges, Saverio; Tigbe, William; Gómez-Olivé, Francesc Xavier; Thorogood, Margaret; Kandala, Ngianga-Bakwin

2012-08-01

To estimate the prevalence of sleep problems and the effect of potential correlates in low-income settings from Africa and Asia, where the evidence is lacking. Cross-sectional. Community-wide samples from 8 countries across Africa and Asia participating in the INDEPTH WHO-SAGE multicenter collaboration during 2006-2007. The participating sites included rural populations in Ghana, Tanzania, South Africa, India, Bangladesh, Vietnam, and Indonesia, and an urban area in Kenya. There were 24,434 women and 19,501 men age 50 yr and older. N/A. Two measures of sleep quality, over the past 30 days, were assessed alongside a number of sociodemographic variables, measures of quality of life, and comorbidities. Overall, 16.6% of participants reported severe/extreme nocturnal sleep problems, with a striking variation across the 8 populations, ranging from 3.9% (Purworejo, Indonesia and Nairobi, Kenya) to more than 40.0% (Matlab, Bangladesh). There was a consistent pattern of higher prevalence of sleep problems in women and older age groups. In bivariate analyses, lower education, not living in partnership, and poorer self-rated quality of life were consistently associated with higher prevalence of sleep problems (P < 0.001). In multivariate logistic regression analyses, limited physical functionality or greater disability and feelings of depression and anxiety were consistently strong, independent correlates of sleep problems, in both women and men, across the 8 sites (P < 0.001). A large number of older adults in low-income settings are currently experiencing sleep problems, which emphasizes the global dimension of this emerging public health issue. This study corroborates the multifaceted nature of sleep problems, which are strongly linked to poorer general well-being and quality of life, and psychiatric comorbidities.

Unsupervised online classifier in sleep scoring for sleep deprivation studies.

PubMed

Libourel, Paul-Antoine; Corneyllie, Alexandra; Luppi, Pierre-Hervé; Chouvet, Guy; Gervasoni, Damien

2015-05-01

This study was designed to evaluate an unsupervised adaptive algorithm for real-time detection of sleep and wake states in rodents. We designed a Bayesian classifier that automatically extracts electroencephalogram (EEG) and electromyogram (EMG) features and categorizes non-overlapping 5-s epochs into one of the three major sleep and wake states without any human supervision. This sleep-scoring algorithm is coupled online with a new device to perform selective paradoxical sleep deprivation (PSD). Controlled laboratory settings for chronic polygraphic sleep recordings and selective PSD. Ten adult Sprague-Dawley rats instrumented for chronic polysomnographic recordings. The performance of the algorithm is evaluated by comparison with the score obtained by a human expert reader. Online detection of PS is then validated with a PSD protocol with duration of 72 hours. Our algorithm gave a high concordance with human scoring with an average κ coefficient > 70%. Notably, the specificity to detect PS reached 92%. Selective PSD using real-time detection of PS strongly reduced PS amounts, leaving only brief PS bouts necessary for the detection of PS in EEG and EMG signals (4.7 ± 0.7% over 72 h, versus 8.9 ± 0.5% in baseline), and was followed by a significant PS rebound (23.3 ± 3.3% over 150 minutes). Our fully unsupervised data-driven algorithm overcomes some limitations of the other automated methods such as the selection of representative descriptors or threshold settings. When used online and coupled with our sleep deprivation device, it represents a better option for selective PSD than other methods like the tedious gentle handling or the platform method. © 2015 Associated Professional Sleep Societies, LLC.

A novel unsupervised analysis of electrophysiological signals reveals new sleep substages in mice.

PubMed

Katsageorgiou, Vasiliki-Maria; Sona, Diego; Zanotto, Matteo; Lassi, Glenda; Garcia-Garcia, Celina; Tucci, Valter; Murino, Vittorio

2018-05-01

Sleep science is entering a new era, thanks to new data-driven analysis approaches that, combined with mouse gene-editing technologies, show a promise in functional genomics and translational research. However, the investigation of sleep is time consuming and not suitable for large-scale phenotypic datasets, mainly due to the need for subjective manual annotations of electrophysiological states. Moreover, the heterogeneous nature of sleep, with all its physiological aspects, is not fully accounted for by the current system of sleep stage classification. In this study, we present a new data-driven analysis approach offering a plethora of novel features for the characterization of sleep. This novel approach allowed for identifying several substages of sleep that were hidden to standard analysis. For each of these substages, we report an independent set of homeostatic responses following sleep deprivation. By using our new substages classification, we have identified novel differences among various genetic backgrounds. Moreover, in a specific experiment with the Zfhx3 mouse line, a recent circadian mutant expressing both shortening of the circadian period and abnormal sleep architecture, we identified specific sleep states that account for genotypic differences at specific times of the day. These results add a further level of interaction between circadian clock and sleep homeostasis and indicate that dissecting sleep in multiple states is physiologically relevant and can lead to the discovery of new links between sleep phenotypes and genetic determinants. Therefore, our approach has the potential to significantly enhance the understanding of sleep physiology through the study of single mutations. Moreover, this study paves the way to systematic high-throughput analyses of sleep.

A New Model to Study Sleep Deprivation-Induced Seizure

PubMed Central

Lucey, Brendan P.; Leahy, Averi; Rosas, Regine; Shaw, Paul J.

2015-01-01

Background and Study Objectives: A relationship between sleep and seizures is well-described in both humans and rodent animal models; however, the mechanism underlying this relationship is unknown. Using Drosophila melanogaster mutants with seizure phenotypes, we demonstrate that seizure activity can be modified by sleep deprivation. Design: Seizure activity was evaluated in an adult bang-sensitive seizure mutant, stress sensitive B (sesB9ed4), and in an adult temperature sensitive seizure mutant seizure (seits1) under baseline and following 12 h of sleep deprivation. The long-term effect of sleep deprivation on young, immature sesB9ed4 flies was also assessed. Setting: Laboratory. Participants: Drosophila melanogaster. Interventions: Sleep deprivation. Measurements and Results: Sleep deprivation increased seizure susceptibility in adult sesB9ed4/+ and seits1 mutant flies. Sleep deprivation also increased seizure susceptibility when sesB was disrupted using RNAi. The effect of sleep deprivation on seizure activity was reduced when sesB9ed4/+ flies were given the anti-seizure drug, valproic acid. In contrast to adult flies, sleep deprivation during early fly development resulted in chronic seizure susceptibility when sesB9ed4/+ became adults. Conclusions: These findings show that Drosophila is a model organism for investigating the relationship between sleep and seizure activity. Citation: Lucey BP, Leahy A, Rosas R, Shaw PJ. A new model to study sleep deprivation-induced seizure. SLEEP 2015;38(5):777–785. PMID:25515102

When a gold standard isn't so golden: Lack of prediction of subjective sleep quality from sleep polysomnography.

PubMed

Kaplan, Katherine A; Hirshman, Jason; Hernandez, Beatriz; Stefanick, Marcia L; Hoffman, Andrew R; Redline, Susan; Ancoli-Israel, Sonia; Stone, Katie; Friedman, Leah; Zeitzer, Jamie M

2017-02-01

Reports of subjective sleep quality are frequently collected in research and clinical practice. It is unclear, however, how well polysomnographic measures of sleep correlate with subjective reports of prior-night sleep quality in elderly men and women. Furthermore, the relative importance of various polysomnographic, demographic and clinical characteristics in predicting subjective sleep quality is not known. We sought to determine the correlates of subjective sleep quality in older adults using more recently developed machine learning algorithms that are suitable for selecting and ranking important variables. Community-dwelling older men (n=1024) and women (n=459), a subset of those participating in the Osteoporotic Fractures in Men study and the Study of Osteoporotic Fractures study, respectively, completed a single night of at-home polysomnographic recording of sleep followed by a set of morning questions concerning the prior night's sleep quality. Questionnaires concerning demographics and psychological characteristics were also collected prior to the overnight recording and entered into multivariable models. Two machine learning algorithms, lasso penalized regression and random forests, determined variable selection and the ordering of variable importance separately for men and women. Thirty-eight sleep, demographic and clinical correlates of sleep quality were considered. Together, these multivariable models explained only 11-17% of the variance in predicting subjective sleep quality. Objective sleep efficiency emerged as the strongest correlate of subjective sleep quality across all models, and across both sexes. Greater total sleep time and sleep stage transitions were also significant objective correlates of subjective sleep quality. The amount of slow wave sleep obtained was not determined to be important. Overall, the commonly obtained measures of polysomnographically-defined sleep contributed little to subjective ratings of prior-night sleep quality. Though they explained relatively little of the variance, sleep efficiency, total sleep time and sleep stage transitions were among the most important objective correlates. Published by Elsevier B.V.

When a gold standard isn't so golden: Lack of prediction of subjective sleep quality from sleep polysomnography

PubMed Central

Kaplan, Katherine A.; Hirshman, Jason; Hernandez, Beatriz; Stefanick, Marcia L.; Hoffman, Andrew R.; Redline, Susan; Ancoli-Israel, Sonia; Stone, Katie; Friedman, Leah; Zeitzer, Jamie M.

2016-01-01

Background Reports of subjective sleep quality are frequently collected in research and clinical practice. It is unclear, however, how well polysomnographic measures of sleep correlate with subjective reports of prior-night sleep quality in elderly men and women. Furthermore, the relative importance of various polysomnographic, demographic and clinical characteristics in predicting subjective sleep quality is not known. We sought to determine the correlates of subjective sleep quality in in older adults using more recently developed machine learning algorithms that are suitable for selecting and ranking important variables. Methods Community-dwelling older men (n=1024) and women (n=459), a subset of those participating in the Osteoporotic Fractures in Men study and the Study of Osteoporotic Fractures study, respectively, completed a single night of at-home polysomnographic recording of sleep followed by a set of morning questions concerning the prior night's sleep quality. Questionnaires concerning demographics and psychological characteristics were also collected prior to the overnight recording and entered into multivariable models. Two machine learning algorithms, lasso penalized regression and random forests, determined variable selection and the ordering of variable importance separately for men and women. Results Thirty-eight sleep, demographic and clinical correlates of sleep quality were considered. Together, these multivariable models explained only 11-17% of the variance in predicting subjective sleep quality. Objective sleep efficiency emerged as the strongest correlate of subjective sleep quality across all models, and across both sexes. Greater total sleep time and sleep stage transitions were also significant objective correlates of subjective sleep quality. The amount of slow wave sleep obtained was not determined to be important. Conclusions Overall, the commonly obtained measures of polysomnographically-defined sleep contributed little to subjective ratings of prior-night sleep quality. Though they explained relatively little of the variance, sleep efficiency, total sleep time and sleep stage transitions were among the most important objective correlates. PMID:27889439

The Impact of Sleep-Related Attentional Bias on Polysomnographically Measured Sleep in Primary Insomnia

PubMed Central

Spiegelhalder, Kai; Kyle, Simon D.; Feige, Bernd; Prem, Martin; Nissen, Christoph; Espie, Colin A.; Riemann, Dieter

2010-01-01

Study Objectives: Although sleep-related attentional bias has been shown to be evident in primary insomnia, the association with objectively measured sleep has not been investigated. In the present study, we used polysomnography (PSG) to fill this void. Design: Patients with primary insomnia and healthy controls were studied using a visual dot probe task (VDP) and an emotional Stroop task (EST). Additionally, polysomnography was carried out in a sub-sample (n = 22) of patients in the subsequent night. Setting: Department of Psychiatry and Psychotherapy of the University of Freiburg Medical Center. Participants: Thirty patients with primary insomnia and 30 matched healthy controls. Interventions: N/A Measurements and Results: Patients with primary insomnia demonstrated a significant sleep-related attentional bias compared to controls in the EST but no significant group effects were found for the VDP. VDP attentional bias scores were positively correlated with measures of sleep pressure, including total sleep time, sleep efficiency, and the amount of slow wave sleep. EST attentional bias scores were not correlated with subsequent PSG parameters, and we did not observe a correlation between attentional bias scores on the two tasks. Conclusions: The unexpected relationship between increased attentional bias, in the VDP task, and improved markers of sleep duration and continuity, may be indicative of a homeostatic craving for sleep in those with high attentional bias. This awaits further testing in multiple night studies, to shed light on the mechanisms and implications of sleep-related attentional bias. Citation: Spiegelhalder K; Kyle SD; Feige B; Prem M; Nissen C; Espie CA; Riemann D. The impact of sleep-related attentional bias on polysomnographically measured sleep in primary insomnia. SLEEP 2010;33(1):107-112. PMID:20120627

Objective Sleep Structure and Cardiovascular Risk Factors in the General Population: The HypnoLaus Study

PubMed Central

Haba-Rubio, José; Marques-Vidal, Pedro; Andries, Daniela; Tobback, Nadia; Preisig, Martin; Vollenweider, Peter; Waeber, Gérard; Luca, Gianina; Tafti, Mehdi; Heinzer, Raphaël

2015-01-01

Study Objectives: To evaluate the association between objective sleep measures and metabolic syndrome (MS), hypertension, diabetes, and obesity. Design: Cross-sectional study. Setting: General population sample. Participants: There were 2,162 patients (51.2% women, mean age 58.4 ± 11.1). Interventions: Patients were evaluated for hypertension, diabetes, overweight/obesity, and MS, and underwent a full polysomnography (PSG). Measurements and Results: PSG measured variables included: total sleep time (TST), percentage and time spent in slow wave sleep (SWS) and in rapid eye movement (REM) sleep, sleep efficiency and arousal index (ArI). In univariate analyses, MS was associated with decreased TST, SWS, REM sleep, and sleep efficiency, and increased ArI. After adjustment for age, sex, smoking, alcohol, physical activity, drugs that affect sleep and depression, the ArI remained significantly higher, but the difference disappeared in patients without significant sleep disordered breathing (SDB). Differences in sleep structure were also found according to the presence or absence of hypertension, diabetes, and overweight/obesity in univariate analysis. However, these differences were attenuated after multivariate adjustment and after excluding subjects with significant SDB. Conclusions: In this population-based sample we found significant associations between sleep structure and metabolic syndrome (MS), hypertension, diabetes, and obesity. However, these associations were cancelled after multivariate adjustment. We conclude that normal variations in sleep contribute little if any to MS and associated disorders. Citation: Haba-Rubio J, Marques-Vidal P, Andries D, Tobback N, Preisig M, Vollenweider P, Waeber G, Luca G, Tafti M, Heinzer R. Objective sleep structure and cardiovascular risk factors in the general population: the HypnoLaus study. SLEEP 2015;38(3):391–400. PMID:25325467

Electrocardiogram-Based Sleep Spectrogram Measures of Sleep Stability and Glucose Disposal in Sleep Disordered Breathing

PubMed Central

Pogach, Melanie S.; Punjabi, Naresh M.; Thomas, Neil; Thomas, Robert J.

2012-01-01

Study Objectives: Sleep disordered breathing (SDB) is independently associated with insulin resistance, glucose intolerance, and type 2 diabetes mellitus. Experimental sleep fragmentation has been shown to impair insulin sensitivity. Conventional electroencephalogram (EEG)-based sleep-quality measures have been inconsistently associated with indices of glucose metabolism. This analysis explored associations between glucose metabolism and an EEG-independent measure of sleep quality, the sleep spectrogram, which maps coupled oscillations of heart-rate variability and electrocardiogram (ECG)-derived respiration. The method allows improved characterization of the quality of stage 2 non-rapid eye movement (NREM) sleep. Design: Cross-sectional study. Setting: N/A. Participants: Nondiabetic subjects with and without SDB (n = 118) underwent the frequently sampled intravenous glucose tolerance test (FSIVGTT) and a full-montage polysomnogram. The sleep spectrogram was generated from ECG collected during polysomnography. Interventions: N/A. Measurements and Results: Standard polysomnographic stages (stages 1, 2, 3+4, and rapid eye movement [REM]) were not associated with the disposition index (DI) derived from the FSIVGTT. In contrast, spectrographic high-frequency coupling (a marker of stable or “effective” sleep) duration was associated with increased, and very-low-frequency coupling (a marker of wake/REM/transitions) associated with reduced DI. This relationship was noted after adjusting for age, sex, body mass index, slow wave sleep, total sleep time, stage 1, the arousal index, and the apnea-hypopnea index. Conclusions: ECG-derived sleep-spectrogram measures of sleep quality are associated with alterations in glucose-insulin homeostasis. This alternate mode of estimating sleep quality could improve our understanding of sleep and sleep-breathing effects on glucose metabolism. Citation: Pogach MS; Punjabi NM; Thomas N; Thomas RJ. Electrocardiogram-based sleep spectrogram measures of sleep stability and glucose disposal in sleep disordered breathing. SLEEP 2012;35(1):139-148. PMID:22215928

REM sleep behavior disorder and narcoleptic features in anti-Ma2-associated encephalitis.

PubMed

Compta, Yaroslau; Iranzo, Alex; Santamaría, Joan; Casamitjana, Roser; Graus, Francesc

2007-06-01

A 69-year-old man with anti-Ma2 paraneoplastic encephalitis presented with subacute onset of severe hypersomnia, memory loss, parkinsonism, and gaze palsy. A brain magnetic resonance imaging study showed bilateral damage in the dorsolateral midbrain, amygdala, and paramedian thalami. Videopolysomnography disclosed rapid eye movement (REM) sleep behavior disorder, and a Multiple Sleep Latency Test showed a mean sleep latency of 7 minutes and 4 sleep-onset REM periods. The level of hypocretin-1 in the cerebrospinal fluid was low (49 pg/mL). This observation illustrates that REM sleep behavior disorder and narcoleptic features are 2 REM-sleep abnormalities that (1) may share the same autoimmune-mediated origin affecting the brainstem, limbic, and diencephalic structures and (2) may occur in the setting of the paraneoplastic anti-Ma2-associated encephalitis.

Sleep and Performance Research Center

DTIC Science & Technology

2012-05-01

upon the placement of the work period with respect to the circadian rhythm. Additional studies were published by SPRC care factually during the...Research Center (SPRC) conducts human and animal studies in laboratory and field settings in support of basic and applied sleep research at Washington...Program of Research Field Studies in Humans In a field study of serving police officers, Charles, et al. (2011) found that perceived shorter

Clinical and Polysomnographic Predictors of the Natural History of Poor Sleep in the General Population

PubMed Central

Fernandez-Mendoza, Julio; Vgontzas, Alexandros N.; Bixler, Edward O.; Singareddy, Ravi; Shaffer, Michele L.; Calhoun, Susan L.; Karataraki, Maria; Vela-Bueno, Antonio; Liao, Duanping

2012-01-01

Study Objectives: Approximately 8-10% of the general population suffers from chronic insomnia, whereas another 20-30% of the population has insomnia symptoms at any given time (i.e., poor sleep). However, few longitudinal studies have examined risk factors of the natural history of poor sleep, and none have examined the role of polysomnographic (PSG) variables. Design: Representative longitudinal study. Setting: Sleep laboratory. Participants: From a random, general population sample of 1,741 individuals of the adult Penn State Cohort, 1,395 were followed up after 7.5 yr. Measurements: Full medical evaluation and 1-night PSG at baseline and telephone interview at follow-up. Results: The rate of incident poor sleep was 18.4%. Physical (e.g., obesity, sleep apnea, and ulcer) and mental (e.g., depression) health conditions and behavioral factors (e.g., smoking and alcohol consumption) increased the odds of incident poor sleep as compared to normal sleep. The rates of persistent, remitted, and poor sleepers who developed chronic insomnia were 39%, 44%, and 17%, respectively. Risk factors for persistent poor sleep were physical health conditions combined with psychologic distress. Shorter objective sleep duration and a family history of sleep problems were risk factors for poor sleep evolving into chronic insomnia. Conclusions: Poor sleep appears to be primarily a symptom of physical and mental health conditions, whereas the persistence of poor sleep is associated with psychologic distress. Importantly, sleep apnea appears to be associated with incident poor sleep but not with chronic insomnia. Finally, this study suggests that objective short sleep duration in poor sleepers is a biologic marker of genetic predisposition to chronic insomnia. Citation: Fernandez-Mendoza J; Vgontzas AN; Bixler EO; Singareddy R; Shaffer ML; Calhoun SL; Karataraki M; Vela-Bueno A; Liao D. Clinical and polysomnographic predictors of the natural history of poor sleep in the general population. SLEEP 2012;35(5):689-697. PMID:22547895

Reducing sound and light exposure to improve sleep on the adult intensive care unit: An inclusive narrative review.

PubMed

Bion, Victoria; Lowe, Alex Sw; Puthucheary, Zudin; Montgomery, Hugh

2018-05-01

Sleep disturbance is common in intensive care units. It is associated with detrimental psychological impacts and has potential to worsen outcome. Irregular exposure to sound and light may disrupt circadian rhythm and cause frequent arousals from sleep. We sought to review the efficacy of environmental interventions to reduce sound and light exposure with the aim of improving patient sleep on adult intensive care units. We searched both PubMed (1966-30 May 2017) and Embase (1974-30 May 2017) for all relevant human (adult) studies and meta-analyses published in English using search terms ((intensive care OR critical care), AND (sleep OR sleep disorders), AND (light OR noise OR sound)). Bibliographies were explored. Articles were included if reporting change in patient sleep in response to an intervention to reduce disruptive intensive care unit sound /light exposure. Fifteen studies were identified. Nine assessed mechanical interventions, four of which used polysomnography to assess sleep. Five studies looked at environmental measures to facilitate sleep and a further two (one already included as assessing a mechanical intervention) studied the use of sound to promote sleep. Most studies found a positive impact of the intervention on sleep. However, few studies used objective sleep assessments, sample sizes were small, methodologies sometimes imperfect and analysis limited. Data are substantially derived from specialist (neurosurgical, post-operative, cardiothoracic and cardiological) centres. Patients were often at the 'less sick' end of the spectrum in a variety of settings (open ward beds or side rooms). Simple measures to reduce intensive care unit patient sound/light exposure appear effective. However, larger and more inclusive high-quality studies are required in order to identify the measures most effective in different patient groups and any impacts on outcome.

Consistently High Sports/Exercise Activity Is Associated with Better Sleep Quality, Continuity and Depth in Midlife Women: The SWAN Sleep Study

PubMed Central

Kline, Christopher E.; Irish, Leah A.; Krafty, Robert T.; Sternfeld, Barbara; Kravitz, Howard M.; Buysse, Daniel J.; Bromberger, Joyce T.; Dugan, Sheila A.; Hall, Martica H.

2013-01-01

Study Objectives: To examine relationships between different physical activity (PA) domains and sleep, and the influence of consistent PA on sleep, in midlife women. Design: Cross-sectional. Setting: Community-based. Participants: 339 women in the Study of Women's Health Across the Nation Sleep Study (52.1 ± 2.1 y). Interventions: None. Measurements and Results: Sleep was examined using questionnaires, diaries and in-home polysomnography (PSG). PA was assessed in three domains (Active Living, Household/Caregiving, Sports/Exercise) using the Kaiser Physical Activity Survey (KPAS) up to 4 times over 6 years preceding the sleep assessments. The association between recent PA and sleep was evaluated using KPAS scores immediately preceding the sleep assessments. The association between the historical PA pattern and sleep was examined by categorizing PA in each KPAS domain according to its pattern over the 6 years preceding sleep assessments (consistently low, inconsistent/consistently moderate, or consistently high). Greater recent Sports/Exercise activity was associated with better sleep quality (diary “restedness” [P < 0.01]), greater sleep continuity (diary sleep efficiency [SE; P = 0.02]) and depth (higher NREM delta electroencephalographic [EEG] power [P = 0.04], lower NREM beta EEG power [P < 0.05]), and lower odds of insomnia diagnosis (P < 0.05). Consistently high Sports/Exercise activity was also associated with better Pittsburgh Sleep Quality Index scores (P = 0.02) and higher PSG-assessed SE (P < 0.01). Few associations between sleep and Active Living or Household/Caregiving activity (either recent or historical pattern) were noted. Conclusion: Consistently high levels of recreational physical activity, but not lifestyle- or household-related activity, are associated with better sleep in midlife women. Increasing recreational physical activity early in midlife may protect against sleep disturbance in this population. Citation: Kline CE; Irish LA; Krafty RT; Sternfeld B; Kravitz HM; Buysse DJ; Bromberger JT; Dugan SA; Hall MH. Consistently high sports/exercise activity is associated with better sleep quality, continuity and depth in midlife women: the SWAN Sleep Study. SLEEP 2013;36(9):1279-1288. PMID:23997360

Single and Combined Effects of Air, Road, and Rail Traffic Noise on Sleep and Recuperation

PubMed Central

Basner, Mathias; Müller, Uwe; Elmenhorst, Eva-Maria

2011-01-01

Study Objective: Traffic noise disturbs sleep and may impair recuperation. There is limited information on single and combined effects of air, road, and rail traffic noise on sleep and recuperation. Design: Repeated measures. Setting: Polysomnographic laboratory study. Participants: 72 healthy subjects, mean ± standard deviation 40 ± 13 years, range 18-71 years, 32 male. Interventions: Exposure to 40, 80, or 120 rail, road, and/or air traffic noise events. Measurement and Results: Subjects were investigated for 11 consecutive nights, which included 8 noise exposure nights and one noise-free control night. Noise effects on sleep structure and continuity were subtle, even in nights with combined exposure, most likely because of habituation and an increase in arousal thresholds both within and across nights. However, cardiac arousals did not habituate across nights. Noise exposure significantly affected subjective assessments of sleep quality and recuperation, whereas objective performance was unaffected, except for a small increase in mean PVT reaction time (+4 ms, adjusted P < 0.05). Road traffic noise led to the strongest changes in sleep structure and continuity, whereas subjective assessments of sleep were worse after nights with air and rail traffic noise exposure. In contrast to daytime annoyance, cortical arousal probabilities and cardiac responses were significantly lower for air than for road and rail traffic noise (all P < 0.0001). These differences were explained by sound pressure level rise time and high frequency (> 3 kHz) noise event components. Conclusions: Road, rail, and air traffic noise differentially affect objective and subjective assessments of sleep. Differences in the degree of noise-induced sleep fragmentation between traffic modes were explained by the specific spectral and temporal composition of noise events, indicating potential targets for active and passive noise control. Field studies are needed to validate our findings in a setting with higher ecologic validity. Citation: Basner M; Müller U; Elmenhorst EM. Single and combined effects of air, road, and rail traffic noise on sleep and recuperation. SLEEP 2011;34(1):11-23. PMID:21203365

Understanding Sleep Disorders in a College Student Population.

ERIC Educational Resources Information Center

Jensen, Dallas R.

2003-01-01

College students' sleep habits are changing dramatically, and related sleep problems are increasing. Reviews the current literature on sleep problems, focusing on the college student population. The unique challenges of college settings are discussed as they apply to understanding sleep problems, and suggestions are made for professionals who work…

REM Sleep Behavior Disorder and Narcoleptic Features in Anti–Ma2-associated Encephalitis

PubMed Central

Compta, Yaroslau; Iranzo, Alex; Santamaría, Joan; Casamitjana, Roser; Graus, Francesc

2007-01-01

A 69-year-old man with anti-Ma2 paraneoplastic encephalitis presented with subacute onset of severe hypersomnia, memory loss, parkinsonism, and gaze palsy. A brain magnetic resonance imaging study showed bilateral damage in the dorsolateral midbrain, amygdala, and paramedian thalami. Videopolysomnography disclosed rapid eye movement (REM) sleep behavior disorder, and a Multiple Sleep Latency Test showed a mean sleep latency of 7 minutes and 4 sleep-onset REM periods. The level of hypocretin-1 in the cerebrospinal fluid was low (49 pg/mL). This observation illustrates that REM sleep behavior disorder and narcoleptic features are 2 REM-sleep abnormalities that (1) may share the same autoimmune-mediated origin affecting the brainstem, limbic, and diencephalic structures and (2) may occur in the setting of the paraneoplastic anti–Ma2-associated encephalitis. Citation: Compta Y; Iranzo A; Santamaría J et al. REM Sleep Behavior Disorder and Narcoleptic Features in Anti–Ma2-associated Encephalitis. SLEEP 2007;30(6):767-769. PMID:17580598

Sleep duration predicts behavioral and neural differences in adult speech sound learning.

PubMed

Earle, F Sayako; Landi, Nicole; Myers, Emily B

2017-01-01

Sleep is important for memory consolidation and contributes to the formation of new perceptual categories. This study examined sleep as a source of variability in typical learners' ability to form new speech sound categories. We trained monolingual English speakers to identify a set of non-native speech sounds at 8PM, and assessed their ability to identify and discriminate between these sounds immediately after training, and at 8AM on the following day. We tracked sleep duration overnight, and found that light sleep duration predicted gains in identification performance, while total sleep duration predicted gains in discrimination ability. Participants obtained an average of less than 6h of sleep, pointing to the degree of sleep deprivation as a potential factor. Behavioral measures were associated with ERP indexes of neural sensitivity to the learned contrast. These results demonstrate that the relative success in forming new perceptual categories depends on the duration of post-training sleep. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Sleep duration predicts behavioral and neural differences in adult speech sound learning

PubMed Central

Earle, F. Sayako; Landi, Nicole; Myers, Emily B.

2016-01-01

Sleep is important for memory consolidation and contributes to the formation of new perceptual categories. This study examined sleep as a source of variability in typical learners’ ability to form new speech sound categories. We trained monolingual English speakers to identify a set of non-native speech sounds at 8PM, and assessed their ability to identify and discriminate between these sounds immediately after training, and at 8AM on the following day. We tracked sleep duration overnight, and found that light sleep duration predicted gains in identification performance, while total sleep duration predicted gains in discrimination ability. Participants obtained an average of less than 6 hours of sleep, pointing to the degree of sleep deprivation as a potential factor. Behavioral measures were associated with ERP indexes of neural sensitivity to the learned contrast. These results demonstrate that the relative success in forming new perceptual categories depends on the duration of post-training sleep. PMID:27793703

DeepSleepNet: A Model for Automatic Sleep Stage Scoring Based on Raw Single-Channel EEG.

PubMed

Supratak, Akara; Dong, Hao; Wu, Chao; Guo, Yike

2017-11-01

This paper proposes a deep learning model, named DeepSleepNet, for automatic sleep stage scoring based on raw single-channel EEG. Most of the existing methods rely on hand-engineered features, which require prior knowledge of sleep analysis. Only a few of them encode the temporal information, such as transition rules, which is important for identifying the next sleep stages, into the extracted features. In the proposed model, we utilize convolutional neural networks to extract time-invariant features, and bidirectional-long short-term memory to learn transition rules among sleep stages automatically from EEG epochs. We implement a two-step training algorithm to train our model efficiently. We evaluated our model using different single-channel EEGs (F4-EOG (left), Fpz-Cz, and Pz-Oz) from two public sleep data sets, that have different properties (e.g., sampling rate) and scoring standards (AASM and R&K). The results showed that our model achieved similar overall accuracy and macro F1-score (MASS: 86.2%-81.7, Sleep-EDF: 82.0%-76.9) compared with the state-of-the-art methods (MASS: 85.9%-80.5, Sleep-EDF: 78.9%-73.7) on both data sets. This demonstrated that, without changing the model architecture and the training algorithm, our model could automatically learn features for sleep stage scoring from different raw single-channel EEGs from different data sets without utilizing any hand-engineered features.

Geographic distribution of insufficient sleep across the United States: a county-level hotspot analysis.

PubMed

Grandner, Michael A; Smith, Tony E; Jackson, Nicholas; Jackson, Tara; Burgard, Sarah; Branas, Charles

2015-09-01

Insufficient sleep is associated with cardiometabolic risk and neurocognitive impairment. Determinants of insufficient sleep include many social and environmental factors. Assessment of geographic hot/coldspots may uncover novel risk groups and/or targets for public health intervention. The aim of this study was to discern geographic patterns in the first data set to include county-level sleep data. The 2009 Behavioral Risk Factor Surveillance System was used. Insufficient sleep was assessed with a survey item and dichotomized. Data from n = 2231 counties were available. Tests for significant spatial concentrations of high/low levels of insufficient sleep (hotspots/coldspots) used the Getis-Ord G* statistic of local spatial concentration, chosen due to the nature of missing data. Eighty-four counties were hotspots, with high levels of insufficient sleep ( P < .01), and 45 were coldspots, with low insufficient sleep ( P < .01). Hotspots were found in Alabama (1 county), Arkansas (1), Georgia (1), Illinois (1), Kentucky (25), Louisiana (1), Missouri (4), Ohio (7), Tennessee (12), Texas (9), Virginia (6), and West Virginia (16). Coldspots were found in Alabama (1 county), Georgia (2), Illinois (6), Iowa (6), Michigan (2), Minnesota (1), North Carolina (1), Texas (7), Virginia (12), and Wisconsin (6). Several contiguous hotspots and coldspots were evident. Notably, the 17 counties with the highest levels of insufficient sleep were found in a contiguous set at the intersection of Kentucky, Tennessee, Virginia, and West Virginia (all P < .0002). Geographic distribution of insufficient sleep in the United States is uneven. Some areas (most notably parts of Appalachia) experience disproportionately high amounts of insufficient sleep and may be targets of intervention. Further investigation of determinants of geographic variability needs to be explored, which would enhance the utility of these data for development of public health campaigns.

Morning administration of oral methamphetamine dose-dependently disrupts nighttime sleep in recreational stimulant users.

PubMed

Herrmann, Evan S; Johnson, Patrick S; Bruner, Natalie R; Vandrey, Ryan; Johnson, Matthew W

2017-09-01

Use of amphetamine-type stimulants (e.g., methamphetamine) is associated with acute sleep disruptions. No prior reports have characterized the acute effects of methamphetamine on sleep using polysomnography, the gold standard for objective sleep monitoring. Recreational stimulant users (n=19) completed a baseline assessment, which included questionnaires assessing demographic and substance use characteristics, and the Pittsburgh Sleep Quality Index (PSQI), which assesses sleep quality over the past month. Participants were administered 0mg (placebo), 20mg, or 40mg oral methamphetamine at 08:15h on study days, using a double-blind, randomized, within-subjects design. Sleep was monitored using polysomnography from 22:20 that evening until 06:15 the following morning. PSQI scores indicated more than half of participants reported poor sleep quality at baseline. Methamphetamine dose-dependently increased sleep latency, and decreased total sleep time, sleep efficiency, time in NREM 2 sleep, number of REM periods, and total time in REM sleep. Sleep under placebo conditions was consistent with what would be expected from healthy adults. Morning oral administration of methamphetamine produces robust disruptions in nighttime sleep. Future research should examine relations between stimulant use and sleep disruption in naturalistic settings, with regard to both stimulant abuse and licit prescription use. Copyright © 2017. Published by Elsevier B.V.

Sleep characteristics and progression of coronary artery calcification: Results from the Heinz Nixdorf Recall cohort study.

PubMed

Kowall, Bernd; Lehmann, Nils; Mahabadi, Amir-Abbas; Lehnich, Anna-Therese; Moebus, Susanne; Budde, Thomas; Seibel, Rainer; Grönemeyer, Dietrich; Erbel, Raimund; Jöckel, Karl-Heinz; Stang, Andreas

2018-04-01

Sleep characteristics are associated with incident cardiovascular diseases (CVD), but there is a lack of studies on the association between sleep characteristics and incidence/progression of coronary artery calcification (CAC). In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany, CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. In an analysis set of 3043 subjects (age at baseline 45-74 years; 47% men), we fitted logistic and linear regression models to assess associations between self-rated sleep characteristics (nocturnal and total sleep duration; napping; various sleep disorders) and CAC incidence/CAC progression. Progression was measured as 5-year progression factor, as categories of absolute CAC change, and additionally characterized as rapid or slow compared to an extrapolation of baseline CAC values. We observed barely any association between sleep characteristics and CAC progression regardless of the chosen statistical approach; associations between sleep and CAC incidence were slightly larger, e.g., the geometric mean of the 5-year CAC progression factor was 6.8% (95% confidence interval: -9.5; 25.9) larger for ≤5 h, 2.9% (-7.3; 14.3) larger for 5.1-6.9 h and 7.1% (-2.4; 15.7) smaller for ≥7.5 h total sleep compared to 7- <7.5 h total sleep. For subjects with any regular sleep disorder, the geometric mean of the 5-year CAC progression was 3.5% (-4.7; 11.2) smaller compared to subjects without any regular sleep disorder. In this German cohort study, sleep characteristics were barely associated with CAC progression. Copyright © 2018 Elsevier B.V. All rights reserved.

Efficacy of Eight Months of Nightly Zolpidem: A Prospective Placebo-Controlled Study

PubMed Central

Randall, Surilla; Roehrs, Timothy A.; Roth, Thomas

2012-01-01

Study Objectives: To evaluate the long-term (8 months) efficacy of zolpidem in adults with chronic primary insomnia using polysomnography. Design: Randomized, double-blind, placebo-controlled clinical trial. Setting: Sleep disorders and research center. Participants: Healthy participants (n = 91), ages 23-70, meeting DSM-IV-TR criteria for primary insomnia. Interventions: Nightly zolpidem, 10 mg (5 mg for patients > 60 yrs) or placebo 30 minutes before bedtime for 8 months. Measurements and Results: Polysomnographic sleep parameters and morning subject assessments of sleep on 2 nights in months 1 and 8. Relative to placebo, zolpidem significantly increased overall total sleep time and sleep efficiency, reduced sleep latency and wake after sleep onset when assessed at months 1 and 8. Overall, subjective evaluations of efficacy were not shown among treatment groups. Conclusions: In adults with primary insomnia, nightly zolpidem administration remained efficacious across 8 months of nightly use. Clinical Trial Information: ClinicalTrials.gov Identifier: NCT01006525; Trial Name: Safety and Efficacy of Chronic Hypnotic Use; http://clinicaltrials.gov/ct2/show/NCT01006525. Citation: Randall S; Roehrs TA; Roth T. Efficacy of eight months of nightly zolpidem: a prospective placebo-controlled study. SLEEP 2012;35(11):1551-1557. PMID:23115404

Comparison of objective and subjective assessments of sleep time in subjects with bipolar disorder.

PubMed

Gonzalez, R; Tamminga, C; Tohen, M; Suppes, T

2013-07-01

Sleep disturbance is a core feature of bipolar disorder. To date there are a limited number of studies that compare subjective and objective measures of sleep in populations of subjects with mood disorders. This study evaluated the relationship between subjective and objective measurements of total sleep time (TST) in a bipolar type I disorder (BD I) population. Thirty-nine subjects diagnosed with BD I participated in the study. Mood symptoms were assessed via YMRS and IDS-30-C. Subjects wore an actigraph device and maintained a sleep diary for seven consecutive days. Differences between TST as estimated via sleep diaries and actigraphy were calculated. Objective and subjective measures of TST were significantly correlated (r=0.5151, p=0.0008). Secondary analysis revealed that the severity of depressive symptoms did correlate to this discrepancy (t=2.65, p=0.01). The impact that medications have on the accuracy of TST reported was not investigated. Also, sleep diaries may have acted to prompt subjects to pay closer attention to their sleep habits and therefore more accurately report TST than in the average clinical setting. The results of the current study demonstrate a significant correlation between the estimation of TST as measured objectively via actigraphy and subjectively via sleep diaries in BD patients. Mood symptomotology might impact the accuracy of TST reported. Further study is warranted. Copyright © 2013 Elsevier B.V. All rights reserved.

Delayed Sleep Phase Disorder In Temporal Isolation

PubMed Central

Campbell, Scott S.; Murphy, Patricia J.

2007-01-01

Study Objectives: This study sought to characterize sleep and the circadian rhythm of body core temperature of an individual with delayed sleep phase disorder (DSPD) in the absence of temporal cues and social entrainment and to compare those measures to age-matched normal control subjects studied under identical conditions. Design: Polysomnography and body temperature were recorded continuously for 4 days in entrained conditions, followed immediately by 17 days in a “free-running” environment. Setting: Temporal isolation facility in the Laboratory of Human Chronobiology, Weill Cornell Medical College. Participants: One individual who met criteria for delayed sleep phase disorder according to the International Classification of Sleep Disorders Diagnostic and Coding Manual (ICSD-2) and 3 age-matched control subjects. Interventions: None. Measurements and Results: The DSPD subject had a spontaneous period length (tau) of 25.38 hours compared to an average tau of 24.44 hours for the healthy controls. The DSPD subject also showed an altered phase relationship between sleep/wake and body temperature rhythms, as well as longer sleep latency, poorer sleep efficiency, and altered distribution of slow wave sleep (SWS) within sleep episodes, compared to control subjects. Conclusions: Delayed sleep phase disorder may be the reflection of an abnormal circadian timing system characterized not only by a long tau, but also by an altered internal phase relationship between the sleep/wake system and the circadian rhythm of body temperature. The latter results in significantly disturbed sleep, even when DSPD patients are permitted to sleep and wake at their preferred times. Citation: Campbell SS; Murphy PJ. Delayed sleep phase disorder in temporal isolation. SLEEP 2007;30(9):1225-1228. PMID:17910395

Combining Human Epigenetics and Sleep Studies in Caenorhabditis elegans: A Cross-Species Approach for Finding Conserved Genes Regulating Sleep.

PubMed

Huang, Huiyan; Zhu, Yong; Eliot, Melissa N; Knopik, Valerie S; McGeary, John E; Carskadon, Mary A; Hart, Anne C

2017-06-01

We aimed to test a combined approach to identify conserved genes regulating sleep and to explore the association between DNA methylation and sleep length. We identified candidate genes associated with shorter versus longer sleep duration in college students based on DNA methylation using Illumina Infinium HumanMethylation450 BeadChip arrays. Orthologous genes in Caenorhabditis elegans were identified, and we examined whether their loss of function affected C. elegans sleep. For genes whose perturbation affected C. elegans sleep, we subsequently undertook a small pilot study to re-examine DNA methylation in an independent set of human participants with shorter versus longer sleep durations. Eighty-seven out of 485,577 CpG sites had significant differential methylation in young adults with shorter versus longer sleep duration, corresponding to 52 candidate genes. We identified 34 C. elegans orthologs, including NPY/flp-18 and flp-21, which are known to affect sleep. Loss of five additional genes alters developmentally timed C. elegans sleep (B4GALT6/bre-4, DOCK180/ced-5, GNB2L1/rack-1, PTPRN2/ida-1, ZFYVE28/lst-2). For one of these genes, ZFYVE28 (also known as hLst2), the pilot replication study again found decreased DNA methylation associated with shorter sleep duration at the same two CpG sites in the first intron of ZFYVE28. Using an approach that combines human epigenetics and C. elegans sleep studies, we identified five genes that play previously unidentified roles in C. elegans sleep. We suggest sleep duration in humans may be associated with differential DNA methylation at specific sites and that the conserved genes identified here likely play roles in C. elegans sleep and in other species. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Sleep assessment by patients and nurses in the intensive care: An exploratory descriptive study.

PubMed

Aitken, Leanne M; Elliott, Rosalind; Mitchell, Marion; Davis, Chelsea; Macfarlane, Bonnie; Ullman, Amanda; Wetzig, Krista; Datt, Ashika; McKinley, Sharon

2017-03-01

Sleep disruption is common in intensive care unit (ICU) patients, with reports indicating reduced quality and quantity of sleep in many patients. There is growing evidence that sleep in this setting may be improved. To describe ICU patients' self-report assessment of sleep, examine the relationship between patients' self-reported sleep and their reported sleep by the bedside nurse, and describe the strategies suggested by patients to promote sleep. An exploratory descriptive study was undertaken with communicative adult patients consecutively recruited in 2014-2015. Patients reported sleep using the Richards-Campbell Sleep Questionnaire (score range 0-100mm; higher score indicates better sleep quality), with nursing assessment of sleep documented across a five level ordinal variable. Patients were asked daily to describe strategies that helped or hindered their sleep. Ethical approval for the study was gained. Descriptive statistical analysis was performed [median (interquartile range)]; relationships were tested using Spearman's rank correlation and differences assessed using the Kruskal-Wallis test; p<0.05 was considered significant. Participants (n=151) were recruited [age: 60 (46-71) years; ICU length of stay 4 (2-9) days] with 356 self-reports of sleep. Median perceived sleep quality was 46 (26-65) mm. A moderate relationship existed between patients' self-assessment and nurses' assessment of sleep (Spearman's rank correlation coefficient 0.39-0.50; p<0.001). Strategies identified by patients to improve sleep included adequate pain relief and sedative medication, a peaceful and comfortable environment and physical interventions, e.g. clustering care, ear plugs. Patients reported on their sleep a median of 2 (1-3) days during their ICU stay, suggesting that routine use of self-report was feasible. These reports revealed low sleep quality. Patients reported multiple facilitators and barriers for sleep, with environmental and patient comfort factors being most common. Interventions that target these factors to improve patient sleep should be implemented. Copyright © 2016 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Effects of a Single Night of Postpartum Sleep on Childless Women’s Daytime Functioning

PubMed Central

McBean, Amanda L.; Kinsey, Steven G.; Montgomery-Downs, Hawley E.

2017-01-01

Study Objectives The maternal postpartum period is characterized by sleep fragmentation, which is associated with daytime impairment, mental health disturbances, and changes in melatonin patterns. In addition to sleep fragmentation, women undergo a complex set of physiological and environmental changes upon entering the postpartum period, confounding our understanding of effects of postpartum sleep disturbance. The primary study aim was to understand the basic impact of a single night of postpartum-like sleep fragmentation on sleep architecture, nocturnal melatonin levels, mood, daytime sleepiness, and neurobehavioral performance. Measurements and Results For one week prior to entry into the laboratory, eleven healthy nulliparous women kept a stable sleep-wake schedule (verified via actigraphy). Participants contributed three consecutive nights of laboratory overnight polysomnography: (1) a habituation/sleep disorder screening night; (2) a baseline night; and (3) a sleep fragmentation night, when participants were awakened three times for ~30 min each. Self-reported sleep quality and mood (Profile of Mood States Survey) both decreased significantly after sleep fragmentation compared to baseline measurements. Unexpectedly, daytime sleepiness (Multiple Sleep Latency Test) decreased significantly after sleep fragmentation. Experimental fragmentation had no significant effect on time spent in nocturnal sleep stages, urinary 6-sulphatoxymelatonin concentration, or psychomotor vigilance test performance. Participants continued to provide actigraphy data, and daily PVTs and self-reported sleep quality assessments at home for one week following sleep fragmentation; these assessments did not differ from baseline values. Conclusions While there were no changes in measured physiological components of a single night of postpartum-like experimental sleep fragmentation, there were decreases in self-reported measures of mood and sleep quality. Future research should examine the effects of multiple nights of modeling postpartum-like sleep fragmentation on objective measures of sleep and daytime functioning. PMID:26776447

The relationship between micronutrient status and sleep patterns: a systematic review

PubMed Central

Ji, Xiaopeng; Grandner, Michael A; Liu, Jianghong

2017-01-01

Objective To review articles on the relationship of dietary and circulating micronutrients with sleep patterns, and to identify issues surrounding implications for future research and public health practice. Design A systematic review was conducted. PubMed, Embase and Scopus were searched through January 2016. Setting Both experimental and observational studies were included. However, studies that focused on secondary sleep impairment due to comorbidities were excluded. Subjects Individuals in different age groups, from infants to older adults. Results A total of twenty-six articles were selected. In the articles reviewed, researchers generally supported a potential role of micronutrients, particularly Fe and Mg, in the development of sleep stages among infants and in reversing age-related alterations in sleep architecture in older adults. Micronutrient status has also been linked to sleep duration, with sleep duration positively associated with Fe, Zn and Mg levels, and negatively associated with Cu, K and vitamin B12 levels. The mechanisms underlying these relationships include the impact of micronutrients on excitatory/inhibitory neurotransmitters and the expression of circadian genes. Conclusions Although the number of studies on the relationship between micronutrient status and sleep remains low, evidence has emerged that suggests a link between dietary/circulating micronutrients and sleep. Future research is needed to investigate the dose-dependent as well as the longitudinal relationships between micronutrient levels and human sleep across populations, test the interactions among micronutrients on sleep outcomes, and ultimately examine the clinical relevance of micronutrients on sleep health. PMID:27702409

Napping Reverses Increased Pain Sensitivity Due to Sleep Restriction

PubMed Central

Faraut, Brice; Léger, Damien; Medkour, Terkia; Dubois, Alexandre; Bayon, Virginie; Chennaoui, Mounir; Perrot, Serge

2015-01-01

Study Objective To investigate pain sensitivity after sleep restriction and the restorative effect of napping. Design A strictly controlled randomized crossover study with continuous polysomnography monitoring was performed. Setting Laboratory-based study. Participants 11 healthy male volunteers. Interventions Volunteers attended two three-day sessions: “sleep restriction” alone and “sleep restriction and nap”. Each session involved a baseline night of normal sleep, a night of sleep deprivation and a night of free recovery sleep. Participants were allowed to sleep only from 02:00 to 04:00 during the sleep deprivation night. During the “sleep restriction and nap” session, volunteers took two 30-minute naps, one in the morning and one in the afternoon. Measurements and Results Quantitative sensory testing was performed with heat, cold and pressure, at 10:00 and 16:00, on three areas: the supraspinatus, lower back and thigh. After sleep restriction, quantitative sensory testing revealed differential changes in pain stimuli thresholds, but not in thermal threshold detection: lower back heat pain threshold decreased, pressure pain threshold increased in the supraspinatus area and no change was observed for the thigh. Napping restored responses to heat pain stimuli in the lower back and to pressure stimuli in the supraspinatus area. Conclusions Sleep restriction induces different types of hypersensitivity to pain stimuli in different body areas, consistent with multilevel mechanisms, these changes being reversed by napping. The napping restorative effect on pain thresholds result principally from effects on pain mechanisms, since it was independent of vigilance status. PMID:25723495

Effects of unconditioned stimulus intensity and fear extinction on subsequent sleep architecture in an afternoon nap.

PubMed

Sturm, Anna; Czisch, Michael; Spoormaker, Victor I

2013-12-01

Impaired fear extinction and disturbed sleep coincide in post-traumatic stress disorder (PTSD), but the nature of this relationship is unclear. Rapid eye movement (REM) sleep deprivation impairs fear extinction recall in rodents and young healthy subjects, and animal models have demonstrated both disrupted sleep after fear conditioning and normalized sleep after extinction learning. As a correlation between unconditioned stimulus (US) responding and subsequent sleep architecture has been observed in healthy subjects, the goal of this study was to test whether US intensity would causally affect subsequent sleep. Twenty-four young healthy subjects underwent a fear conditioning session with skin conductance response measurements before an afternoon session of polysomnographically recorded sleep (up to 120 min) in the sleep laboratory. Two factors were manipulated experimentally in a 2 × 2 design: US (electrical shock) was set at high or low intensity, and subjects did or did not receive an extinction session after fear conditioning. We observed that neither factor affected REM sleep amount, that high US intensity nominally increased sleep fragmentation (more Stage 1 sleep, stage shifts and wake after sleep onset), and that extinction increased Stage 4 amount. Moreover, reduced Stage 1 and increased Stage 4 and REM sleep were associated with subjective sleep quality of the afternoon nap. These results provide evidence for the notion that US intensity and extinction affect subsequent sleep architecture in young healthy subjects, which may provide a translational bridge from findings in animal studies to correlations observed in PTSD patients. © 2013 European Sleep Research Society.

How do we know when patients sleep properly or why they do not?

PubMed

Sjöberg, Folke; Svanborg, Eva

2013-05-15

The importance of adequate sleep for good health and immune system function is well documented as is reduced sleep quality experienced by ICU patients. In the previous issue of Critical Care, Elliot and co-workers present a well done, largest of its kind, single-center study on sleep patterns in critically ill patients. They base their study on the 'gold standard', the polysomnography technique, which is resource demanding to perform and often difficult to evaluate. The results are especially interesting as the authors not only used polysomnography in a large sample but also, in contrast to others, excluded patients with prior sleep problems. They also recorded patients' subjective sleep experiences in the ICU and thereafter in the ward (validated questionnaires) with simultaneous data collection of factors known to affect sleep in the ICU (mainly treatment interventions, light and sound disturbances). Interestingly, but not surprisingly, sleep was both quantitatively and qualitatively poor. Furthermore, there seemed to be little or no improvement over time when compared to earlier studies. This study stresses the magnitude of the sleep problem despite interventions such as earplugs and/or eyeshades. Sound disturbance was found to be the most significant but improvable factor. The study highlights the challenge and the importance of evaluating sleep in the critical care setting and the present need for alternative methods to measure it. All that in conjunction can be used to solve an important problem for this patient group.

Sleep Impairment and Prognosis of Acute Myocardial Infarction: A Prospective Cohort Study

PubMed Central

Clark, Alice; Lange, Theis; Hallqvist, Johan; Jennum, Poul; Rod, Naja Hulvej

2014-01-01

Study Objectives: Impaired sleep is an established risk factor for the development of cardiovascular disease, whereas less is known about how impaired sleep affects cardiovascular prognosis. The aim of this study is to determine how different aspects of impaired sleep affect the risk of case fatality and subsequent cardiovascular events following first-time acute myocardial infarction (AMI). Design: Prospective cohort study. Setting: The Stockholm Heart Epidemiology Program, Sweden. Participants: There were 2,246 first-time AMI cases. Measurements and Results: Sleep impairment was assessed by the Karolina Sleep Questionnaire, which covers various indices of impaired sleep: disturbed sleep, impaired awakening, daytime sleepiness, and nightmares. Case fatality, defined as death within 28 days of initial AMI, and new cardiovascular events within up to 10 y of follow-up were identified through national registries. In women, disturbed sleep showed a consistently higher risk of long-term cardiovascular events: AMI (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 0.95–3.00), stroke (HR = 2.61; 95% CI: 1.19–5.76), and heart failure (HR = 2.43; 95% CI: 1.18–4.97), whereas no clear effect of impaired sleep on case fatality was found in women. In men, a strong effect on case fatality (odds ratio = 3.27; 95% CI: 1.76–6.06) was observed in regard to impaired awakening; however, no consistent effect of impaired sleep was seen on long-term cardiovascular prognosis. Conclusion: Results suggest sex-specific effects of impaired sleep that differ by short- and long-term prognosis. Sleep complaints are frequent, easily recognizable, and potentially manageable. Evaluation of sleep complaints may, even if they represent prognostic markers rather than risk factors, provide additional information in clinical risk assessment that could benefit secondary cardiovascular prevention. Citation: Clark A, Lange T, Hallqvist J, Jennum P, Rod NH. Sleep impairment and prognosis of acute myocardial infarction: a prospective cohort study. SLEEP 2014;37(5):851-858. PMID:24790263

Pairwise measures of causal direction in the epidemiology of sleep problems and depression.

PubMed

Rosenström, Tom; Jokela, Markus; Puttonen, Sampsa; Hintsanen, Mirka; Pulkki-Råback, Laura; Viikari, Jorma S; Raitakari, Olli T; Keltikangas-Järvinen, Liisa

2012-01-01

Depressive mood is often preceded by sleep problems, suggesting that they increase the risk of depression. Sleep problems can also reflect prodromal symptom of depression, thus temporal precedence alone is insufficient to confirm causality. The authors applied recently introduced statistical causal-discovery algorithms that can estimate causality from cross-sectional samples in order to infer the direction of causality between the two sets of symptoms from a novel perspective. Two common-population samples were used; one from the Young Finns study (690 men and 997 women, average age 37.7 years, range 30-45), and another from the Wisconsin Longitudinal study (3101 men and 3539 women, average age 53.1 years, range 52-55). These included three depression questionnaires (two in Young Finns data) and two sleep problem questionnaires. Three different causality estimates were constructed for each data set, tested in a benchmark data with a (practically) known causality, and tested for assumption violations using simulated data. Causality algorithms performed well in the benchmark data and simulations, and a prediction was drawn for future empirical studies to confirm: for minor depression/dysphoria, sleep problems cause significantly more dysphoria than dysphoria causes sleep problems. The situation may change as depression becomes more severe, or more severe levels of symptoms are evaluated; also, artefacts due to severe depression being less well presented in the population data than minor depression may intervene the estimation for depression scales that emphasize severe symptoms. The findings are consistent with other emerging epidemiological and biological evidence.

Longitudinal Evaluation of Sleep-Disordered Breathing and Sleep Symptoms with Change in Quality of Life: The Sleep Heart Health Study (SHHS)

PubMed Central

Silva, Graciela E.; An, Ming-Wen; Goodwin, James L.; Shahar, Eyal; Redline, Susan; Resnick, Helaine; Baldwin, Carol M.; Quan, Stuart F.

2009-01-01

Study Objectives: Findings from population studies evaluating the progression and incidence of sleep disordered breathing have shown evidence of a longitudinal increase in the severity of sleep disordered breathing. The present study evaluates the association among changes in sleep disordered breathing, sleep symptoms, and quality of life over time. Design: Prospective cohort study. Data were from the Sleep Heart Health Study. Setting: Multicenter study. Participants: Three thousand seventy-eight subjects aged 40 years and older from the baseline and follow-up examination cycles were included. Measurements: The primary outcomes were changes in the Physical Component Summary and Mental Component Summary scales obtained from the Medical Outcomes Study Short-Form Health Survey. The primary exposure was change in the respiratory disturbance index obtained from unattended overnight polysomnograms performed approximately 5 years apart. Other covariates included measures of excessive daytime sleepiness and difficulty initiating and maintaining sleep. Results: Mean respiratory disturbance index increased from 8.1 ± 11 SD at baseline to 10.9 ± 14 (P < 0.0001) at follow-up. The mean Physical Component Summary and Mental Component Summary scores were 48.5 and 54.1 at baseline and 46.3 and 54.8 at follow-up. No associations between change in respiratory disturbance index and changes in Physical Component Summary or Mental Component Summary scores were seen. However, worsening of difficulty initiating and maintaining sleep and excessive daytime sleepiness were significantly associated with lower quality of life. Conclusions: A slight increase in severity of sleep disordered breathing was seen over 5 years; this was not associated with worsening of quality of life. However, subjective symptoms of quality of sleep and daytime sleepiness were associated with declining quality of life. Citation: Silva GE; An MW; Goodwin JL; Shahar E; Redline S; Resnick H; Baldwin CM; Quan SF. Longitudinal evaluation of sleep-disordered breathing and sleep symptoms with change in quality of life: the Sleep Heart Health Study (SHHS). SLEEP 2009;32(8):1049-1057. PMID:19725256

Patient Aggression and the Wellbeing of Nurses: A Cross-Sectional Survey Study in Psychiatric and Non-Psychiatric Settings.

PubMed

Pekurinen, Virve; Willman, Laura; Virtanen, Marianna; Kivimäki, Mika; Vahtera, Jussi; Välimäki, Maritta

2017-10-18

Wellbeing of nurses is associated with patient aggression. Little is known about the differences in these associations between nurses working in different specialties. We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non-psychiatric specialties (medical and surgical, and emergency medicine). A sample of 5288 nurses (923 psychiatric nurses, 4070 medical and surgical nurses, 295 emergency nurses) participated in the study. Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychological distress and perceived work ability). Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses. Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses, whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work ability more frequently than both of the non-psychiatric nursing groups, whereas medical and surgical nurses reported psychological distress and sleep disturbances more often. Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year, were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings. Compared to medical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types of aggression are more common in emergency settings. Psychiatric nurses have worse subjective health and work ability than both of the non-psychiatric nursing groups, while their psychiatric wellbeing is better and they have less sleep problems compared to medical and surgical nurses. Psychiatric nurses maintain better psychiatric wellbeing and experience fewer sleep problems than non-psychiatric nurses after events of exposure to patient aggression. This suggest that more attention should be given to non-psychiatric settings for maintaining the wellbeing of nurses after exposure to patient aggression.

Arvicanthis ansorgei, a Novel Model for the Study of Sleep and Waking in Diurnal Rodents

PubMed Central

Hubbard, Jeffrey; Ruppert, Elisabeth; Calvel, Laurent; Robin-Choteau, Ludivine; Gropp, Claire-Marie; Allemann, Caroline; Reibel, Sophie; Sage-Ciocca, Dominique; Bourgin, Patrice

2015-01-01

Study Objectives: Sleep neurobiology studies use nocturnal species, mainly rats and mice. However, because their daily sleep/wake organization is inverted as compared to humans, a diurnal model for sleep studies is needed. To fill this gap, we phenotyped sleep and waking in Arvicanthis ansorgei, a diurnal rodent widely used for the study of circadian rhythms. Design: Video-electroencephalogram (EEG), electromyogram (EMG), and electrooculogram (EOG) recordings. Setting: Rodent sleep laboratory. Participants: Fourteen male Arvicanthis ansorgei, aged 3 mo. Interventions: 12 h light (L):12 h dark (D) baseline condition, 24-h constant darkness, 6-h sleep deprivation. Measurements and Results: Wake and rapid eye movement (REM) sleep showed similar electrophysiological characteristics as nocturnal rodents. On average, animals spent 12.9 h ± 0.4 awake per 24-h cycle, of which 6.88 h ± 0.3 was during the light period. NREM sleep accounted for 9.63 h ± 0.4, which of 5.13 h ± 0.2 during dark period, and REM sleep for 89.9 min ± 6.7, which of 52.8 min ± 4.4 during dark period. The time-course of sleep and waking across the 12 h light:12 h dark was overall inverted to that observed in rats or mice, though with larger amounts of crepuscular activity at light and dark transitions. A dominant crepuscular regulation of sleep and waking persisted under constant darkness, showing the lack of a strong circadian drive in the absence of clock reinforcement by external cues, such as a running wheel. Conservation of the homeostatic regulation was confirmed with the observation of higher delta power following sustained waking periods and a 6-h sleep deprivation, with subsequent decrease during recovery sleep. Conclusions: Arvicanthis ansorgei is a valid diurnal rodent model for studying the regulatory mechanisms of sleep and so represents a valuable tool for further understanding the nocturnality/diurnality switch. Citation: Hubbard J, Ruppert E, Calvel L, Robin-Choteau L, Gropp CM, Allemann C, Reibel S, Sage-Ciocca D, Bourgin P. Arvicanthis ansorgei, a novel model for the study of sleep and waking in diurnal rodents. SLEEP 2015;38(6):979–988. PMID:25409107

Restless pillow, ruffled mind: sleep and affect coupling in interepisode bipolar disorder.

PubMed

Gershon, Anda; Thompson, Wesley K; Eidelman, Polina; McGlinchey, Eleanor L; Kaplan, Katherine A; Harvey, Allison G

2012-11-01

Disturbances in sleep and affect are prominent features of bipolar disorder, even during interepisode periods. Few longitudinal studies have prospectively examined the relationship between naturally occurring sleep and affect, and no studies to date have done so during interepisode periods of bipolar disorder and using the entire set of "gold standard" sleep parameters. Participants diagnosed with bipolar I disorder who were interepisode (n = 32) and healthy controls (n = 36) completed diagnostic and symptom severity interviews, and a daily sleep and affect diary, as well as an actigraphy sleep assessment, for eight weeks (M = 54 days, ± 8 days). Mutual information analysis was used to assess the degree of statistical dependence, or coupling, between time series data of sleep and affect. As measured by actigraphy, longer sleep onset latency was coupled with higher negative affect more strongly in the bipolar group than in the control group. As measured by sleep diary, longer wakefulness after sleep onset and lower sleep efficiency were coupled with higher negative affect significantly more strongly in the bipolar group than in the control group. By contrast, there were no significant differences between groups in the degree of coupling between any measures of sleep and positive affect. Findings support the coupling of sleep disturbance and negative affect during interepisode bipolar disorder. Ongoing monitoring of sleep-affect coupling may provide an important target for intervention in bipolar disorder. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Older men's experiences of sleep in the hospital.

PubMed

Lee, Chau Yuen; Low, Lisa Pau Le; Twinn, Sheila

2007-02-01

The aim of this study was to examine the sleep experiences of older patients during a period of hospitalization on an extended care ward. Hospital wards have been demonstrated as environments that are not conducive to sleep for patients. Findings highlight the difficulties of falling asleep and getting insufficient sleep as the major causes of sleep disturbances. Such studies limit themselves to patients of Intensive Care Units and acute care settings. Relatively little is known about understanding the sleep experiences of older patients whilst hospitalized on extended care wards. An exploratory qualitative design was used with a convenience sample of six Chinese male informants, recruited from an extended care ward of a Rehabilitation Hospital in Hong Kong. Multiple data collection methods were used, including repeated semi-structured interviews and a one-week sleep diary. The findings demonstrated that all informants experienced dynamic changes in their sleeping patterns during hospitalization, resulting in sleep disruption and deprivation. The public nature of the ward environment and perceived sense of helplessness significantly interfered with sleep. Some cultural beliefs and practices were perceived by older patients to be associated with the quality of their sleep experiences. The findings contributed to an understanding of the sleep experiences of older patients during hospitalization. Implications for nursing practice indicate the significance of including focused sleep assessment of patients during admission into the ward, so strategies perceived by older patients as being able to improve sleep would be included as part of the usual ward routine and nursing practice, where possible.

Association between Sleep Duration and Measurable Cardiometabolic Risk Factors in Healthy Korean Women: The Fourth and Fifth Korean National Health and Nutrition Examination Surveys (KNHANES IV and V)

PubMed Central

Min, Hyeyeon; Um, Yoo Jin; Jang, Bum Sup; Shin, Doosup; Choi, EunJoo

2016-01-01

Study Objectives. To examine the association between sleep duration and prevalence of metabolic syndrome (MetS) and its components in healthy Korean women. Design. Cross-sectional study, using the Fourth and Fifth Korean National Health and Nutrition Examination Surveys. Methods. Among 8505 women (25–70 years) from KNHANES IV and V, participants were classified into five sleep groups based on self-reported sleep duration. MetS and its components were defined using the criteria set forth in National Cholesterol Education Program-Adult Treatment Panel III. We used multivariate logistic regression analysis. Results. After adjusting for various confounders, shorter sleep duration (≤6 h) was found to have an association with low risk of reduced high-density lipoprotein cholesterol and increased triglycerides, whereas very long sleep duration was found to have high risk of increased triglycerides. However, abdominal obesity showed an opposite trend: short sleep duration was associated with higher risk of abdominal obesity than long sleep duration. Fasting glucose levels increased as sleep duration increased, but without significance. Moreover, blood pressure was not significantly associated with sleep duration. Consequently, MetS was less prevalent in those with short sleep duration. Conclusions. Sleep duration was positively associated with MetS, especially dyslipidemia and fasting hyperglycemia, but inversely associated with abdominal obesity. PMID:27956898

Outpatient treatment of sleep disorders in Alzheimer patients

PubMed Central

Scoralick, Francisca Magalhães; Camargos, Einstein Francisco; Freitas, Marco Polo Dias; Nóbrega, Otávio Toledo

2015-01-01

Sleep disorders are common in patients with Alzheimer dementia and affect the quality of life of patients and of their caregivers. Despite the rising number of studies in the area, almost all of them are about non-pharmacological treatment. Our objective was to review the literature concerning pharmacological and non-pharmacological approaches to treat sleep disorders of elderly patients with Alzheimer dementia in the ambulatory setting. The treatments revised consisted of sleep hygiene and/or use of intense light coupled or not with use of melatonin, cholinesterase inhibitors, antipsychotics, hypnotics or antidepressants. In addition to the non-pharmacological measures, there is evidence that the use of trazodone may aid the treatment of sleep disorders of older individuals with Alzheimer dementia. More studies are necessary to examine the non-pharmacological and pharmacological treatments revised herein. PMID:25946052

Polysomnographic Abnormalities in Succinic Semialdehyde Dehydrogenase (SSADH) Deficiency

PubMed Central

Pearl, Phillip L.; Shamim, Sadat; Theodore, William H.; Gibson, K. Michael; Forester, Katherine; Combs, Susan E.; Lewin, Daniel; Dustin, Irene; Reeves-Tyer, Patricia; Jakobs, Cornelis; Sato, Susumu

2009-01-01

Objectives: Patients with SSADH deficiency, a disorder of chronically elevated endogenous GABA and GHB, were studied for sleep symptoms and polysomnography. We hypothesized that patients would have excessive daytime somnolence and decreased REM sleep. Design: Polysomnography and MSLT were performed on patients enrolled for comprehensive clinical studies of SSADH deficiency. Setting: Sleep studies were obtained in the sleep laboratories at CNMC and NIH. Patients: Sleep recordings were obtained in 10 patients with confirmed SSADH deficiency. Interventions: Thirteen overnight polysomnograms were obtained in 10 patients (7 male, 3 female, ages 11-27 y). Eleven MSLT studies were completed in 8 patients. Measurements and Results: Polysomnograms showed prolongation of REM stage latency (mean 272 ± 89 min) and decreased percent stage REM (mean 8.9%, range 0.3% to 13.8%). Decreased mean sleep latency was present in 6 of 11 MSLTs. Conclusions: SSADH deficiency is associated with prolonged latency to stage REM and decreased percent stage REM. This disorder represents a model of chronic GABA and GHB accumulation associated with suppression of REM sleep. Citation: Pearl PL; Shamim S; Theodore WH; Gibson M; Forester K; Combs SE; Lewin D; Dustin I; Reeves P; Jakobs C; Sato S. Polysomnographic abnormalities in succinic semialdehyde dehydrogenase (SSADH) deficiency. SLEEP 2009;32(12):1645-1648. PMID:20041601

The effects of two types of sleep deprivation on visual working memory capacity and filtering efficiency.

PubMed

Drummond, Sean P A; Anderson, Dane E; Straus, Laura D; Vogel, Edward K; Perez, Veronica B

2012-01-01

Sleep deprivation has adverse consequences for a variety of cognitive functions. The exact effects of sleep deprivation, though, are dependent upon the cognitive process examined. Within working memory, for example, some component processes are more vulnerable to sleep deprivation than others. Additionally, the differential impacts on cognition of different types of sleep deprivation have not been well studied. The aim of this study was to examine the effects of one night of total sleep deprivation and 4 nights of partial sleep deprivation (4 hours in bed/night) on two components of visual working memory: capacity and filtering efficiency. Forty-four healthy young adults were randomly assigned to one of the two sleep deprivation conditions. All participants were studied: 1) in a well-rested condition (following 6 nights of 9 hours in bed/night); and 2) following sleep deprivation, in a counter-balanced order. Visual working memory testing consisted of two related tasks. The first measured visual working memory capacity and the second measured the ability to ignore distractor stimuli in a visual scene (filtering efficiency). Results showed neither type of sleep deprivation reduced visual working memory capacity. Partial sleep deprivation also generally did not change filtering efficiency. Total sleep deprivation, on the other hand, did impair performance in the filtering task. These results suggest components of visual working memory are differentially vulnerable to the effects of sleep deprivation, and different types of sleep deprivation impact visual working memory to different degrees. Such findings have implications for operational settings where individuals may need to perform with inadequate sleep and whose jobs involve receiving an array of visual information and discriminating the relevant from the irrelevant prior to making decisions or taking actions (e.g., baggage screeners, air traffic controllers, military personnel, health care providers).

Switch-Task Performance in Rats Is Disturbed by 12 h of Sleep Deprivation But Not by 12 h of Sleep Fragmentation

PubMed Central

Leenaars, Cathalijn H.C.; Joosten, Ruud N.J.M.A.; Zwart, Allard; Sandberg, Hans; Ruimschotel, Emma; Hanegraaf, Maaike A.J.; Dematteis, Maurice; Feenstra, Matthijs G.P.; van Someren, Eus J.W.

2012-01-01

Study Objectives: Task-switching is an executive function involving the prefrontal cortex. Switching temporarily attenuates the speed and/or accuracy of performance, phenomena referred to as switch costs. In accordance with the idea that prefrontal function is particularly sensitive to sleep loss, switch-costs increase during prolonged waking in humans. It has been difficult to investigate the underlying neurobiological mechanisms because of the lack of a suitable animal model. Here, we introduce the first switch-task for rats and report the effects of sleep deprivation and inactivation of the medial prefrontal cortex. Design: Rats were trained to repeatedly switch between 2 stimulus-response associations, indicated by the presentation of a visual or an auditory stimulus. These stimulus-response associations were offered in blocks, and performance was compared for the first and fifth trials of each block. Performance was tested after exposure to 12 h of total sleep deprivation, sleep fragmentation, and their respective movement control conditions. Finally, it was tested after pharmacological inactivation of the medial prefrontal cortex. Settings: Controlled laboratory settings. Participants: 15 male Wistar rats. Measurements & Results: Both accuracy and latency showed switch-costs at baseline. Twelve hours of total sleep deprivation, but not sleep fragmentation, impaired accuracy selectively on the switch-trials. Inactivation of the medial prefrontal cortex by local neuronal inactivation resulted in an overall decrease in accuracy. Conclusions: We developed and validated a switch-task that is sensitive to sleep deprivation. This introduces the possibility for in-depth investigations on the neurobiological mechanisms underlying executive impairments after sleep disturbance in a rat model. Citation: Leenaars CHC; Joosten RNJMA; Zwart A; Sandberg H; Ruimschotel E; Hanegraaf MAJ; Dematteis M; Feenstra MGP; van Someren EJW. Switch-task performance in rats is disturbed by 12 h of sleep deprivation but not by 12 h of sleep fragmentation. SLEEP 2012;35(2):211-221. PMID:22294811

Sleep Increases Explicit Solutions and Reduces Intuitive Judgments of Semantic Coherence

ERIC Educational Resources Information Center

Zander, Thea; Volz, Kirsten G.; Born, Jan; Diekelmann, Susanne

2017-01-01

Sleep fosters the generation of explicit knowledge. Whether sleep also benefits implicit intuitive decisions about underlying patterns is unclear. We examined sleep's role in explicit and intuitive semantic coherence judgments. Participants encoded sets of three words and after a sleep or wake period were required to judge the potential…

Early pathology in sleep studies of patients with familial Creutzfeldt-Jakob disease.

PubMed

Givaty, Gili; Maggio, Nicola; Cohen, Oren S; Blatt, Ilan; Chapman, Joab

2016-10-01

In this study, we aimed to assess sleep function in patients with recent-onset familial Creutzfeldt-Jakob disease (fCJD). The largest cluster of fCJD patients is found in Jews of Libyan origin, linked to the prion protein gene (PRNP) E200K mutation. The high index of suspicion in these patients often leads to early diagnosis, with complaints of insomnia being a very common presenting symptom of the disease. The study included 10 fCJD patients diagnosed by clinical manifestations, magnetic resonance imaging (MRI) scan of the brain, elevated tau protein in the cerebrospinal fluid (CSF) and positive PRNP E200K mutation. Standard polysomnography was performed after a brief interview confirming the presence of sleep disturbances. All patients showed a pathological sleep pattern according to all scoring evaluation settings. The sleep stages were characterized by (i) disappearance of sleep spindles; (ii) outbursts of periodic sharp waves and shallowing of sleep consisting in increased Stage 2 and wake periods during the night, as well as decrease of slow-wave sleep and rapid eye movement (REM) sleep. Recordings of respiratory functions reported irregular breathing with central and obstructive apnea and hypopnea. The typical hypotonia occurring during the night and atonia during REM sleep were replaced by hyperactive sleep consisting of multiple jerks, movements and parasomnia (mainly talking) throughout the night. In conclusion, we report unique pathological sleep patterns in early fCJD associated with the E200K mutation. Specific respiratory disturbances and lack of atonia could possibly serve as new, early diagnostic tools in the disease. © 2016 European Sleep Research Society.

Effects of Sleep after Experimental Trauma on Intrusive Emotional Memories.

PubMed

Kleim, Birgit; Wysokowsky, Julia; Schmid, Nuria; Seifritz, Erich; Rasch, Björn

2016-12-01

To investigate sleep's effect in the immediate aftermath of experiencing an analog trauma in the laboratory on reducing intrusive emotional memory formation. Sixty-five healthy women were exposed to an experimental laboratory trauma. They viewed a neutral and a trauma film in the laboratory and were randomly allocated to either a group that slept following film viewing or a group that remained awake. Sleep was recorded with electroencephalogram in a subgroup of participants in the sleep group. All participants recorded intrusive memories in the week following the film. The sleep group experienced fewer and less distressing intrusive trauma memories compared to the wake group. These effects were particularly evident toward the end of the week. Duration spent in stage N2 as opposed to light N1 sleep, a higher number of fast parietal sleep spindles and a lower rapid eye movement sleep density predicted intrusion frequency. Our results have clinical implications and set the ground for early-intervention sleep studies following trauma and prevention of chronic posttrauma disorders. © 2016 Associated Professional Sleep Societies, LLC.

Effect of Inhaled Lavender and Sleep Hygiene on Self-Reported Sleep Issues: A Randomized Controlled Trial

PubMed Central

Lillehei, Angela Smith; Savik, Kay; Reis, Reilly

2015-01-01

Abstract Objectives: To compare the effectiveness of lavender (Lavandula angustifolia) and sleep hygiene versus sleep hygiene alone on sleep quantity and sleep quality and to determine sustained effect at two-week follow-up. Design: A randomized controlled trial with investigator blinding and steps taken to blind the participants. Setting: Participants' usual sleep setting. Subjects: Seventy-nine college students with self-reported sleep issues. Interventions: The intervention took place over five nights with baseline, postintervention, and two-week follow-up assessments. Both groups practiced good sleep hygiene and wore an inhalation patch on their chest at night. One group wore a patch with 55 μl of lavender essential oil and the other group wore a blank patch. Outcome measures: Sleep quantity was measured using a Fitbit® tracker and a sleep diary, and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) and the NIH Patient-Reported Outcomes Measurement Information System (PROMIS) sleep disturbance short form. Results: The lavender and sleep hygiene group demonstrated better sleep quality at postintervention and two-week follow-up (PSQI p=0 .01, <0.001 and PROMIS p=0.04, 0.007, respectively). The sleep-hygiene-only group also demonstrated better sleep quality but to a lesser extent (PSQI p=0.02, 0.06 and PROMIS p=0.03, 0.03, respectively). Additionally, a clinical effect was found for the lavender group at postintervention, along with a significant finding for waking feeling refreshed (p=0.01). Sleep quantity did not differ between groups. Conclusions: Lavender and sleep hygiene together, and sleep hygiene alone to a lesser degree, improved sleep quality for college students with self-reported sleep issues, with an effect remaining at follow-up. PMID:26133206

The Effects of Extended Bedtimes on Sleep Duration and Food Desire in Overweight Young Adults: A Home-Based Intervention

PubMed Central

Tasali, Esra; Chapotot, Florian; Wroblewski, Kristen; Schoeller, Dale

2014-01-01

Introduction Sleep curtailment is an endemic behavior in modern society. Well-controlled laboratory studies have shown that sleep loss in young adults is associated with increased desire for high-calorie food and obesity risk. However, the relevance of these laboratory findings to real life is uncertain. We conducted a 3 week, within-participant, intervention study to assess the effects of extended bedtimes on sleep duration and food desire under real life conditions in individuals who are at risk for obesity. Methods Ten overweight young adults reporting average habitual sleep duration of less than 6.5 hours were studied in the home environment. Habitual bedtimes for 1-week (baseline) were followed by bedtimes extended to 8.5 hours for 2-weeks (intervention). Participants were unaware of the intervention until after the baseline period. Participants received individualized behavioural counselling on sleep hygiene on the first day of the intervention period. Sleep duration was recorded by wrist actigraphy throughout the study. Participants rated their sleepiness, vigor and desire for various foods using visual analog scales at the end of baseline and intervention periods. Results On average, participants obtained 1.6 hours more sleep with extended bedtimes (5.6 vs. 7.1; p<0.001) and reported being less sleepy (p=0.004) and more vigorous (p=0.034). Additional sleep was associated with a 14% decrease in overall appetite (p=0.030) and a 62% decrease in desire for sweet and salty foods (p=0.017). Desire for fruits, vegetables and protein-rich nutrients was not affected by added sleep. Conclusions Sleep duration can be successfully increased in real life settings and obtaining adequate sleep is associated with less desire for high calorie foods in overweight young adults who habitually curtail their sleep. PMID:24858836

A Nine-Year Follow-up Study of Sleep Patterns and Mortality in Community-Dwelling Older Adults in Taiwan

PubMed Central

Chen, Hsi-Chung; Su, Tung-Ping; Chou, Pesus

2013-01-01

Study Objectives: To simultaneously explore the associations between mortality and insomnia, sleep duration, and the use of hypnotics in older adults. Design: A fixed cohort study. Setting: A community in Shih-Pai area, Taipei, Taiwan. Participants: A total of 4,064 participants over the age of 65 completed the study. Intervention: N/A. Measurements and Results: Insomnia was classified using an exclusionary hierarchical algorithm, which categorized insomnia as “no insomnia,” “subjective poor sleep quality,” “Pittsburgh Sleep Quality Index > 5 insomnia,” “1-month insomnia disorder,” and “6-month insomnia disorder.” The main outcome variables were 9-year all-cause mortality rates. In the all-cause mortality analyses, when hypnotic use, depressive symptoms and total sleep time were excluded from a proportional hazards regression model, subjects with “Pittsburgh Sleep Quality Index > 5 insomnia” had a higher mortality risk (HR: 1.21, 95% CI: 1.01-1.45). In the full model, frequent hypnotic use and long sleep duration predicted higher mortality rates. However, the increased mortality risk for subjects with “Pittsburgh Sleep Quality Index > 5 insomnia” was not observed in the full model. On the contrary, individuals with a 6-month DSM-IV insomnia disorder had a lower risk for premature death (HR: 0.64, 95% CI: 0.43-0.96). Conclusions: Long sleep duration and frequent hypnotics use predicted an increased mortality risk within a community-dwelling sample of older adults. The association between insomnia and mortality was affected by insomnia definition and other parameters related to sleep patterns. Citation: Chen HC; Su TP; Chou P. A nine-year follow-up study of sleep patterns and mortality in community-dwelling older adults in Taiwan. SLEEP 2013;36(8):1187-1198. PMID:23904679

Urinary arsenic, pesticides, heavy metals, phthalates, polyaromatic hydrocarbons, and polyfluoroalkyl compounds are associated with sleep troubles in adults: USA NHANES, 2005-2006.

PubMed

Shiue, Ivy

2017-01-01

Links between environmental chemicals and human health have emerged, but the effects on sleep health were less studied. Therefore, the aim of the present study was to investigate the relationships of different sets of environmental chemicals and common sleep troubles in a national and population-based setting. Data were retrieved from the United States National Health and Nutrition Examination Surveys, 2005-2006 including demographics, serum measurements, lifestyle factors, self-reported sleep troubles, and urinary environmental chemical concentrations. Statistical analyses including descriptive statistics, t-test, chi-square test, and survey-weighted logistic regression models were performed. Of all 5563 Americans aged 18-85, 2331 (42.0%) had wake-up at night, 2914 (52.5%) felt unrested during the day, 740 (13.4%) had leg jerks while sleeping, and 1059 (19.1%) had leg cramps for 2+ times a month. Higher levels of urinary arsenic, phthalates, and polyfluoroalkyl compounds were associated with wake-up at night. Higher levels of urinary 4-tert-octylphenol and polyfluoroalkyl compounds were associated with being unrested during the day. Higher levels of urinary arsenic, polyaromatic hydrocarbons, and polyfluoroalkyl compounds were associated with leg jerks while sleeping. Higher levels of urinary pesticides, heavy metals, phthalates, and polyaromatic hydrocarbons were associated with leg cramps while sleeping. However, there were no significant associations with other environmental chemicals such as parabens, bisphenol A, benzophenone-3, triclosan, perchlorate, nitrate, or thiocyanate. Eliminating arsenic, heavy metals, phthalate, pesticides, polyaromatic hydrocarbons, and polyfluoroalkyl compounds to improve sleep health might be considered while understanding the biological pathway with a longitudinal or experimental approach in future research would be suggested.

Gray Matter-Specific Changes in Brain Bioenergetics after Acute Sleep Deprivation: A 31P Magnetic Resonance Spectroscopy Study at 4 Tesla

PubMed Central

Plante, David T.; Trksak, George H.; Jensen, J. Eric; Penetar, David M.; Ravichandran, Caitlin; Riedner, Brady A.; Tartarini, Wendy L.; Dorsey, Cynthia M.; Renshaw, Perry F.; Lukas, Scott E.; Harper, David G.

2014-01-01

Study Objectives: A principal function of sleep may be restoration of brain energy metabolism caused by the energetic demands of wakefulness. Because energetic demands in the brain are greater in gray than white matter, this study used linear mixed-effects models to examine tissue-type specific changes in high-energy phosphates derived using 31P magnetic resonance spectroscopy (MRS) after sleep deprivation and recovery sleep. Design: Experimental laboratory study. Setting: Outpatient neuroimaging center at a private psychiatric hospital. Participants: A total of 32 MRS scans performed in eight healthy individuals (mean age 35 y; range 23-51 y). Interventions: Phosphocreatine (PCr) and β-nucleoside triphosphate (NTP) were measured using 31P MRS three dimensional-chemical shift imaging at high field (4 Tesla) after a baseline night of sleep, acute sleep deprivation, and 2 nights of recovery sleep. Novel linear mixed-effects models were constructed using spectral and tissue segmentation data to examine changes in bioenergetics in gray and white matter. Measurements and Results: PCr increased in gray matter after 2 nights of recovery sleep relative to sleep deprivation with no significant changes in white matter. Exploratory analyses also demonstrated that increases in PCr were associated with increases in electroencephalographic slow wave activity during recovery sleep. No significant changes in β-NTP were observed. Conclusions: These results demonstrate that sleep deprivation and subsequent recovery-induced changes in high-energy phosphates primarily occur in gray matter, and increases in phosphocreatine after recovery sleep may be related to sleep homeostasis. Citation: Plante DT, Trksak GH, Jensen JE, Penetar DM, Ravichandran C, Riedner BA, Tartarini WL, Dorsey CM, Renshaw PF, Lukas SE, Harper DG. Gray matter-specific changes in brain bioenergetics after acute sleep deprivation: a 31P magnetic resonance spectroscopy study at 4 Tesla. SLEEP 2014;37(12):1919-1927. PMID:25325507

Development and Evaluation of a Measure to Assess Restorative Sleep

PubMed Central

Drake, Christopher L.; Hays, Ron D.; Morlock, Robert; Wang, Fong; Shikiar, Richard; Frank, Lori; Downey, Ralph; Roth, Thomas

2014-01-01

Background: There are validated measures assessing insomnia and disturbed sleep, but few psychometrically sound instruments to assess perceptions of the restorative or inadequate properties of sleep are available. Study Objectives: To develop and evaluate a new instrument, the Restorative Sleep Questionnaire (RSQ). Design and Setting: Focus groups were conducted using participants with and without nonrestorative sleep complaints. Questions were designed to elicit the feelings and experiences people have about their sleep and their view of daytime consequences of sleep. Expert panels confirmed the importance of nonrestorative sleep (NRS) as a frequently encountered problem either with or without other sleep complaints. The resulting RSQ was administered in three studies: (1) a telephone interview with healthy controls and individuals with sleep problems; (2) a randomized clinical trial of patients with primary insomnia assessed by polysomnography (PSG); (3) a PSG study of subjects with NRS complaints. Measurement and Results: Across all studies, the new measures were shown to be significantly correlated with health-related quality of life (HRQL) domains hypothesized to be related to NRS. The RSQ had good psychometric properties (α > 0.90; rtest-retest > 0.80), and factor analysis confirmed the unidimensionality of the measure. The RSQ was able to distinguish between healthy controls, patients with primary insomnia, and insomnia patients with isolated NRS complaints but without PSG defined sleep onset, duration, or maintenance problems. Normal sleepers reported sleep that was about a standard deviation more restorative than that of those with NRS on the RSQ. Conclusions: The results of the study provide support for the reliability and validity of the RSQ as a measure of NRS in subjects with and without self-reported or PSG confirmed sleep initiation and maintenance difficulties. ClinicalTrials.gov Identifiers: NCT00655369; NCT00705601 Citation: Drake CL, Hays RD, Morlock R, Wang F, Shikiar R, Frank L, Downey R, Roth T. Development and evaluation of a measure to assess restorative sleep. J Clin Sleep Med 2014;10(7):733-741. PMID:25024650

Sleep patterns and sleep disturbances across pregnancy.

PubMed

Mindell, Jodi A; Cook, Rae Ann; Nikolovski, Janeta

2015-04-01

This study sought to characterize sleep patterns and sleep problems in a large sample of women across all months of pregnancy. A total of 2427 women completed an Internet-based survey that included the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, vitality scale of the Short Form 36 Health Survey (SF-36), Insomnia Severity Index (ISI), Berlin questionnaire, International Restless Legs Syndrome (IRLS) question set, and a short version of the Pregnancy Symptoms Inventory (PSI). Across all months of pregnancy, women experienced poor sleep quality (76%), insufficient nighttime sleep (38%), and significant daytime sleepiness (49%). All women reported frequent nighttime awakenings (100%), and most women took daytime naps (78%). Symptoms of insomnia (57%), sleep-disordered breathing (19%), and restless legs syndrome (24%) were commonly endorsed, with no difference across the month of pregnancy for insomnia, sleep-disorder breathing, daytime sleepiness, or fatigue. In addition, high rates of pregnancy-related symptoms were found to disturb sleep, especially frequent urination (83%) and difficulty finding a comfortable sleep position (79%). Women experience significant sleep disruption, inadequate sleep, and high rates of symptoms of sleep disorder throughout pregnancy. These results suggest that all women should be screened and treated for sleep disturbances throughout pregnancy, especially given the impact of inadequate sleep and sleep disorders on fetal, pregnancy, and postpartum outcomes. Copyright © 2014 Elsevier B.V. All rights reserved.

Feedback Blunting: Total Sleep Deprivation Impairs Decision Making that Requires Updating Based on Feedback.

PubMed

Whitney, Paul; Hinson, John M; Jackson, Melinda L; Van Dongen, Hans P A

2015-05-01

To better understand the sometimes catastrophic effects of sleep loss on naturalistic decision making, we investigated effects of sleep deprivation on decision making in a reversal learning paradigm requiring acquisition and updating of information based on outcome feedback. Subjects were randomized to a sleep deprivation or control condition, with performance testing at baseline, after 2 nights of total sleep deprivation (or rested control), and following 2 nights of recovery sleep. Subjects performed a decision task involving initial learning of go and no go response sets followed by unannounced reversal of contingencies, requiring use of outcome feedback for decisions. A working memory scanning task and psychomotor vigilance test were also administered. Six consecutive days and nights in a controlled laboratory environment with continuous behavioral monitoring. Twenty-six subjects (22-40 y of age; 10 women). Thirteen subjects were randomized to a 62-h total sleep deprivation condition; the others were controls. Unlike controls, sleep deprived subjects had difficulty with initial learning of go and no go stimuli sets and had profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Working memory scanning performance was not significantly affected by sleep deprivation. And although sleep deprived subjects showed expected attentional lapses, these could not account for impairments in reversal learning decision making. Sleep deprivation is particularly problematic for decision making involving uncertainty and unexpected change. Blunted reactions to feedback while sleep deprived underlie failures to adapt to uncertainty and changing contingencies. Thus, an error may register, but with diminished effect because of reduced affective valence of the feedback or because the feedback is not cognitively bound with the choice. This has important implications for understanding and managing sleep loss-induced cognitive impairment in emergency response, disaster management, military operations, and other dynamic real-world settings with uncertain outcomes and imperfect information. © 2015 Associated Professional Sleep Societies, LLC.

Direct comparison of two actigraphy devices with polysomnographically recorded naps in healthy young adults.

PubMed

Cellini, Nicola; Buman, Matthew P; McDevitt, Elizabeth A; Ricker, Ashley A; Mednick, Sara C

2013-06-01

The last 20 yrs have seen a marked increase in studies utilizing actigraphy in free-living environments. The aim of the present study is to directly compare two commercially available actigraph devices with concurrent polysomnography (PSG) during a daytime nap in healthy young adults. Thirty healthy young adults, ages 18-31 (mean 20.77 yrs, SD 3.14 yrs) simultaneously wore AW-64 and GT3X+ devices during a polysomnographically recorded nap. Mann-Whitney U (M-U) test, intraclass correlation coefficients, and Bland-Altman statistic were used to compare total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) between the two actigraphs and PSG. Epoch-by-epoch (EBE) agreement was calculated to determine accuracy, sensitivity, specificity, predictive values for sleep (PVS) and wake (PVW), and kappa and prevalence- and bias-adjusted kappa (PABAK) coefficients. All frequency settings provided by the devices were examined. For both actigraphs, EBE analysis found accuracy, sensitivity, specificity, PVS, and PVW comparable to previous reports of other similar devices. Kappa and PABAK coefficients showed moderate to high agreement with PSG depending on device settings. The GT3X+ overestimated TST and SE, and underestimated SOL and WASO, whereas no significant difference was found between AW-64 and PSG. However, GT3X+ showed overall better EBE agreements to PSG than AW-64. We conclude that both actigraphs are valid and reliable devices for detecting sleep/wake diurnal patterns. The choice between devices should be based on several parameters as reliability, cost of the device, scoring algorithm, target population, experimental condition, and aims of the study (e.g., sleep and/or physical activity).

Investigating the Family Bed

ERIC Educational Resources Information Center

Evenson, Amber; Moran, Tracy E.

2013-01-01

Although it remains a contentious issue, co-sleeping is becoming more popular in Western, industrialized societies. This article explores the practice of co-sleeping in crosscultural settings, examining the role of culture, the dominant Western discourse regarding sleep, and changes in policy recommendations regarding sleeping approaches. Although…

After Being Challenged by a Video Game Problem, Sleep Increases the Chance to Solve It

PubMed Central

Beijamini, Felipe; Pereira, Sofia Isabel Ribeiro; Cini, Felipe Augusto; Louzada, Fernando Mazzilli

2014-01-01

In the past years many studies have demonstrated the role of sleep on memory consolidation. It is known that sleeping after learning a declarative or non-declarative task, is better than remaining awake. Furthermore, there are reports of a possible role for dreams in consolidation of declarative memories. Other studies have reported the effect of naps on memory consolidation. With similar protocols, another set of studies indicated that sleep has a role in creativity and problem-solving. Here we hypothesised that sleep can increase the likelihood of solving problems. After struggling to solve a video game problem, subjects who took a nap (n = 14) were almost twice as likely to solve it when compared to the wake control group (n = 15). It is interesting to note that, in the nap group 9 out 14 subjects engaged in slow-wave sleep (SWS) and all solved the problem. Surprisingly, we did not find a significant involvement of Rapid Eye Movement (REM) sleep in this task. Slow-wave sleep is believed to be crucial for the transfer of memory-related information to the neocortex and implement intentions. Sleep can benefit problem-solving through the generalisation of newly encoded information and abstraction of the gist. In conclusion, our results indicate that sleep, even a nap, can potentiate the solution of problems that involve logical reasoning. Thus, sleep's function seems to go beyond memory consolidation to include managing of everyday-life events. PMID:24416219

After being challenged by a video game problem, sleep increases the chance to solve it.

PubMed

Beijamini, Felipe; Pereira, Sofia Isabel Ribeiro; Cini, Felipe Augusto; Louzada, Fernando Mazzilli

2014-01-01

In the past years many studies have demonstrated the role of sleep on memory consolidation. It is known that sleeping after learning a declarative or non-declarative task, is better than remaining awake. Furthermore, there are reports of a possible role for dreams in consolidation of declarative memories. Other studies have reported the effect of naps on memory consolidation. With similar protocols, another set of studies indicated that sleep has a role in creativity and problem-solving. Here we hypothesised that sleep can increase the likelihood of solving problems. After struggling to solve a video game problem, subjects who took a nap (n = 14) were almost twice as likely to solve it when compared to the wake control group (n = 15). It is interesting to note that, in the nap group 9 out 14 subjects engaged in slow-wave sleep (SWS) and all solved the problem. Surprisingly, we did not find a significant involvement of Rapid Eye Movement (REM) sleep in this task. Slow-wave sleep is believed to be crucial for the transfer of memory-related information to the neocortex and implement intentions. Sleep can benefit problem-solving through the generalisation of newly encoded information and abstraction of the gist. In conclusion, our results indicate that sleep, even a nap, can potentiate the solution of problems that involve logical reasoning. Thus, sleep's function seems to go beyond memory consolidation to include managing of everyday-life events.

Poor Self-Reported Sleep Quality Predicts Mortality within One Year of Inpatient Post-Acute Rehabilitation among Older Adults

PubMed Central

Martin, Jennifer L.; Fiorentino, Lavinia; Jouldjian, Stella; Mitchell, Michael; Josephson, Karen R.; Alessi, Cathy A.

2011-01-01

Study Objective: To evaluate the association between self-reported sleep quality among older adults during inpatient post-acute rehabilitation and one-year survival. Design: Prospective, observational cohort study. Setting: Two inpatient post-acute rehabilitation sites (one community and one Veterans Administration). Participants: Older patients (aged ≥ 65 years, n = 245) admitted for inpatient post-acute rehabilitation. Interventions: None. Measurements and Results: Within one year of post-acute rehabilitation, 57 participants (23%) were deceased. Cox proportional hazards models showed that worse Pittsburgh Sleep Quality Index (PSQI) total scores during the post-acute care stay were associated with increased mortality risk when controlling for amount of rehabilitation therapy received, comorbidities, and cognitive functioning (Hazard ratio [95% CI] = 1.11 [1.02-1.20]). Actigraphically estimated sleep was unrelated to mortality risk. Conclusions: Poorer self-reported sleep quality, but not objectively estimated sleep parameters, during post-acute rehabilitation was associated with shorter survival among older adults. This suggests self-reported poor sleep may be an important and potentially modifiable risk factor for negative outcomes in these vulnerable older adults. Studies of interventions to improve sleep quality during inpatient rehabilitation should therefore be undertaken, and the long-term health benefits of improved sleep should be explored. Citation: Martin JL; Fiorentino L; Jouldjian S; Mitchell M; Josephson KR; Alessi CA. Poor self-reported sleep quality predicts mortality within one year of inpatient post-acute rehabilitation among older adults. SLEEP 2011;34(12):1715-1721. PMID:22131610

Sleep Is Associated with the Metabolic Syndrome in a Multi-Ethnic Cohort of Midlife Women: The SWAN Sleep Study

PubMed Central

Hall, Martica H.; Okun, Michele L.; Sowers, MaryFran; Matthews, Karen A.; Kravitz, Howard M.; Hardin, Kimberly; Buysse, Daniel J.; Bromberger, Joyce T.; Owens, Jane F.; Karpov, Irina; Sanders, Mark H.

2012-01-01

Study Objectives: We evaluated associations among subjective and objective measures of sleep and the metabolic syndrome in a multi-ethnic sample of midlife women. Design: Cross-sectional study. Setting: Participants' homes. Participants: Caucasian (n = 158), African American (n = 125), and Chinese women (n = 57); mean age = 51 years. Age range = 46-57 years. Interventions: None. Measurements and Results: Metabolic syndrome was measured in the clinic and sleep quality was assessed by self-report. Indices of sleep duration, continuity/fragmentation, depth, and sleep disordered breathing were assessed by in-home polysomnography (PSG). Covariates included sociodemographics, menopausal status, use of medications that affect sleep, and self-reported health complaints and health behaviors known to influence metabolic syndrome risk. Logistic regression was used to test the hypothesis that the metabolic syndrome would be associated with increased subjective sleep complaints and PSG-assessed sleep disturbances. In univariate analyses, the metabolic syndrome was associated with decreased sleep duration and efficiency and increased NREM beta power and apnea-hypopnea index (AHI). After covariate adjustment, sleep efficiency (odds ratio [OR] = 2.06, 95% confidence interval [CI]: 1.08-3.93), NREM beta power (OR = 2.09, 95% CI: 1.09-3.98), and AHI (OR = 1.86, 95% CI: 1.40-2.48) remained significantly associated with the metabolic syndrome (odds ratio values are expressed in standard deviation units). These relationships did not differ by race. Conclusions: Objective indices of sleep continuity, depth, and sleep disordered breathing are significant correlates of the metabolic syndrome in midlife women, independent of race, menopausal status and other factors that might otherwise account for these relationships. Citation: Hall MH; Okun ML; Sowers M; Matthews KA; Kravitz HM; Hardin K; Buysse DJ; Bromberger JT; Owens JF; Karpov I; Sanders MH. Sleep is associated with the metabolic syndrome in a multi-ethnic cohort of midlife women: the SWAN Sleep Study. SLEEP 2012;35(6):783-790. PMID:22654197

Poor sleep quality and later sleep timing are risk factors for osteopenia and sarcopenia in middle-aged men and women: The NEO study

PubMed Central

de Mutsert, Renée; le Cessie, Saskia; Appelman-Dijkstra, Natasha M.; Rosendaal, Frits R.; van Heemst, Diana; den Heijer, Martin; Biermasz, Nienke R.

2017-01-01

Context Sleep deprivation has detrimental metabolic consequences. Osteopenia and sarcopenia usually occur together and increase risk of fractures and disease. Results from studies linking sleep parameters to osteopenia or sarcopenia are scarce and inconsistent. Objective To examine the associations of sleep parameters with osteopenia and sarcopenia, considering the influence of sex and menopause. Design, setting and participants Cross-sectional analysis of 915 participants (45–65 years, 56% women, BMI 26 (range: 18–56) kg/m2) in the Netherlands Epidemiology of Obesity (NEO) study, a population-based cohort study. Sleep duration, quality, and timing were assessed with the Pittsburgh Sleep Quality Index (PSQI); bone mineral density and relative appendicular muscle mass were measured by DXA scans. Linear and logistic regressions were performed to associate sleep parameters to bone mineral density, relative appendicular muscle mass, osteopenia (t-score between -1 and -2.5) and sarcopenia (1 SD below average muscle mass). Results After adjustment for confounding factors, one unit increase in PSQI score (OR and 95% CI, 1.09, 1.03–1.14), declined self-rated sleep quality (1.76, 1.03–3.01), sleep latency (1.18, 1.06–1.31), and a one hour later sleep timing (1.51, 1.08–2.11), but not sleep duration (1.05, 0.90–1.23), were associated with osteopenia. PSQI score (1.10, 1.02–1.19) was also associated with sarcopenia; OR’s of sleep latency and later mid-sleep time with sarcopenia were 1.14 (0.99–1.31) and 1.54 (0.91–2.61), respectively. Associations were somewhat stronger in women and varied per menopausal status. Conclusions These results suggest that decreased sleep quality and a later sleep timing are risk factors for osteopenia and sarcopenia in middle aged individuals. PMID:28459884

Effect of Aptensio XR (Methylphenidate HCl Extended-Release) Capsules on Sleep in Children with Attention-Deficit/Hyperactivity Disorder.

PubMed

Owens, Judith; Weiss, Margaret; Nordbrock, Earl; Mattingly, Greg; Wigal, Sharon; Greenhill, Laurence L; Chang, Wei-Wei; Childress, Ann; Kupper, Robert J; Adjei, Akwete

2016-12-01

To evaluate measures of sleep (exploratory endpoints) in two pivotal studies of a multilayer bead extended-release methylphenidate (MPH-MLR) treatment of attention-deficit/hyperactivity disorder in children. Study 1 evaluated the time course of response to MPH-MLR (n = 26) patients in an analog classroom setting through four phases: screening (≤28 days), open label (OL) dose optimization (4 weeks), double-blind (DB) crossover (2 weeks; placebo vs. optimized dose), and follow-up call. Study 2 was a forced-dose parallel evaluation of MPH-MLR (n = 230) in four phases: screening (≤28 days), DB (1 week; placebo or MPH-MLR 10, 15, 20, or 40 mg/day), OL dose optimization (11 weeks), and follow-up call. Sleep was evaluated by parents using the Children's or Adolescent Sleep Habits Questionnaire (CSHQ or ASHQ) during the DB and OL phases. DB analysis: Study 1 (crossover), analysis of variance; Study 2, analysis of covariance. OL analysis: paired t-test. DB: treatments were significantly different in Study 1 only for CSHQ Sleep Onset Delay (MPH-MLR, 1.90 vs. placebo, 1.34; p = 0.0046, placebo was better), and Study 2 for CSHQ Parasomnias (treatment, p = 0.0295), but no MPH-MLR treatment was different from placebo (pairwise MPH-MLR treatment to placebo, all p ≥ 0.170). OL: CSHQ total and Bedtime Resistance, Sleep Duration, Sleep Anxiety, Night Wakings, Parasomnias, and Sleep-disordered Breathing subscales decreased (improved, Study 1) significant only for CSHQ Night Wakings (p < 0.05); in Study 2 CSHQ total and Bedtime Resistance, Sleep Duration, Night Wakings, Parasomnias, and Daytime Sleepiness, and ASHQ total, Bedtime, Sleep Behavior, and Morning Waking all significantly improved (p < 0.05). In both studies, there was minimal negative impact of MPH-MLR on sleep during the brief DB phase and none during the longer duration OL phase. Some measures of sleep improved with optimized MPH-MLR dose.

Socially Isolated Mice Exhibit a Blunted Homeostatic Sleep Response to Acute Sleep Deprivation Compared to Socially Paired Mice

PubMed Central

Kaushal, Navita; Nair, Deepti; Gozal, David; Ramesh, Vijay

2012-01-01

Sleep is an important physiological process underlying maintenance of physical, mental and emotional health. Consequently, sleep deprivation (SD) is associated with adverse consequences and increases the risk for anxiety, immune, and cognitive disorders. SD is characterized by increased energy expenditure responses and sleep rebound upon recovery that are regulated by homeostatic processes, which in turn are influenced by stress. Since all previous studies on SD were conducted in a setting of social isolation, the impact of the social contextual setting is unknown. Therefore, we used a relatively stress-free SD paradigm in mice to assess the impact of social isolation on sleep, wakefulness and delta electroencephalogram (EEG) power during non-rapid eye movement (NREM) sleep. Paired or isolated C57BL/6J adult chronically-implanted male mice were exposed to SD for 6 hours and telemetric polygraphic recordings were conducted, including 18 hours recovery. Recovery from SD in the paired group showed a significant decrease in wake and significant increase in NREM sleep and rapid eye movement (REM), and a similar, albeit less robust response occurred in the isolated mice. Delta power during NREM sleep was increased in both groups immediately following SD, but paired mice exhibited significantly higher delta power throughout the dark period. The increase in body temperature and gross motor activity observed during the SD procedure was decreased during the dark period. In both open field and elevated plus maze tests, socially isolated mice showed significantly higher anxiety than paired mice. The homeostatic processes altered by SD are differentially affected in paired and isolated mice, suggesting that the social context of isolation stress may adversely affect the quantity and quality of sleep in mice. PMID:22498175

Metabolic Response of the Cerebral Cortex Following Gentle Sleep Deprivation and Modafinil Administration

PubMed Central

Petit, Jean-Marie; Tobler, Irene; Kopp, Caroline; Morgenthaler, Florence; Borbély, Alexander A.; Magistretti, Pierre J.

2010-01-01

Study Objectives: The main energy reserve of the brain is glycogen, which is almost exclusively localized in astrocytes. We previously reported that cerebral expression of certain genes related to glycogen metabolism changed following instrumental sleep deprivation in mice. Here, we extended our investigations to another set of genes related to glycogen and glucose metabolism. We also compared the effect of instrumentally and pharmacologically induced prolonged wakefulness, followed (or not) by 3 hours of sleep recovery, on the expression of genes related to brain energy metabolism. Design: Sleep deprivation for 6–7 hours. Setting: Animal sleep research laboratory. Participants: Adults OF1 mice. Interventions: Wakefulness was maintained by “gentle sleep deprivation” method (GSD) or by administration of the wakefulness-promoting drug modafinil (MOD) (200 mg/kg i.p.). Measurements and Results: Levels of mRNAs encoding proteins related to energy metabolism were measured by quantitative real-time PCR in the cerebral cortex. The mRNAs encoding protein targeting to glycogen (PTG) and the glial glucose transporter were significantly increased following both procedures used to prolong wakefulness. Glycogenin mRNA levels were increased only after GSD, while neuronal glucose transporter mRNA only after MOD. These effects were reversed after sleep recovery. A significant enhancement of glycogen synthase activity without any changes in glycogen levels was observed in both conditions. Conclusions: These results indicate the existence of a metabolic adaptation of astrocytes aimed at maintaining brain energy homeostasis during the sleep-wake cycle. Citation: Petit, JM; Tobler I; Kopp C; Morgenthaler F; Borbély AA; Magistretti PJ. Metabolic response of the cerebral cortex following gentle sleep deprivation and modafinil administration. SLEEP 2010;33(7):901–908. PMID:20614850

Effects of non-invasive ventilation on objective sleep and nocturnal respiration in patients with amyotrophic lateral sclerosis.

PubMed

Boentert, Matthias; Brenscheidt, Inga; Glatz, Christian; Young, Peter

2015-09-01

In amyotrophic lateral sclerosis (ALS), non-invasive ventilation (NIV) is indicated if sleep-disordered breathing (SDB), daytime hypercapnia, or significant diaphragmatic weakness is present. We investigated both short-term and long-term effects of NIV on objective measures of sleep and nocturnal respiration in patients with ALS. Polysomnography (PSG) and transcutaneous capnography were conducted for diagnosis of SDB (T0), for treatment initiation (T1), and follow-up 3, 9, and 15 months later (T2, T3, and T4, respectively). Records from 65 patients were retrospectively analyzed at T0 and T1. At subsequent timepoints, the number of full data sets decreased since follow-up sleep studies frequently included polygraphy rather than PSG (T2, 38 patients, T3, 17 patients, T4, 11 patients). At T0, mean age was 63.2 years, 29 patients were female, and 22 patients had bulbar ALS. Immediate sequelae of NIV initiation included significant increases of slow wave sleep, rapid eye movement sleep, and oxygen saturation. Mean apnea-hypopnea index, respiratory rate, and the maximum transcutaneous carbon dioxide tension were reduced. At T2-T4, normoxia and normocapnia were preserved. Sleep quality measures showed no alteration as diurnal use of NIV gradually increased reflecting disease progression. In contrast to previous reports, improvement of sleep and respiratory outcomes was found in both non-bulbar and bulbar patients. NIV significantly improves objective sleep quality and SDB in the first night of treatment in patients with bulbar and non-bulbar ALS. NIV warrants nocturnal normoventilation without deterioration of sleep quality in the long run with only minor changes to ventilator settings.

Deepening Sleep by Hypnotic Suggestion

PubMed Central

Cordi, Maren J.; Schlarb, Angelika A.; Rasch, Björn

2014-01-01

Study Objectives: Slow wave sleep (SWS) plays a critical role in body restoration and promotes brain plasticity; however, it markedly declines across the lifespan. Despite its importance, effective tools to increase SWS are rare. Here we tested whether a hypnotic suggestion to “sleep deeper” extends the amount of SWS. Design: Within-subject, placebo-controlled crossover design. Setting: Sleep laboratory at the University of Zurich, Switzerland. Participants: Seventy healthy females 23.27 ± 3.17 y. Intervention: Participants listened to an auditory text with hypnotic suggestions or a control tape before napping for 90 min while high-density electroencephalography was recorded. Measurements and Results: After participants listened to the hypnotic suggestion to “sleep deeper” subsequent SWS was increased by 81% and time spent awake was reduced by 67% (with the amount of SWS or wake in the control condition set to 100%). Other sleep stages remained unaffected. Additionally, slow wave activity was significantly enhanced after hypnotic suggestions. During the hypnotic tape, parietal theta power increases predicted the hypnosis-induced extension of SWS. Additional experiments confirmed that the beneficial effect of hypnotic suggestions on SWS was specific to the hypnotic suggestion and did not occur in low suggestible participants. Conclusions: Our results demonstrate the effectiveness of hypnotic suggestions to specifically increase the amount and duration of slow wave sleep (SWS) in a midday nap using objective measures of sleep in young, healthy, suggestible females. Hypnotic suggestions might be a successful tool with a lower risk of adverse side effects than pharmacological treatments to extend SWS also in clinical and elderly populations. Citation: Cordi MJ, Schlarb AA, Rasch B. Deepening sleep by hypnotic suggestion. SLEEP 2014;37(6):1143-1152. PMID:24882909

Comparison of actigraphy immobility rules with polysomnographic sleep onset latency in children and adolescents.

PubMed

Meltzer, Lisa J; Walsh, Colleen M; Peightal, Ashley A

2015-12-01

While actigraphy has gained popularity in pediatric sleep research, questions remain about the validity of actigraphy as an estimate of sleep-wake patterns. In particular, there is little consistency in the field in terms of scoring rules used to determine sleep onset latency. The purpose of this study was to evaluate different criteria of immobility as a measure of sleep onset latency in children and adolescents. Ninety-five youth (ages 3-17 years, 46 % male) wore both the Ambulatory Monitoring Inc. Motionlogger Sleep Watch (AMI) and the Philips Respironics Mini-Mitter Actiwatch-2 (PRMM) during overnight polysomnography in a pediatric sleep lab. We examined different sleep onset latency scoring rules (3, 5, 10, 15, and 20 min of immobility) using different algorithms (Sadeh and Cole-Kripke) and sensitivity settings (low, medium, high) for the devices. Comparisons were also made across age groups (preschoolers, school-aged, adolescents) and sleep disordered breathing status (no obstructive sleep apnea [OSA], mild OSA, clinically significant OSA). For the AMI device, shorter scoring rules performed best for children and longer scoring rules were better for adolescents, with shorter scoring rules best across sleep disordered breathing groups. For the PRMM device, medium to longer scoring rules performed best across age and sleep disordered breathing groups. Researchers are encouraged to determine the scoring rule that best fits their population of interest. Future studies are needed with larger samples of children and adolescents to further validate actigraphic immobility as a proxy for sleep onset latency.

Partial Sleep Deprivation Attenuates the Positive Affective System: Effects Across Multiple Measurement Modalities.

PubMed

Finan, Patrick H; Quartana, Phillip J; Remeniuk, Bethany; Garland, Eric L; Rhudy, Jamie L; Hand, Matthew; Irwin, Michael R; Smith, Michael T

2017-01-01

Ample behavioral and neurobiological evidence links sleep and affective functioning. Recent self-report evidence suggests that the affective problems associated with sleep loss may be stronger for positive versus negative affective state and that those effects may be mediated by changes in electroencepholographically measured slow wave sleep (SWS). In the present study, we extend those preliminary findings using multiple measures of affective functioning. In a within-subject randomized crossover experiment, we tested the effects of one night of sleep continuity disruption via forced awakenings (FA) compared to one night of uninterrupted sleep (US) on three measures of positive and negative affective functioning: self-reported affective state, affective pain modulation, and affect-biased attention. The study was set in an inpatient clinical research suite. Healthy, good sleeping adults (N = 45) were included. Results indicated that a single night of sleep continuity disruption attenuated positive affective state via FA-induced reductions in SWS. Additionally, sleep continuity disruption attenuated the inhibition of pain by positive affect as well as attention bias to positive affective stimuli. Negative affective state, negative affective pain facilitation, nor negative attention bias were altered by sleep continuity disruption. The present findings, observed across multiple measures of affective function, suggest that sleep continuity disruption has a stronger influence on the positive affective system relative to the negative affective affective system. © Sleep Research Society 2016. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Sleep Symptoms, Race/Ethnicity, and Socioeconomic Position

PubMed Central

Grandner, Michael A.; Petrov, Megan E. Ruiter; Rattanaumpawan, Pinyo; Jackson, Nicholas; Platt, Alec; Patel, Nirav P.

2013-01-01

Study Objectives: Growing evidence indicates sleep is a major public health issue. Race/ethnicity and socioeconomics may contribute to sleep problems. This study assessed whether sleep symptoms were more prevalent among minorities and/or the socioeconomically disadvantaged. Design: Cross-sectional. Setting: Epidemiologic survey. Patients or Participants: 2007-2008 National Health and Nutrition Examination Survey (N = 4,081). Interventions: None. Measurements and Results: Sociodemographics included age, sex, race/ethnicity, marital status, and immigration. Socioeconomics included poverty, education, private insurance, and food insecurity. Sleep symptoms assessed were sleep latency > 30 min, difficulty falling asleep, sleep maintenance difficulties, early morning awakenings, non-restorative sleep, daytime sleepiness, snorting/gasping, and snoring. Decreased reported problems for most symptoms were found among minorities, immigrants, and lower education levels. In general, in fully adjusted models, long sleep latency was associated with female gender, being black/African American, lower education attainment, no private insurance, and food insecurity. Difficulty falling asleep, sleep maintenance difficulties, early morning awakenings, and non-restorative sleep were also associated with female gender and food insecurity. Daytime sleepiness was seen in female and divorced respondents. Snorting/gasping was more prevalent among male, other-Hispanic/Latino, and 9th- to 11th-grade-level respondents. Snoring was prevalent among male, other-Hispanic/Latino, less-educated, and food-insecure respondents. Conclusions: Sleep symptoms were associated with multiple sociodemographic and economic factors, though these relationships differed by predictor and sleep outcome. Also, reports depended on question wording. Citation: Grandner MA; Petrov MER; Rattanaumpawan P; Jackson N; Platt A; Patel NP. Sleep symptoms, race/ethnicity, and socioeconomic position. J Clin Sleep Med 2013;9(9):897-905. PMID:23997702

Scalp and Source Power Topography in Sleepwalking and Sleep Terrors: A High-Density EEG Study

PubMed Central

Castelnovo, Anna; Riedner, Brady A.; Smith, Richard F.; Tononi, Giulio; Boly, Melanie; Benca, Ruth M.

2016-01-01

Study Objectives: To examine scalp and source power topography in sleep arousals disorders (SADs) using high-density EEG (hdEEG). Methods: Fifteen adult subjects with sleep arousal disorders (SADs) and 15 age- and gender-matched good sleeping healthy controls were recorded in a sleep laboratory setting using a 256 channel EEG system. Results: Scalp EEG analysis of all night NREM sleep revealed a localized decrease in slow wave activity (SWA) power (1–4 Hz) over centro-parietal regions relative to the rest of the brain in SADs compared to good sleeping healthy controls. Source modelling analysis of 5-minute segments taken from N3 during the first half of the night revealed that the local decrease in SWA power was prominent at the level of the cingulate, motor, and sensori-motor associative cortices. Similar patterns were also evident during REM sleep and wake. These differences in local sleep were present in the absence of any detectable clinical or electrophysiological sign of arousal. Conclusions: Overall, results suggest the presence of local sleep differences in the brain of SADs patients during nights without clinical episodes. The persistence of similar topographical changes in local EEG power during REM sleep and wakefulness points to trait-like functional changes that cross the boundaries of NREM sleep. The regions identified by source imaging are consistent with the current neurophysiological understanding of SADs as a disorder caused by local arousals in motor and cingulate cortices. Persistent localized changes in neuronal excitability may predispose affected subjects to clinical episodes. Citation: Castelnovo A, Riedner BA, Smith RF, Tononi G, Boly M, Benca RM. Scalp and source power topography in sleepwalking and sleep terrors: a high-density EEG study. SLEEP 2016;39(10):1815–1825. PMID:27568805

Disturbed Dreaming and the Instability of Sleep: Altered Nonrapid Eye Movement Sleep Microstructure in Individuals with Frequent Nightmares as Revealed by the Cyclic Alternating Pattern

PubMed Central

Simor, Péter; Bódizs, Róbert; Horváth, Klára; Ferri, Raffaele

2013-01-01

Study Objectives: Nightmares are disturbing mental experiences during sleep that usually result in abrupt awakenings. Frequent nightmares are associated with poor subjective sleep quality, and recent polysomnographic data suggest that nightmare sufferers exhibit impaired sleep continuity during nonrapid eye movement (NREM) sleep. Because disrupted sleep might be related to abnormal arousal processes, the goal of this study was to examine polysomnographic arousal-related activities in a group of nightmare sufferers and a healthy control group. Design: Sleep microstructure analysis was carried out by scoring the cyclic alternating pattern (CAP) in NREM sleep and the arousal index in rapid eye movement (REM) sleep on the second night of the polysomnographic examination. Setting: Hospital-based sleep research laboratory. Participants: There were 17 in the nightmare (NMs) group and 23 in the healthy control (CTLs) group. Interventions: N/A. Measurements and Results: The NMs group exhibited reduced amounts of CAP A1 subtype and increased CAP A2 and A3 subtypes, as well as longer duration of CAP A phases in comparison with CTLs. Moreover, these differences remained significant after controlling for the confounding factors of anxious and depressive symptoms. The absolute number and frequency of REM arousals did not differ significantly between the two groups. Conclusions: The results of our study indicate that NREM sleep microstructure is altered during nonsymptomatic nights of nightmares. Disrupted sleep in the NMs group seems to be related to abnormal arousal processes, specifically an imbalance in sleep-promoting and arousing mechanisms during sleep. Citation: Simor P; Bódizs R; Horváth K; Ferri R. Disturbed dreaming and the instability of sleep: altered nonrapid eye movement sleep microstructure in individuals with frequent nightmares as revealed by the cyclic alternating pattern. SLEEP 2013;36(3):413-419. PMID:23449753

A Cognitive Vulnerability Model of Sleep and Mood in Adolescents under Naturalistically Restricted and Extended Sleep Opportunities

PubMed Central

Bei, Bei; Wiley, Joshua F.; Allen, Nicholas B.; Trinder, John

2015-01-01

Study Objectives: School terms and vacations represent naturally occurring periods of restricted and extended sleep opportunities. A cognitive model of the relationships among objective sleep, subjective sleep, and negative mood was tested across these periods, with sleep-specific (i.e., dysfunctional beliefs and attitudes about sleep) and global (i.e., dysfunctional attitudes) cognitive vulnerabilities as moderators. Design: Longitudinal study over the last week of a school term (Time-E), the following 2-w vacation (Time-V), and the first week of the next term (Time-S). Setting: General community. Participants: 146 adolescents, 47.3% male, mean age = 16.2 years (standard deviation ± 1 year). Interventions: N/A. Measurements and Results: Objective sleep was measured continuously by actigraphy. Sociodemographics and cognitive vulnerabilities were assessed at Time-E; subjective sleep, negative mood (anxiety and depressive symptoms), and academic stress were measured at each time point. Controlling for academic stress and sex, subjective sleep quality mediated the relationship between objective sleep and negative mood at all time points. During extended (Time-V), but not restricted (Time-E and Time-S) sleep opportunity, this mediation was moderated by global cognitive vulnerability, with the indirect effects stronger with higher vulnerability. Further, at Time-E and Time-V, but not Time-S, greater sleep-specific and global cognitive vulnerabilities were associated with poorer subjective sleep quality and mood, respectively. Conclusions: Results highlighted the importance of subjective sleep perception in the development of sleep related mood problems, and supported the role of cognitive vulnerabilities as potential mechanisms in the relationships between objective sleep, subjective sleep, and negative mood. Adolescents with higher cognitive vulnerability are more susceptible to perceived poor sleep and sleep related mood problems. These findings have practical implications for interventions. Citation: Bei B, Wiley JF, Allen NB, Trinder J. A cognitive vulnerability model of sleep and mood in adolescents under naturalistically restricted and extended sleep opportunities. SLEEP 2015;38(3):453–461. PMID:25325471

Sleep quality evaluation, chronotype, sleepiness and anxiety of Paralympic Brazilian athletes: Beijing 2008 Paralympic Games.

PubMed

Silva, Andressa; Queiroz, Sandra Souza; Winckler, Ciro; Vital, Roberto; Sousa, Ronnie Andrade; Fagundes, Vander; Tufik, Sergio; de Mello, Marco Túlio

2012-02-01

The objective of this study was to evaluate the sleep quality, sleepiness, chronotype and the anxiety level of Brazilian Paralympics athletes before the 2008 Beijing Paralympic Games. Cross-sectional study. Setting Exercise and Psychobiology Studies Center (CEPE) and Universidade Federal de São Paulo, an urban city in Brazil. A total of 27 Paralympics athletes of both genders (16 men and 11 women) with an average age of 28±6 years who practised athletics (track and field events) were evaluated. Sleep quality was evaluated using the Pittsburgh Scale and the Epworth Sleepiness Scale to evaluate sleepiness. Chronotype was determined by the Horne and Östberg questionnaire and anxiety through the State-Trait Anxiety Inventory. The evaluations were performed in Brazil 10 days before the competition. The study's results demonstrate that 83.3% of the athletes that presented excessive daytime sleepiness also had poor sleep quality. The authors noted that 71.4% were classified into the morning type and 72% of the athletes who presented a medium anxiety level also presented poor sleep quality. Athletes with poor sleep quality showed significantly lower sleep efficiency (p=0.0119) and greater sleep latency (p=0.0068) than athletes with good sleep quality. Athletes who presented excessive daytime sleepiness presented lower sleep efficiency compared to non-sleepy athletes (p=0.0241). The authors conclude that the majority of athletes presented poor sleep quality before the competition. This information should be taken into consideration whenever possible when scheduling rest, training and competition times.

The 2007 AASM Recommendations for EEG Electrode Placement in Polysomnography: Impact on Sleep and Cortical Arousal Scoring

PubMed Central

Ruehland, Warren R.; O'Donoghue, Fergal J.; Pierce, Robert J.; Thornton, Andrew T.; Singh, Parmjit; Copland, Janet M.; Stevens, Bronwyn; Rochford, Peter D.

2011-01-01

Study Objective: To examine the impact of using American Academy of Sleep Medicine (AASM) recommended EEG derivations (F4/M1, C4/M1, O2/M1) vs. a single derivation (C4/M1) in polysomnography (PSG) on the measurement of sleep and cortical arousals, including inter- and intra-observer variability. Design: Prospective, non-blinded, randomized comparison. Setting: Three Australian tertiary-care hospital clinical sleep laboratories. Patients or Participants: 30 PSGs from consecutive patients investigated for obstructive sleep apnea (OSA) during December 2007 and January 2008. Interventions: N/A Measurements and Results: To examine the impact of EEG derivations on PSG summary statistics, 3 scorers from different Australian clinical sleep laboratories each scored separate sets of 10 PSGs twice, once using 3 EEG derivations and once using 1 EEG derivation. To examine the impact on inter- and intra-scorer reliability, all 3 scorers scored a subset of 10 PSGs 4 times, twice using each method. All PSGs were de-identified and scored in random order according to the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Using 3 referential EEG derivations during PSG, as recommended in the AASM manual, instead of a single central EEG derivation, as originally suggested by Rechtschaffen and Kales (1968), resulted in a mean ± SE decrease in N1 sleep of 9.6 ± 3.9 min (P = 0.018) and an increase in N3 sleep of 10.6 ± 2.8 min (P = 0.001). No significant differences were observed for any other sleep or arousal scoring summary statistics; nor were any differences observed in inter-scorer or intra-scorer reliability for scoring sleep or cortical arousals. Conclusion: This study provides information for those changing practice to comply with the 2007 AASM recommendations for EEG placement in PSG, for those using portable devices that are unable to comply with the recommendations due to limited channel options, and for the development of future standards for PSG scoring and recording. As the use of multiple EEG derivations only led to small changes in the distribution of derived sleep stages and no significant differences in scoring reliability, this study calls into question the need to use multiple EEG derivations in clinical PSG as suggested in the AASM manual. Citation: Ruehland WR; O'Donoghue FJ; Pierce RJ; Thornton AT; Singh P; Copland JM; Stevens B; Rochford PD. The 2007 AASM recommendations for EEG electrode placement in polysomnography: impact on sleep and cortical arousal scoring. SLEEP 2011;34(1):73-81. PMID:21203376

Assessment and Management of Sleep Disturbance in Cirrhosis.

PubMed

Formentin, Chiara; Garrido, Maria; Montagnese, Sara

2018-01-01

This review presents an in-depth overview of the sleep-wake phenotype of patients with cirrhosis, together with available pharmacological and non-pharmacological treatment strategies. A set of simple, practical recommendations is also provided. The understanding of the pathophysiology of sleep disorders in this patient population has improved over the past decade, especially in relation to the interplay between homeostatic and circadian sleep regulation. In addition, new tools have been utilised for both screening and in-depth investigation of the sleep-wake profile of these patients. Finally, a number of studies have evaluated the efficacy of novel treatment strategies, often with encouraging results. Since sleep disturbances are common in patients with cirrhosis, more so than in patients with other chronic diseases of similar severity, their assessment should become routine hepatological practice, along with the initiation of adequate treatment.

Insufficient sleep in adolescents and young adults: an update on causes and consequences.

PubMed

Owens, Judith

2014-09-01

Chronic sleep loss and associated sleepiness and daytime impairments in adolescence are a serious threat to the academic success, health, and safety of our nation's youth and an important public health issue. Understanding the extent and potential short- and long-term repercussions of sleep restriction, as well as the unhealthy sleep practices and environmental factors that contribute to sleep loss in adolescents, is key in setting public policies to mitigate these effects and in counseling patients and families in the clinical setting. This report reviews the current literature on sleep patterns in adolescents, factors contributing to chronic sleep loss (ie, electronic media use, caffeine consumption), and health-related consequences, such as depression, increased obesity risk, and higher rates of drowsy driving accidents. The report also discusses the potential role of later school start times as a means of reducing adolescent sleepiness. Copyright © 2014 by the American Academy of Pediatrics.

Prevalence of sleep breathing complaints reported by treatment-seeking chronic insomnia disorder patients on presentation to a sleep medical center: a preliminary report.

PubMed

Krakow, Barry; Ulibarri, Victor A

2013-03-01

Few studies have examined the co-morbidity between insomnia and sleep-disordered breathing in the clinical setting. This study evaluated treatment-seeking insomnia patients and their self-report of sleep breathing complaints. A retrospective chart review was conducted on 1,035 consecutive treatment-seeking, chronic insomnia patients who reported insomnia as their primary problem upon seeking care at a private, community-based sleep medical center. Measurements included the insomnia severity index, standard subjective sleep measures as well as rankings, attributions, and self-reports about sleep breathing disorders, problems, and symptoms. A total of 1,035 adult, treatment-seeking insomnia patients indicated insomnia interfered with daytime functioning, and their average insomnia severity was in the range of a clinically relevant problem: total sleep time (5.50 h, SD = 1.60), sleep efficiency (71.05 %, SD = 18.26), wake time after sleep onset (120.70 min, SD = 92.56), and an insomnia severity index (18.81, SD = 5.09). Of these 1,035 insomnia patients, 42 % also ranked a sleep breathing disorder among their list of reasons for seeking treatment, another 13 % revealed a concern about a sleep breathing problem, and another 26 % reported awareness of sleep breathing symptoms. Only 19 % of this clinical insomnia sample reported no awareness or concerns about sleep breathing disorders, problems, or symptoms. A greater proportion of men than women reported significantly more sleep breathing disorders, problems, or symptoms. Sleep breathing complaints were extremely common among a large sample of treatment-seeking, self-identified, adult chronic insomnia patients. Prospective prevalence research is needed to corroborate or revise these findings, and polysomnography should be considered in appropriate cohorts to determine the clinical relevance of treatment-seeking chronic insomnia patients' sleep breathing complaints.

Behavioral Sleep-Wake Homeostasis and EEG Delta Power Are Decoupled By Chronic Sleep Restriction in the Rat

PubMed Central

Stephenson, Richard; Caron, Aimee M.; Famina, Svetlana

2015-01-01

Study Objectives: Chronic sleep restriction (CSR) is prevalent in society and is linked to adverse consequences that might be ameliorated by acclimation of homeostatic drive. This study was designed to test the hypothesis that the sleep-wake homeostat will acclimatize to CSR. DESIGN: A four-parameter model of proportional control was used to quantify sleep homeostasis with and without recourse to a sleep intensity function. Setting: Animal laboratory, rodent walking-wheel apparatus. Subjects: Male Sprague-Dawley rats. Interventions: Acute total sleep deprivation (TSD, 1 day × 18 or 24 h, N = 12), CSR (10 days × 18 h TSD, N = 6, or 5 days × 20 h TSD, N = 5). Measurements and Results: Behavioral rebounds were consistent with model predictions for proportional control of cumulative times in wake, nonrapid eye movement sleep (NREM) and rapid eye movement sleep (REM). Delta (Δ) energy homeostasis was secondary to behavioral homeostasis; a biphasic NREM Δ power rebound contributed to the dynamics (rapid response) but not to the magnitude of the rebound in Δ energy. REM behavioral homeostasis was little affected by CSR. NREM behavioral homeostasis was attenuated in proportion to cumulative NREM deficit, whereas the biphasic NREM Δ power rebound was only slightly suppressed, indicating decoupled regulatory mechanisms following CSR. Conclusions: We conclude that sleep homeostasis is achieved through behavioral regulation, that the nonrapid eye movement sleep behavioral homeostat is susceptible to attenuation during chronic sleep restriction and that the concept of sleep intensity is not essential in a model of sleep-wake regulation. Citation: Stephenson R, Caron AM, Famina S. Behavioral sleep-wake homeostasis and EEG delta power are decoupled by chronic sleep restriction in the rat. SLEEP 2015;38(5):685–697. PMID:25669184

Sleep and dietary habits in the urban environment: the role of chrono-nutrition.

PubMed

Pot, Gerda K

2017-10-25

The urban environment has changed vastly over past decades, which also has had an impact on our sleep and dietary patterns and possibly health outcomes. Some studies have shown that sleep duration and sleep quality has declined over past decades, especially in children. In parallel, our lifestyle and dietary patterns have also changed including more shift work, more meals outside the home or family setting and more irregular eating patterns, including breakfast skipping and late-night eating. This new area of research in nutritional sciences studying the impact of the timing of eating on health outcomes is called chrono-nutrition, and combines elements from nutritional research with chrono-biology. The objectives of this paper were to discuss secular trends in sleep patterns and related dietary patterns, introduce basic concepts and mechanisms of chrono-nutrition and discuss the evidence for the importance of sleep and chrono-nutrition in relation to health outcomes. Overall, chrono-nutrition could mediate the effects between sleep, diet and urbanisation, and more research is needed to elucidate the importance of chrono-nutrition for metabolic health and its impact on public health.

Direct Comparison of Two New Actigraphs and Polysomnography in Children and Adolescents

PubMed Central

Meltzer, Lisa J.; Walsh, Colleen M.; Traylor, Joel; Westin, Anna M. L.

2012-01-01

Study Objectives: To evaluate the validity and reliability of 2 new models of commercially available actigraphs compared to polysomnography for children and adolescents. Design and Setting: Subjects concurrently wore the Ambulatory Monitoring Inc. Motionlogger Sleep Watch (AMI) and the Phillips Respironics Mini-Mitter Actiwatch-2 (PRMM) while undergoing overnight polysomnography (PSG) in a pediatric sleep laboratory housed in a tertiary care children's hospital. Participants: 115 youth (59 girls, 56 boys), ages 3-18 years (mean 8.8 years, SD 4.4 years). Measurements: Outcome variables were total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). Epoch-by-epoch comparisons were made between the 2 devices and PSG to determine sensitivity, specificity, and accuracy. Agreement between the 2 devices was determined with t-tests and the Bland-Altman concordance technique. Different algorithms/sensitivities, developmental age groups, and sleep disordered breathing (SDB) status were also examined. Results: For both device brands, sensitivity (0.89-0.97), specificity (0.54-0.77), and accuracy (0.87-0.90) were similar to previous reports. Notably, compared to PSG, both device brands significantly overestimated WASO, while the AMI device also significantly underestimated TST. Inter-device comparison of the 2 brands found poor agreement for TST, WASO, and SE. Agreement with PSG differed depending on the scoring algorithm (AMI) or sensitivity setting (PRMM), as well as across developmental age group and sleep disordered breathing (SDB) status. Conclusions: Similar to previous reports, both new actigraph brands were found to have good sensitivity (to detect sleep), but poorer specificity (to detect wake). Study results also suggest that researchers should adjust the scoring algorithm/sensitivity depending on a study's design (e.g., young children vs. adolescents, healthy children vs. youth with SDB). Further, inter-device reliability was poor, suggesting the need for caution when comparing results across studies that use different brands of actigraphic devices. Citation: Meltzer LJ; Walsh CM; Traylor J; Westin AML. Direct comparison of two new actigraphs and polysomnography in children and adolescents. SLEEP 2012;35(1):159-166. PMID:22215930

Sleep Behaviors and Sleep Quality in Children with Autism Spectrum Disorders

PubMed Central

Souders, Margaret C.; Mason, Thorton B. A.; Valladares, Otto; Bucan, Maja; Levy, Susan E.; Mandell, David S.; Weaver, Terri E.; Pinto-Martin, Jennifer

2009-01-01

Study Objectives: (1) Compare sleep behaviors of children with autism spectrum disorders (ASD) with sleep behaviors of typically developing (TD) children using the Children's Sleep Habits Questionnaire (CSHQ); (2) compare sleep quality—defined as mean activity, sleep latency, number of awakenings, sleep efficiency and total sleep time—of the cohort of children with ASD and TD, as measured by 10 nights of actigraphy; and (3) estimate the prevalence of sleep disturbances in the ASD and TD cohorts. Design: Descriptive cross-sectional study. Setting: The Children's Hospital of Philadelphia. Participants: Randomly selected children from the Regional Autism Center. The ASD cohort of 59 children, aged 4 to 10 years, (26 with autism, 21 with pervasive developmental disorder-not otherwise specified [PDD-NOS], and 12 with Asperger disorder) were compared with 40 TD control subjects. Measurements and Results: The CSHQ, sleep diaries, and 10 nights of actigraphy using the Sadeh algorithm of children with ASD and TD control subjects were compared. CSHQ showed 66.1% of parents of children with ASD (62.5% autism, 76.2% PDD-NOS, 58.3% Asperger disorder) and 45% of parents of the control subjects reported that their children had sleep problems. Actigraphic data showed that 66.7% of children with ASD (75% autism, 52.4% PDD-NOS, 75% Asperger disorder) and 45.9% of the control subjects had disturbed sleep. Conclusions: The prevalence estimate of 45% for mild sleep disturbances in the TD cohort highlights pediatric sleep debt as a public health problem of concern. The prevalence estimate of 66% for moderate sleep disturbances in the ASD cohort underscores the significant sleep problems that the families of these children face. The predominant sleep disorders in the ASD cohort were behavioral insomnia sleep-onset type and insomnia due to PDD. Citation: Souders MC; Mason TBA; Valladares O; Bucan M; Levy SE; Mandell DS; Weaver TE; Pinto-Martin D. Sleep behaviors and sleep quality in children with autism spectrum disorders. SLEEP 2009;32(12):1566-1578. PMID:20041592

Sleep duration and insulin resistance in healthy black and white adolescents.

PubMed

Matthews, Karen A; Dahl, Ronald E; Owens, Jane F; Lee, Laisze; Hall, Martica

2012-10-01

Poor sleep may play a role in insulin resistance and diabetes risk. Yet few studies of sleep and insulin resistance have focused on the important developmental period of adolescence. To address this gap, we examined the association of sleep and insulin resistance in healthy adolescents. Cross-sectional. Community setting in one high school. 245 (137 African Americans, 116 males) high school students. Participants provided a fasting blood draw and kept a sleep log and wore a wrist actigraph for one week during the school year. Participants' families were from low to middle class based on family Hollingshead scores. Total sleep time across the week averaged 7.4 h by diary and 6.4 h by actigraph; homeostatic model assessment of insulin resistance ([HOMA-IR] unadjusted) averaged 4.13. Linear regression analyses adjusted for age, race, gender, body mass index, and waist circumference showed that the shorter the sleep, the higher the HOMA-IR, primarily due to sleep duration during the week. No evidence was found for long sleep being associated with elevated HOMA-IR. Fragmented sleep was not associated with HOMA-IR but was associated with glucose levels. Reduced sleep duration is associated with HOMA-IR in adolescence. Long sleep duration is not associated. Interventions to extend sleep duration may reduce diabetes risk in youth.

Napping: A public health issue. From epidemiological to laboratory studies.

PubMed

Faraut, Brice; Andrillon, Thomas; Vecchierini, Marie-Françoise; Leger, Damien

2017-10-01

Sleep specialists have proposed measures to counteract the negative short- and long-term consequences of sleep debt, and some have suggested the nap as a potential and powerful "public health tool". Here, we address this countermeasure aspect of napping viewed as an action against sleep deprivation rather than an action associated with poor health. We review the physiological functions that have been associated positively with napping in both public health and clinical settings (sleep-related accidents, work and school, and cardiovascular risk) and in laboratory-based studies with potential public health issues (cognitive performance, stress, immune function and pain sensitivity). We also discuss the circumstances in which napping-depending on several factors, including nap duration, frequency, and age-could be a potential public health tool and a countermeasure for sleep loss in terms of reducing accidents and cardiovascular events and improving sleep-restriction-sensitive working performance. However, the impact of napping and the nature of the sleep stage(s) involved still need to be evaluated, especially from the perspective of coping strategies in populations with chronic sleep debt, such as night and shift workers. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Maternal Lifestyle Study: Sleep Problems in Children with Prenatal Substance Exposure

PubMed Central

Stone, Kristen C.; LaGasse, Linda L.; Lester, Barry M.; Shankaran, Seetha; Bada, Henrietta S.; Bauer, Charles R.; Hammond, Jane A.

2010-01-01

Objective To examine the relationships between sleep problems and prenatal exposure to cocaine, opiates, marijuana, alcohol, and nicotine in children 1 month to 12 years of age. Design Sleep data was collected by maternal report in a prospective longitudinal follow-up of children participating in the Maternal Lifestyle multisite study. Setting Hospital based research centers in Providence, RI, Miami, FL, Detroit, MI, and Memphis, TN Participants There were 808 participants: 374 exposed to cocaine and/or opiates; 434 comparison. Main exposure Prenatal cocaine, opiate, marijuana, alcohol, and nicotine exposure. Outcome measure Sleep problems in early, middle, and late childhood, assessed as composites of maternal report items. Results Of the five substances, prenatal nicotine exposure was the only unique predictor of sleep problems (B = .074, R2 Δ = .008, p = .012) with adjustment for covariates including SES, marital status, physical abuse, prenatal medical care, and postnatal cigarette smoke exposure. Conclusion Prenatal exposure to nicotine was positively associated with children's sleep problems persisting throughout the first 12 years of life. Targeting this group of children for educational and behavioral efforts to prevent and treat sleep problems is merited given that good sleep may serve as a protective factor for other developmental outcomes. PMID:20439796

The impact of sleep on female sexual response and behavior: a pilot study.

PubMed

Kalmbach, David A; Arnedt, J Todd; Pillai, Vivek; Ciesla, Jeffrey A

2015-05-01

The etiological role of sleep disturbance in sexual difficulties has been largely overlooked. Research suggests that short sleep duration and poor sleep quality lead to poor female sexual response. However, prior research consists of cross-sectional studies, and the influence of sleep on sexual functioning and behavior has not been prospectively examined. We sought to examine the influence of nightly sleep duration, sleep quality, and sleep onset latency on daily female sexual response and activity. This study used a longitudinal design to study 171 women free of antidepressants and with reliable Internet access who were recruited from a university setting in the United States. Participants first completed baseline measures in a laboratory, and then completed web-delivered surveys at their habitual wake time for 14 consecutive days. All outcome measures were modified for daily recall. Participants completed the Profile of Female Sexual Function's desire, subjective arousal, and orgasmic functioning scales and the Female Sexual Function Index's genital arousal scale, and indicated whether they engaged in partnered sexual activity or self-stimulation in response to dichotomous items. Analyses revealed that longer sleep duration was related to greater next-day sexual desire (b = 0.32, P = 0.02), and that a 1-hour increase in sleep length corresponded to a 14% increase in odds of engaging in partnered sexual activity (odds ratio = 1.14, P < 0.05). In contrast, sleeping longer predicted poorer next-day genital arousal (b = -0.19, P < 0.01). However, results showed that women with longer average sleep duration reported better genital arousal than women with shorter average sleep length (b = 0.54, P = 0.03). Obtaining sufficient sleep is important to the promotion of healthy sexual desire and genital response, as well as the likelihood of engaging in partnered sexual activity. These relationships were independent of daytime affect and fatigue. Future directions may investigate sleep disorders as risk factors for sexual dysfunction. © 2015 International Society for Sexual Medicine.

Characteristics of chronic pain associated with sleep difficulty in the older population: The MOBILIZE Boston Study

PubMed Central

Chen, Qian; Hayman, Laura L.; Shmerling, Robert H.; Bean, Jonathan F.; Leveille, Suzanne G.

2012-01-01

Objectivers To evaluate pain severity and distribution in relation to sleep difficulty in older adults. Design Population-based cross-sectional study Setting Community within a 5-mile radius of the study center at the Institute for Aging Research, Hebrew SeniorLife (HSL) in Boston Participants 765 participants of the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study, aged 64 and older. Measurements Pain severity was measured using the Brief Pain Inventory (BPI), Pain Severity Subscale. Musculoskeletal pain distribution was grouped according to no pain, single site, ≥2 sites, and widespread pain (upper and lower extremities and back pain). We measured 3 aspects of sleep difficulty using items from the CESD-R (trouble getting to sleep, sleep more than usual, and restless sleep). Results Prevalence of trouble getting to sleep according to BPI severity was 17.8%, 19.7%, 32.0%, and 37.0% for the lowest to highest pain severity quartiles, respectively. Similar relationships between pain and sleep were observed across sleep measures according to pain severity and distribution. Adjusted for sociodemographic characteristics, chronic conditions and health behaviors, chronic pain was strongly associated with trouble sleeping (≥1d/week), (single site pain, OR=1.77, 95%CI, 1.10–2.87; multisite pain OR=2.38, 95% CI, 1.48–3.83; and widespread pain, OR=2.55, 95% CI, 1.43–4.54, each compared with no pain). Similar associations were observed for restless sleep and sleeping more than usual. With specific pain sites alone or in combination with other sites of pain, only modest associations were observed with sleep problems. Conclusion Widespread or other multisite pain and moderate to severe pain are strongly associated with sleep difficulty in older adults. Further research is needed to better understand the burden and consequences of pain-related sleep problems in the older population. PMID:21806564

Sleep education during pregnancy for new mothers.

PubMed

Kempler, Liora; Sharpe, Louise; Bartlett, Delwyn

2012-12-17

There is a high association between disturbed (poor quality) sleep and depression, which has lead to a consensus that there is a bidirectional relationship between sleep and mood. One time in a woman's life when sleep is commonly disturbed is during pregnancy and following childbirth. It has been suggested that sleep disturbance is another factor that may contribute to the propensity for women to become depressed in the postpartum period compared to other periods in their life. Post Natal Depression (PND) is common (15.5%) and associated with sleep disturbance, however, no studies have attempted to provide a sleep-focused intervention to pregnant women and assess whether this can improve sleep, and consequently maternal mood post-partum. The primary aim of this research is to determine the efficacy of a brief psychoeducational sleep intervention compared with a control group to improve sleep management, with a view to reduce depressive symptoms in first time mothers. This randomised controlled trial will recruit 214 first time mothers during the last trimester of their pregnancy. Participants will be randomised to receive either a set of booklets (control group) or a 3 hour psychoeducational intervention that focuses on sleep. The primary outcomes of this study are sleep-related, that is sleep quality and sleepiness for ten months following the birth of the baby. The secondary outcome is depressive symptoms. It is hypothesised that participants in the intervention group will have better sleep quality and sleepiness in the postpartum period than women in the control condition. Further, we predict that women who receive the sleep intervention will have lower depression scores postpartum compared with the control group. This study aims to provide an intervention that will improve maternal sleep in the postpartum period. If sleep can be effectively improved through a brief psychoeducational program, then it may have a protective role in reducing maternal postpartum depressive symptoms. This trial is registered with the Australian New Zealand Clinical Trials Register under the registration number ACTRN12611000859987

Before-after field study of effects of wind turbine noise on polysomnographic sleep parameters.

PubMed

Jalali, Leila; Bigelow, Philip; Nezhad-Ahmadi, Mohammad-Reza; Gohari, Mahmood; Williams, Diane; McColl, Steve

2016-01-01

Wind is considered one of the most advantageous alternatives to fossil energy because of its low operating cost and extensive availability. However, alleged health-related effects of exposure to wind turbine (WT) noise have attracted much public attention and various symptoms, such as sleep disturbance, have been reported by residents living close to wind developments. Prospective cohort study with synchronous measurement of noise and sleep physiologic signals was conducted to explore the possibility of sleep disturbance in people hosting new industrial WTs in Ontario, Canada, using a pre and post-exposure design. Objective and subjective sleep data were collected through polysomnography (PSG), the gold standard diagnostic test, and sleep diary. Sixteen participants were studied before and after WT installation during two consecutive nights in their own bedrooms. Both audible and infrasound noises were also concurrently measured inside the bedroom of each participant. Different noise exposure parameters were calculated (LAeq, LZeq) and analyzed in relation to whole-night sleep parameters. Results obtained from PSG show that sleep parameters were not significantly changed after exposure. However, reported sleep qualities were significantly (P = 0.008) worsened after exposure. Average noise levels during the exposure period were low to moderate and the mean of inside noise levels did not significantly change after exposure. The result of this study based on advanced sleep recording methodology together with extensive noise measurements in an ecologically valid setting cautiously suggests that there are no major changes in the sleep of participants who host new industrial WTs in their community. Further studies with a larger sample size and including comprehensive single-event analyses are warranted.

Before–After Field Study of Effects of Wind Turbine Noise on Polysomnographic Sleep Parameters

PubMed Central

Jalali, Leila; Bigelow, Philip; Nezhad-Ahmadi, Mohammad-Reza; Gohari, Mahmood; Williams, Diane; McColl, Steve

2016-01-01

Wind is considered one of the most advantageous alternatives to fossil energy because of its low operating cost and extensive availability. However, alleged health-related effects of exposure to wind turbine (WT) noise have attracted much public attention and various symptoms, such as sleep disturbance, have been reported by residents living close to wind developments. Prospective cohort study with synchronous measurement of noise and sleep physiologic signals was conducted to explore the possibility of sleep disturbance in people hosting new industrial WTs in Ontario, Canada, using a pre and post-exposure design. Objective and subjective sleep data were collected through polysomnography (PSG), the gold standard diagnostic test, and sleep diary. Sixteen participants were studied before and after WT installation during two consecutive nights in their own bedrooms. Both audible and infrasound noises were also concurrently measured inside the bedroom of each participant. Different noise exposure parameters were calculated (LAeq, LZeq) and analyzed in relation to whole-night sleep parameters. Results obtained from PSG show that sleep parameters were not significantly changed after exposure. However, reported sleep qualities were significantly (P=0.008) worsened after exposure. Average noise levels during the exposure period were low to moderate and the mean of inside noise levels did not significantly change after exposure. The result of this study based on advanced sleep recording methodology together with extensive noise measurements in an ecologically valid setting cautiously suggests that there are no major changes in the sleep of participants who host new industrial WTs in their community. Further studies with a larger sample size and including comprehensive single-event analyses are warranted. PMID:27569407

Sleep Duration and Body Mass Index in Twins: A Gene-Environment Interaction

PubMed Central

Watson, Nathaniel F.; Harden, Kathryn Paige; Buchwald, Dedra; Vitiello, Michael V.; Pack, Allan I.; Weigle, David S.; Goldberg, Jack

2012-01-01

Study Objectives: To examine whether sleep duration modifies genetic and environmental influences on body mass index (BMI). Design: Genotype-environment interaction twin study. Setting: University of Washington Twin Registry. Patients or Participants: A population-based sample of US twins (1,088 pairs, 604 monozygotic, 484 dizygotic; 66% female; mean age = 36.6 yr, standard deviation (SD) = 15.9 yr). Interventions: N/A. Measurements and Results: Participants self-reported information on height, weight, and sleep. Mean BMI was calculated as 25.3 kg/m2 (SD = 5.4) and mean habitual sleep duration was 7.2 hr/night (SD = 1.2). Data were analyzed using biometric genetic interaction models. Overall the heritability of sleep duration was 34%. Longer sleep duration was associated with decreased BMI (P < 0.05). The heritability of BMI when sleep duration was < 7 hr (h2 = 70%) was more than twice as large as the heritability of BMI when sleep duration was ≥ 9 hr (h2 = 32%); this interaction was significant (P < 0.05). Conclusions: Shorter sleep duration is associated with increased BMI and increased genetic influences on BMI, suggesting that shorter sleep duration increases expression of genetic risks for high body weight. At the same time, longer sleep duration may suppress genetic influences on body weight. Future research aiming to identify specific genotypes for BMI may benefit by considering the moderating role of sleep duration. Citation: Watson NF; Harden KP; Buchwald D; Vitiello MV; Pack AI; Weigle DS; Goldberg J. Sleep duration and body mass index in twins: a gene-environment interaction. SLEEP 2012;35(5):597-603. PMID:22547885

Sex Hormones, Sleep, and Core Body Temperature in Older Postmenopausal Women

PubMed Central

Murphy, Patricia J.; Campbell, Scott S.

2007-01-01

Study Objectives: Assessment of relationships between polysomnographic sleep, sex hormones, and core body temperature in postmenopausal women. Design and Participants: Ten women aged 57 to 71 years, at least 5 years past menopause. Setting: Laboratory of Human Chronobiology at Weill Cornell Medical College. Interventions: N/A. Measurements and Results: Lower estradiol (E2) and higher luteinizing hormone (LH) levels were significantly correlated with indices of poor sleep quality. Relationships between LH and polysomnographic variables were more robust than those for E2. Significant increases from basal LH levels (i.e., LH pulses) occurred more frequently after sleep onset than prior to sleep onset, and 30 of 32 of these LH pulses occurred prior to long awakenings from sleep. In addition, higher body core temperature prior to and during sleep was significantly correlated with poorer sleep efficiency and higher LH levels. Conclusions: Most investigations of relationships between sleep, sex hormones, and body temperature have focused on perimenopausal women, menopausal phenomena such as hot flashes, the role of declining estrogen, and treatment with exogenous estrogen. The current results suggest that altered levels of both sex steroids and gonadotropins may contribute to sleep disturbance in older women and confirm the results of previous studies indicating that higher body core temperature is associated with poorer sleep quality, even in women without vasomotor symptoms. The findings also raise the possibility of alternate treatment avenues for menopause- and age-related sleep disturbance that focus on altering LH levels. Citation: Murphy PJ; Campbell SS. Sex hormones, sleep, and core body temperature in older postmenopausal women. SLEEP 2007;30(12):1788-1794. PMID:18246988

Movement Distribution: A New Measure of Sleep Fragmentation in Children with Upper Airway Obstruction

PubMed Central

Coussens, Scott; Baumert, Mathias; Kohler, Mark; Martin, James; Kennedy, Declan; Lushington, Kurt; Saint, David; Pamula, Yvonne

2014-01-01

Study Objectives: To develop a measure of sleep fragmentation in children with upper airway obstruction based on survival curve analysis of sleep continuity. Design: Prospective repeated measures. Setting: Hospital sleep laboratory. Participants: 92 children aged 3.0 to 12.9 years undergoing 2 overnight polysomnographic (PSG) sleep studies, 6 months apart. Subjects were divided into 3 groups based on their obstructive apnea and hypopnea index (OAHI) and other upper airway obstruction (UAO) symptoms: primary snorers (PS; n = 24, OAHI < 1), those with obstructive sleep apnea syndrome (OSAS; n = 20, OAHI ≥ 1) and non-snoring controls (C; n = 48, OAHI < 1). Interventions: Subjects in the PS and OSAS groups underwent tonsillectomy and adenoidectomy between PSG assessments. Measurements and Results: Post hoc measures of movement and contiguous sleep epochs were exported and analyzed using Kaplan-Meier estimates of survival to generate survival curves for the 3 groups. Statistically significant differences were found between these group curves for sleep continuity (P < 0.05) when using movement events as the sleep fragmenting event, but not if stage 1 NREM sleep or awakenings were used. Conclusion: Using conventional indices of sleep fragmentation in survival curve analysis of sleep continuity does not provide a useful measure of sleep fragmentation in children with upper airway obstruction. However, when sleep continuity is defined as the time between gross body movements, a potentially useful clinical measure is produced. Citation: Coussens S, Baumert M, Kohler M, Martin J, Kennedy D, Lushington K, Saint D, Pamula Y. Movement distribution: a new measure of sleep fragmentation in children with upper airway obstruction. SLEEP 2014;37(12):2025-2034. PMID:25325486

Insomnia with Objective Short Sleep Duration is Associated with a High Risk for Hypertension

PubMed Central

Vgontzas, Alexandros N.; Liao, Duanping; Bixler, Edward O.; Chrousos, George P.; Vela-Bueno, Antonio

2009-01-01

Study Objectives: To examine the joint effect of insomnia and objective short sleep duration on hypertension risk. Design: Representative cross-sectional study. Setting: Sleep laboratory. Participants: 1,741 men and women randomly selected from central Pennsylvania. Interventions: None. Measurements: Insomnia was defined by a complaint of insomnia with a duration ≥ 1 year, while poor sleep was defined as a complaint of difficulty falling asleep, staying asleep, or early final awakening. Polysomnographic sleep duration was classified into 3 categories: ≥ 6 h sleep (top 50% of the sample); 5-6 h (approximately the third quartile of the sample); and ≤ 5 h (approximately the bottom quartile of the sample). Hypertension was defined based either on blood pressure measures or treatment. We controlled for age, race, sex, body mass index, diabetes, smoking, alcohol use, depression, sleep disordered breathing (SDB), and sampling weight. Results: Compared to the normal sleeping and > 6 h sleep duration group, the highest risk of hypertension was in insomnia with < 5 h sleep duration group (OR [95% CI] 5.1 [2.2, 11.8]), and the second highest in insomnia who slept 5-6 hours (OR 3.5 [1.6, 7.9] P < 0.01). The risk for hypertension was significantly higher, but of lesser magnitude, in poor sleepers with short sleep duration. Conclusions: Insomnia with short sleep duration is associated with increased risk of hypertension, to a degree comparable to that of other common sleep disorders, e.g., SDB. Objective sleep duration may predict the severity of chronic insomnia a prevalent condition whose medical impact has been apparently underestimated. Citation: Vgontzas AN; Liao D; Bixler EO; Chrousos GP; Vela-Bueno A. Insomnia with objective short sleep duration is associated with a high risk for hypertension. SLEEP 2009;32(4):491–497. PMID:19413143

Pairwise Measures of Causal Direction in the Epidemiology of Sleep Problems and Depression

PubMed Central

Rosenström, Tom; Jokela, Markus; Puttonen, Sampsa; Hintsanen, Mirka; Pulkki-Råback, Laura; Viikari, Jorma S.; Raitakari, Olli T.; Keltikangas-Järvinen, Liisa

2012-01-01

Depressive mood is often preceded by sleep problems, suggesting that they increase the risk of depression. Sleep problems can also reflect prodromal symptom of depression, thus temporal precedence alone is insufficient to confirm causality. The authors applied recently introduced statistical causal-discovery algorithms that can estimate causality from cross-sectional samples in order to infer the direction of causality between the two sets of symptoms from a novel perspective. Two common-population samples were used; one from the Young Finns study (690 men and 997 women, average age 37.7 years, range 30–45), and another from the Wisconsin Longitudinal study (3101 men and 3539 women, average age 53.1 years, range 52–55). These included three depression questionnaires (two in Young Finns data) and two sleep problem questionnaires. Three different causality estimates were constructed for each data set, tested in a benchmark data with a (practically) known causality, and tested for assumption violations using simulated data. Causality algorithms performed well in the benchmark data and simulations, and a prediction was drawn for future empirical studies to confirm: for minor depression/dysphoria, sleep problems cause significantly more dysphoria than dysphoria causes sleep problems. The situation may change as depression becomes more severe, or more severe levels of symptoms are evaluated; also, artefacts due to severe depression being less well presented in the population data than minor depression may intervene the estimation for depression scales that emphasize severe symptoms. The findings are consistent with other emerging epidemiological and biological evidence. PMID:23226400

An Integrative Review of Nonpharmacological Interventions to Improve Sleep among Adults with Advanced Serious Illness.

PubMed

Capezuti, Elizabeth; Sagha Zadeh, Rana; Woody, Nicole; Basara, Aleksa; Krieger, Ana C

2018-05-01

Sleep fragmentation is common among those with advanced serious illness. Nonpharmacological interventions to improve sleep have few, if any, adverse effects and are often underutilized in these settings. We aimed to summarize the literature related to nonpharmacological interventions to improve sleep among adults with advanced serious illness. We systematically searched six electronic databases for literature reporting sleep outcomes associated with nonpharmacological interventions that included participants with advanced serious illness during the period of 1996-2016. From a total of 2731 results, 42 studies met the inclusion criteria. A total of 31 individual interventions were identified, each evaluated individually and some in combination with other interventions. Twelve of these studies employed either multiple interventions within an intervention category (n = 8) or a multicomponent intervention consisting of interventions from two or more categories (n = 5). The following intervention categories emerged: sleep hygiene (1), environmental (6), physical activity (4), complementary health practices (11), and mind-body practices (13). Of the 42 studies, 22 demonstrated a statistically significant, positive impact on sleep and represented each of the categories. The quality of the studies varied considerably, with 17 studies classified as strong, 17 as moderate, and 8 as weak. Several interventions have been demonstrated to improve sleep in these patients. However, the small number of studies and wide variation of individual interventions within each category limit the generalizability of findings. Further studies are needed to assess interventions and determine effectiveness and acceptability.

Sleep Patterns in Adults with a Diagnosis of High-Functioning Autism Spectrum Disorder

PubMed Central

Baker, Emma K.; Richdale, Amanda L.

2015-01-01

Study Objectives: To examine sleep patterns and sleep problems and their relationship with daytime functioning in adults with a diagnosis of an autism spectrum disorder and no comorbid intellectual disability (high-functioning autism spectrum disorder [HFASD]) compared to neurotypical (NT) adults. Design: Cross-sectional. Setting: Home-based study. Participants: 36 adults with HFASD and 36 age-, intelligence quotient- and sex-matched NT adults. Measurements: Participants completed an online questionnaire battery including the Pittsburgh Sleep Quality Index (PSQI), a 14-d sleep wake diary and 14-d actigraphy data collection. Results: Adults with HFASD had significantly more general sleep disturbances and higher scores on the PSQI, longer sleep onset latencies (actigraphy), and poorer sleep efficiency (diary) and these results remained significant after accounting for the False Discovery Rate. Those adults with HFASD who did not have a comorbid diagnosis of anxiety/depression had significantly shorter total sleep time (diary and actigraphy) compared to NT adults. Compared to NT adults, the HFASD group self-reported significantly poorer refreshment scores upon waking in the morning and higher scores on the daytime dysfunction due to sleepiness subscale of the PSQI. Conclusions: These findings support the notion that problems related to sleep, in particular insomnia, continue into adulthood in individuals with high-functioning autism spectrum disorder. Citation: Baker EK, Richdale AL. Sleep patterns in adults with a diagnosis of high-functioning autism spectrum disorder. SLEEP 2015;38(11):1765–1774. PMID:26237770

A community-based study of sleep and behaviour problems in 12- to 36-month-old children.

PubMed

Hall, W A; Scher, A; Zaidman-Zait, A; Espezel, H; Warnock, F

2012-05-01

While evidence suggests sleep problems are common in young children and linked to behavioural problems, studies of toddlers are rare. This community-based cross-sectional study examined associations between sleep problems and daytime behaviour among 58 children aged 1 to 3 years who attended daycare centres. Mothers and daycare providers completed four and three questionnaires, respectively, about children's sleep patterns and behaviour. Two hypotheses were tested: (1) children with higher sleep problem scores would have more behavioural problems by parental and daycare provider report; (2) problematic napping behaviours would be associated with night sleep problems. Mothers' reports of sleep problems were positively associated with children's behavioural problems at home and daycare providers' reports of nap problems were positively correlated with children's behavioural problems at daycare. Daycare providers' reports of children's behavioural problems at daycare were associated with maternal reports of behavioural problems. Older children in the sleep problem group had maternal reports of more behavioural problems. Daycare providers reported that children with sleep problems were less happy at daycare. Children who were happier following naps had less reported night settling difficulties. Children with difficulty settling for naps at daycare had maternal reports of more behavioural problems. Napping in daycare settings is an important component of toddlers' sleep. Crossover effects between children's sleep and behaviour at daycare and home indicate similarities in mothers' and daycare providers' perceptions. Findings suggest parent and daycare provider interactions include discussions about sleep problems and settling at home and in daycares. Parents and daycare providers would benefit from education about relationships between sleep and behavioural problems. © 2011 Blackwell Publishing Ltd.

Determining Resident Sleep During and After Call With Commercial Sleep Monitoring Devices.

PubMed

Morhardt, Duncan R; Luckenbaugh, Amy; Goldstein, Cathy; Faerber, Gary J

2017-08-01

To demonstrate that commercial activity monitoring devices (CAMDs) are practical for monitoring resident sleep while on call. Studies that have directly monitored resident sleep are limited, likely owing to both cost and difficulty in study interpretation. The advent of wearable CAMDs that estimate sleep presents the opportunity to more readily evaluate resident sleep in physically active settings and "home call," a coverage arrangement familiar to urology programs. Twelve urology residents were outfitted with Fitbit Flex devices during "home call" for a total of 57 (out of 64, or 89%) call or post-call night pairs. Residents were surveyed with the Stanford Sleepiness Scale (SSS), a single-question alertness survey. Time in bed (TIB) was "time to bed" to "rise for day." Fitbit accelerometers register activity as follows: (1) not moving; (2) minimal movement or restless; or (3) above threshold for accelerometer to register steps. Total sleep time (TST) was the number of minutes in level 1 activity during TIB. Sleep efficiency (SE) was defined as TST divided by TIB. While on call, 10 responding (of 12 available, 83%) residents on average reported TIB as 347 minutes, TST as 165 minutes, and had an SE of 47%. Interestingly, SSS responses did not correlate with sleep parameters. Post-call sleep demonstrated increases in TIB, SE, and TST (+23%, +15%, and +44%, respectively) while sleepiness was reduced by 22%. We demonstrate that urologic residents can consistently wear CAMDs while on home call. SSS did not correlate with Fitbit-estimated sleep duration. Further study with such devices may enhance sleep deprivation recognition to improve resident sleep. Copyright © 2017 Elsevier Inc. All rights reserved.

The Effect of Posture on Cheyne-Stokes Respirations and Hemodynamics in Patients with Heart Failure

PubMed Central

Soll, Bruce A.G.; Keong Yeo, Khung; Davis, James W.; Seto, Todd B.; Schatz, Irwin J.; Shen, Edward N.

2009-01-01

Study Objectives: Cheyne-Stokes respirations occur in 40% of patients with heart failure. Orthopnea is a cardinal symptom of heart failure and may affect the patient's sleeping angle. The objective of this study was to assess the respiratory and hemodynamic response to sleeping angle in a group of subjects with stable heart failure. Design: Twenty-five patients underwent overnight polysomnography with simultaneous and continuous impedance cardiographic monitoring. Sleeping polysomnographic and impedance cardiographic data were recorded. Setting: The study was conducted in a sleep center. Patients: All 25 patients had clinically stable heart failure and left ventricular ejection fractions < 40%. Interventions: The patients slept at 0°, 15°, 30°, and 45° in random order. Measurements and Results: Seventeen patients had Cheyne-Stokes apneas (index > 5/h) and 23 patients had hypopneas (index > 5/h). The hypopnea index showed no response to sleeping angle. The Cheyne-Stokes apnea index decreased with increasing sleeping angle (P < 0.001). This effect was seen only during supine sleep and non-rapid eye movement sleep and was absent in non-supine sleep, rapid eye movement sleep, and during periods of wakefulness. Thoracic fluid content index and left ventricular hemodynamics measured by impedance cardiography showed no response to sleeping angle. Conclusions: Changing the heart failure patient's sleeping angle from 0° to 45° results in a significant decrease in Cheyne-Stokes apneas. This decrease occurs on a constant base of hypopneas. The changes in Cheyne-Stokes apneas are not related to changes in lung congestion and left ventricular hemodynamics. Citation: Soll BAG; Yeo KK; Davis JW; Seto TB; Schatz IJ; Shen EN. The effect of posture on Cheyne-Stokes respirations and hemodynamics in patients with heart failure. SLEEP 2009;32(11):1499-1506. PMID:19928389

Evaluation of actigraphy-measured sleep patterns among children with disabilities and associations with caregivers’ educational attainment: results from a cross-sectional study

PubMed Central

Chen, Xiaoli; Velez, Juan Carlos; Barbosa, Clarita; Pepper, Micah; Gelaye, Bizu; Redline, Susan; Williams, Michelle A

2015-01-01

Objectives To use wrist-actrigrphy to collect objective measures of sleep and to characterise actigraphy-measured sleep patterns among children with disabilities. We also assessed the extent to which, if at all, caregivers’ education is associated with children's sleep disturbances. Design Cross-sectional study. Setting A rehabilitation centre in the Patagonia region, Chile. Methods This study was conducted among 125 children aged 6–12 years with disabilities (boys: 55.2%) and their primary caregivers in Chile. Children wore ActiSleep monitors for 7 days. A general linear model was fitted to generate least-square means and SEs of sleep efficiency (proportion of the sleep period spent asleep) across caregivers’ education levels adjusting for children's age, sex, disability type, caregiver–child relationship and caregivers’ age. Multivariable logistic regression analyses were conducted to estimate ORs and 95% CIs of longer sleep latency (≥30 min) and longer wake after sleep onset (WASO) (≥90 min) (a measure of sleep fragmentation) in relation to caregivers’ educational attainment. Results Median sleep latency was 27.3 min, WASO 88.1 min and sleep duration 8.0 h. Mean sleep efficiency was 80.0%. Caregivers’ education was positively and significantly associated with children's sleep efficiency (p trend<0.001). Adjusted mean sleep efficiency was 75.7% (SE=1.4) among children of caregivers high school education. Compared to children whose caregivers had >high school, children of caregivers with

Adaptive servo-ventilation: How does it fit into the treatment of central sleep apnoea syndrome? Expert opinions.

PubMed

Priou, P; d'Ortho, M-P; Damy, T; Davy, J-M; Gagnadoux, F; Gentina, T; Meurice, J-C; Pepin, J-L; Tamisier, R; Philippe, C

2015-12-01

The preliminary results of the SERVE-HF study have led to the release of safety information with subsequent contraindication to the use of adaptive servo-ventilation (ASV) for the treatment of central sleep apnoeas in patients with chronic symptomatic systolic heart failure with left ventricular ejection fraction (LVEF) ≤ 45%. The aim of this article is to review these results, and to provide more detailed arguments based on data from the literature advocating the continued use of ASV in different indications, including heart failure with preserved LVEF, complex sleep apnoea syndrome, opioid-induced central sleep apnea syndrome, idiopathic central SAS, and central SAS due to a stroke. Based on these findings, we propose to set up registers dedicated to patients in whom ASV has been stopped and in the context of the next setting up of ASV in these specific indications to ensure patient safety and allow reasoned decisions on the use of ASV. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Suicidal ideations and sleep-related problems in early adolescence.

PubMed

Franić, Tomislav; Kralj, Zana; Marčinko, Darko; Knez, Rajna; Kardum, Goran

2014-05-01

Suicidal ideation and sleep-related problems are associated with many common psychopathological entities in early adolescence. This study examined possible association between suicidal ideation and sleep-related problems. A cross-sectional study was performed in classroom settings at 840 early adolescents 11-13 years of age. Of those, 791 adolescents fully completed the data and thus represent an actual sample. Suicidal ideations were assessed with three dichotomous (yes/no) items: 'I often think about death'; 'I wish I was dead'; 'I often think about suicide.' A composite measure of perceived sleep-related problems was formed by combining items from the Junior Eysenck Personality Questionnaire (Do you find it hard to sleep at night because you are worrying about things?), Children Depression Inventory (It is hard for me to fall asleep at night), and two additional dichotomous questions (I often was not able to fall asleep because of worrying; At times I was not able to stay asleep because of worrying). This score mainly assessed difficulties in initiating or maintaining sleep. A total of 7.1% adolescents reported suicidal ideation and 86.7% of them had sleep problems. Sleep-related problems were associated with any suicidal ideation and each type of ideation separately. This study suggests association of sleep problems and suicidal ideations in early adolescence. Therefore, clinicians should evaluate this population for sleep disturbances, as they might be a marker of increased risk for suicidality. © 2013 Wiley Publishing Asia Pty Ltd.

Diagnostic value of sleep stage dissociation as visualized on a 2-dimensional sleep state space in human narcolepsy.

PubMed

Olsen, Anders Vinther; Stephansen, Jens; Leary, Eileen; Peppard, Paul E; Sheungshul, Hong; Jennum, Poul Jørgen; Sorensen, Helge; Mignot, Emmanuel

2017-04-15

Type 1 narcolepsy (NT1) is characterized by symptoms believed to represent Rapid Eye Movement (REM) sleep stage dissociations, occurrences where features of wake and REM sleep are intermingled, resulting in a mixed state. We hypothesized that sleep stage dissociations can be objectively detected through the analysis of nocturnal Polysomnography (PSG) data, and that those affecting REM sleep can be used as a diagnostic feature for narcolepsy. A Linear Discriminant Analysis (LDA) model using 38 features extracted from EOG, EMG and EEG was used in control subjects to select features differentiating wake, stage N1, N2, N3 and REM sleep. Sleep stage differentiation was next represented in a 2D projection. Features characteristic of sleep stage differences were estimated from the residual sleep stage probability in the 2D space. Using this model we evaluated PSG data from NT1 and non-narcoleptic subjects. An LDA classifier was used to determine the best separation plane. This method replicates the specificity/sensitivity from the training set to the validation set better than many other methods. Eight prominent features could differentiate narcolepsy and controls in the validation dataset. Using a composite measure and a specificity cut off 95% in the training dataset, sensitivity was 43%. Specificity/sensitivity was 94%/38% in the validation set. Using hypersomnia subjects, specificity/sensitivity was 84%/15%. Analyzing treated narcoleptics the specificity/sensitivity was 94%/10%. Sleep stage dissociation can be used for the diagnosis of narcolepsy. However the use of some medications and presence of undiagnosed hypersomnolence patients impacts the result. Copyright © 2017 Elsevier B.V. All rights reserved.

Poor sleep quality and insufficient sleep of a collegiate student-athlete population.

PubMed

Mah, Cheri D; Kezirian, Eric J; Marcello, Brandon M; Dement, William C

2018-06-01

Poor and inadequate sleep negatively impact cognitive and physical functioning and may also affect sports performance. The study aim is to examine sleep quality, sleep duration, and daytime sleepiness in collegiate student-athletes across a wide range of sports. Questionnaire. University setting. 628 athletes across 29 varsity teams at Stanford University. Athletes completed a questionnaire inquiring about sleep quality via a modified Pittsburgh Sleep Quality Index (PSQI), sleep duration, and daytime sleepiness via Epworth Sleepiness Scale. Sleep quality on campus and while traveling for competition was rated on a 10-point scale. Collegiate athletes were classified as poor sleepers (PSQI 5.38 ± 2.45), and 42.4% of athletes experience poor sleep quality (reporting PSQI global scores >5). Athletes reported lower sleep quality on campus than when traveling for competition (7.1 vs 7.6, P< .001). Inadequate sleep was demonstrated by 39.1% of athletes that regularly obtain <7 hours of sleep on weekdays. Fifty-one percent of athletes reported high levels of daytime sleepiness with Epworth scores ≥10. Teen student-athletes in the first and second year of college reported the highest mean levels of daytime sleepiness. Greater total sleep time was associated with daytime functioning including lower frequency of difficulty waking up for practice or class (P< .001) and lower frequency of trouble staying awake during daily activities (P< .001). Collegiate athletes frequently experience poor sleep quality, regularly obtain insufficient sleep, and commonly exhibit daytime sleepiness. Copyright © 2018 National Sleep Foundation. All rights reserved.

Slow Wave Sleep Enhancement with Gaboxadol Reduces Daytime Sleepiness During Sleep Restriction

PubMed Central

Walsh, James K.; Snyder, Ellen; Hall, Janine; Randazzo, Angela C.; Griffin, Kara; Groeger, John; Eisenstein, Rhody; Feren, Stephen D.; Dickey, Pam; Schweitzer, Paula K.

2008-01-01

Study Objectives: To evaluate the impact of enhanced slow wave sleep (SWS) on behavioral, psychological, and physiological changes resulting from sleep restriction. Design: A double-blind, parallel group, placebo-controlled design was used to compare gaboxadol (GBX) 15 mg, a SWS-enhancing drug, to placebo during 4 nights of sleep restriction (5 h/night). Behavioral, psychological, and physiological measures of the impact of sleep restriction were assessed in both groups at baseline, during sleep restriction and following recovery sleep. Setting: Sleep research laboratory. Participants: Forty-one healthy adults; 9 males and 12 females (mean age: 32.0 ± 9.9 y) in the placebo group and 10 males and 10 females (mean age: 31.9 ± 10.2 y) in the GBX group. Interventions: Both experimental groups underwent 4 nights of sleep restriction. Each group received either GBX 15 mg or placebo on all sleep restriction nights, and both groups received placebo on baseline and recovery nights. Measurements and Results: Polysomnography documented a SWS-enhancing effect of GBX with no group difference in total sleep time during sleep restriction. The placebo group displayed the predicted deficits due to sleep restriction on the multiple sleep latency test (MSLT) and on introspective measures of sleepiness and fatigue. Compared to placebo, the GBX group showed significantly less physiological sleepiness on the MSLT and lower levels of introspective sleepiness and fatigue during sleep restriction. There were no differences between groups on the psychomotor vigilance task (PVT) and a cognitive test battery, but these measures were minimally affected by sleep restriction in this study. The correlation between change from baseline in MSLT on Day 6 and change from baseline in SWS on Night 6 was significant in the GBX group and in both groups combined. Conclusions: The results of this study are consistent with the hypothesis that enhanced SWS, in this study produced by GBX, reduces physiological sleep tendency and introspective sleepiness and fatigue which typically result from sleep restriction. Citation: Walsh JK; Snyder E; Hall J; Randazzo AC; Griffin K; Groeger J; Eisenstein R; Feren SD; Dickey P; Schweitzer PK. Slow Wave Sleep Enhancement with Gaboxadol Reduces Daytime Sleepiness During Sleep Restriction. SLEEP 2008;31(5):659–672. PMID:18517036

Sleep Problems in Children with Autism, Attention-Deficit Hyperactivity Disorder, and Epilepsy

ERIC Educational Resources Information Center

Tsai, Fang-Ju; Chiang, Huey-Ling; Lee, Chi-Mei; Gau, Susan Shur-Fen; Lee, Wang-Tso; Fan, Pi-Chuan; Wu, Yu-Yu; Chiu, Yen-Nan

2012-01-01

This study aimed to examine sleep problems in children with autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD), and epilepsy in clinical settings. We assessed 64 children with ASD, 64 with ADHD, 64 with epilepsy, and 64 typically developing children without any neuropsychiatric disorders by using a sex-and age-matched…

Swaddling: Maternal Option and Sleep Behaviour in Two-Month-Old Infants

ERIC Educational Resources Information Center

Kelmanson, Igor

2013-01-01

This study aimed to assess possible association between swaddling and sleep behaviour in two-month-old infants. It comprised 198 apparently healthy infants from the community setting selected by chance (86 boys, 112 girls), aged two months, who were singletons born in St Petersburg in 2007. The mothers were asked to complete the questionnaires…

Sleep Duration and Age-Related Changes in Brain Structure and Cognitive Performance

PubMed Central

Lo, June C.; Loh, Kep Kee; Zheng, Hui; Sim, Sam K.Y.; Chee, Michael W.L.

2014-01-01

Study Objectives: To investigate the contribution of sleep duration and quality to age-related changes in brain structure and cognitive performance in relatively healthy older adults. Design: Community-based longitudinal brain and cognitive aging study using a convenience sample. Setting: Participants were studied in a research laboratory. Participants: Relatively healthy adults aged 55 y and older at study commencement. Interventions: N/A. Measurements and Results: Participants underwent magnetic resonance imaging and neuropsychological assessment every 2 y. Subjective assessments of sleep duration and quality and blood samples were obtained. Each hour of reduced sleep duration at baseline augmented the annual expansion rate of the ventricles by 0.59% (P = 0.007) and the annual decline rate in global cognitive performance by 0.67% (P = 0.050) in the subsequent 2 y after controlling for the effects of age, sex, education, and body mass index. In contrast, global sleep quality at baseline did not modulate either brain or cognitive aging. High-sensitivity C-reactive protein, a marker of systemic inflammation, showed no correlation with baseline sleep duration, brain structure, or cognitive performance. Conclusions: In healthy older adults, short sleep duration is associated with greater age-related brain atrophy and cognitive decline. These associations are not associated with elevated inflammatory responses among short sleepers. Citation: Lo JC, Loh KK, Zheng H, Sim SK, Chee MW. Sleep duration and age-related changes in brain structure and cognitive performance. SLEEP 2014;37(7):1171-1178. PMID:25061245

A clinical decision rule to prioritize polysomnography in patients with suspected sleep apnea.

PubMed

Rodsutti, Julvit; Hensley, Michael; Thakkinstian, Ammarin; D'Este, Catherine; Attia, John

2004-06-15

To derive and validate a clinical decision rule that can help to prioritize patients who are on waiting lists for polysomnography, Prospective data collection on consecutive patients referred to a sleep center. The Newcastle Sleep Disorders Centre, University of Newcastle, NSW, Australia. Consecutive adult patients who had been scheduled for initial diagnostic polysomnography. Eight hundred and thirty-seven patients were used for derivation of the decision rule. An apnea-hypopnoea index of at least 5 was used as the cutoff point to diagnose sleep apnea. Fifteen clinical features were included in the analyses using logistic regression to construct a model from the derivation data set. Only 5 variables--age, sex, body mass index, snoring, and stopping breathing during sleep--were significantly associated with sleep apnea. A scoring scheme based on regression coefficients was developed, and the total score was trichotomized into low-, moderate-, and high-risk groups with prevalence of sleep apnea of 8%, 51%, and 82%, respectively. Color-coded tables were developed for ease of use. The clinical decision rule was validated on a separate set of 243 patients. Receiver operating characteristic analysis confirmed that the decision rule performed well, with the area under the curve being similar for both the derivation and validation sets: 0.81 and 0.79, P =.612. We conclude that this decision rule was able to accurately classify the risk of sleep apnea and will be useful for prioritizing patients with suspected sleep apnea who are on waiting lists for polysomnography.

Effect of maternal migraine on children's quality of sleep.

PubMed

Güngen, Belma; Yildirim, Ahmet; Aras, Yeşim Guzey; Acar, Bilgehan Atılgan; Tekeşin, Aysel; Ayaz, Ayse Burcu

2017-11-30

Sleep disorders are common problems associated with migraine. These sleep disorders are known to have a debilitating impact on daily lives of migraine patients. The purpose of this study is to assess the effects of sleep disorders experienced by individuals suffering from migraine on their children as well as the presence of sleep disorders in their children. This study included 96 mothers diagnosed with migraine and their 96 healthy children, and a control group formed of 74 healthy mothers and their children. Exclusion criteria were chronic systemic disease or central nervous system disease or a history of smoking/alcohol use for mothers, and chronic disease or regularly occurring headaches or recurrent abdominal pain for children. For maternal evaluation, the Visual Analogue Scale (VAS), Migraine Disability Assessment Scale (MIDAS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Index (BDI) and Beck Anxiety Index (BAI) were used and for the assessment of the children's quality of sleep, the Children's Sleep Habits Questionnaire (CSHQ) was used. The SPSS 21.0 program was employed for statistical analysis, with statistical significance set at p<0.05. The mean age of the group with migraine was 36.6±7.1 years, while that of the control group was 38.01±4.7. Mood and sleep disorders were more frequently observed in the participants with migraine (p<0.05). Sleep disorders were significantly low in children with migraineur mothers (p=0.02); and child sleep anxiety is significantly high in control group (p=0.048). Maternal BAI scores had a significant influence on their children's quality of sleep. In our study, the presence of migraine-type headache in mothers was observed to have a positive effect on reducing sleep disorders in the children. Recurrent headaches of the migraineur mothers with or without sleep disorders and psychiatric comorbidities did not influence the quality of sleep in their children directly, but the sleep anxiety of the children may have had an impact on it.

Perceptual impairment in face identification with poor sleep

PubMed Central

Beattie, Louise; Walsh, Darragh; McLaren, Jessica; Biello, Stephany M.

2016-01-01

Previous studies have shown impaired memory for faces following restricted sleep. However, it is not known whether lack of sleep impairs performance on face identification tasks that do not rely on recognition memory, despite these tasks being more prevalent in security and forensic professions—for example, in photo-ID checks at national borders. Here we tested whether poor sleep affects accuracy on a standard test of face-matching ability that does not place demands on memory: the Glasgow Face-Matching Task (GFMT). In Experiment 1, participants who reported sleep disturbance consistent with insomnia disorder show impaired accuracy on the GFMT when compared with participants reporting normal sleep behaviour. In Experiment 2, we then used a sleep diary method to compare GFMT accuracy in a control group to participants reporting poor sleep on three consecutive nights—and again found lower accuracy scores in the short sleep group. In both experiments, reduced face-matching accuracy in those with poorer sleep was not associated with lower confidence in their decisions, carrying implications for occupational settings where identification errors made with high confidence can have serious outcomes. These results suggest that sleep-related impairments in face memory reflect difficulties in perceptual encoding of identity, and point towards metacognitive impairment in face matching following poor sleep. PMID:27853547

Napping reverses the salivary interleukin-6 and urinary norepinephrine changes induced by sleep restriction.

PubMed

Faraut, Brice; Nakib, Samir; Drogou, Catherine; Elbaz, Maxime; Sauvet, Fabien; De Bandt, Jean-Pascal; Léger, Damien

2015-03-01

Neuroendocrine and immune stresses imposed by chronic sleep restriction are known to be involved in the harmful cardiovascular effects associated with poor sleep. Despite a well-known beneficial effect of napping on alertness, its effects on neuroendocrine stress and immune responses after sleep restriction are largely unknown. This study was a strictly controlled (sleep-wake status, light environment, caloric intake), crossover, randomized design in continuously polysomnography-monitored subjects. The study was conducted in a laboratory-based study. The subjects were 11 healthy young men. We investigated the effects on neuroendocrine and immune biomarkers of a night of sleep restricted to 2 h followed by a day without naps or with 30 minute morning and afternoon naps, both conditions followed by an ad libitum recovery night starting at 20:00. Salivary interleukin-6 and urinary catecholamines were assessed throughout the daytime study periods. The increase in norepinephrine values seen at the end of the afternoon after the sleep-restricted night was not present when the subjects had the opportunity to take naps. Interleukin-6 changes observed after sleep deprivation were also normalized after napping. During the recovery day in the no-nap condition, there were increased levels of afternoon epinephrine and dopamine, which was not the case in the nap condition. A recovery night after napping was associated with a reduced amount of slow-wave sleep compared to after the no-nap condition. Our data suggest that napping has stress-releasing and immune effects. Napping could be easily applied in real settings as a countermeasure to the detrimental health consequences of sleep debt.

[Physical activity, screen time and sleep patterns in Chilean girls].

PubMed

Aguilar, M M; Vergara, F A; Velásquez, E J A; García-Hermoso, A

2015-11-01

Physical activity (PA), screen time (ST), and sleep are modifiable lifestyle habits for health. The objectives of this study were: a) to examine the association between PA, ST, and both, on sleep patterns; and b) to determine the influence of PA and ST on sleep problems in Chilean girls. The study involved 196 children (12.2 years). Patterns and sleep problems were assessed using the Spanish version of the Sleep Self-Report, and the PA through the Physical Activity Questionnaire for Adolescents (PAQ-A), both in Castilian. The ST was assessed using several questions about television, game console and computer use. The ST recommendation (2h a day) was exceeded by 63.2% of the girls. In general, the most active girls (last quartile) that did not exceed the recommendations of ST reported higher sleep quality and total score values compared to those who did not meet both. The logistic regression analysis showed that girls who did not meet both habits were more likely to have sleep quality (odds ratio=17.8, P=.018), and general sleep problems (odds ratio=7.85, P=.025). Parents need to set limits on sedentary leisure time and encourage more active habits, as sleep is a parameter closely linked to a better health profile in youth. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Short Sleep Makes Declarative Memories Vulnerable to Stress in Humans

PubMed Central

Cedernaes, Jonathan; Rångtell, Frida H.; Axelsson, Emil K.; Yeganeh, Adine; Vogel, Heike; Broman, Jan-Erik; Dickson, Suzanne L.; Schiöth, Helgi B.; Benedict, Christian

2015-01-01

Study Objective: This study sought to investigate the role of nocturnal sleep duration for the retrieval of oversleep consolidated memories, both prior to and after being cognitively stressed for ∼30 minutes the next morning. Design: Participants learned object locations (declarative memory task comprising 15 card pairs) and a finger tapping sequence (procedural memory task comprising 5 digits) in the evening. After learning, participants either had a sleep opportunity of 8 hours (between ∼23:00 and ∼07:00, full sleep condition) or they could sleep between ∼03:00 and ∼07:00 (short sleep condition). Retrieval of both memory tasks was tested in the morning after each sleep condition, both before (∼08:30) and after being stressed (∼09:50). Setting: Sleep laboratory. Participants: 15 healthy young men. Results: The analyses demonstrated that oversleep memory changes did not differ between sleep conditions. However, in their short sleep condition, following stress hallmarked by increased subjective stress feelings, the men were unable to maintain their pre-stress performance on the declarative memory task, whereas their performance on the procedural memory task remained unchanged. While men felt comparably subjectively stressed by the stress intervention, overall no differences between pre- and post-stress recalls were observed following a full night of sleep. Conclusions: The findings suggest that 8-h sleep duration, within the range recommended by the US National Sleep Foundation, may not only help consolidate newly learned procedural and declarative memories, but also ensure full access to both during periods of subjective stress. Citation: Cedernaes J, Rångtell FH, Axelsson EK, Yeganeh A, Vogel H, Broman JE, Dickson SL, Schiöth HB, Benedict C. Short sleep makes declarative memories vulnerable to stress in humans. SLEEP 2015;38(12):1861–1868. PMID:26158890

Morning REM Sleep Naps Facilitate Broad Access to Emotional Semantic Networks

PubMed Central

Carr, Michelle; Nielsen, Tore

2015-01-01

Study Objectives: The goals of the study were to assess semantic priming to emotion and nonemotion cue words using a novel measure of associational breadth for participants who either took rapid eye movement (REM) or nonrapid eye movement (NREM) naps or who remained awake, and to assess the relation of priming to REM sleep consolidation and REM sleep inertia effects. Design: The associational breadth task was applied in both a priming condition, where cue words were signaled to be memorized prior to sleep (primed), and a nonpriming condition, where cue words were not memorized (nonprimed). Cue words were either emotional (positive, negative) or nonemotional. Participants were randomly assigned to either an awake (WAKE) or a sleep condition, which was subsequently split into NREM or REM groups depending on stage at awakening. Setting: Hospital-based sleep laboratory. Participants: Fifty-eight healthy participants (22 male) ages 18 to 35 y (mean age = 23.3 ± 4.08 y). Measurements and Results: The REM group scored higher than the NREM or WAKE groups on primed, but not nonprimed emotional cue words; the effect was stronger for positive than for negative cue words. However, REM time and percent correlated negatively with degree of emotional priming. Priming occurred for REM awakenings but not for NREM awakenings, even when the latter sleep episodes contained some REM sleep. Conclusions: Associational breadth may be selectively consolidated during REM sleep for stimuli that have been tagged as important for future memory retrieval. That priming decreased with REM time and was higher only for REM sleep awakenings is consistent with two explanatory REM sleep processes: REM sleep consolidation serving emotional downregulation and REM sleep inertia. Citation: Carr M, Nielsen T. Morning REM sleep naps facilitate broad access to emotional semantic networks. SLEEP 2015;38(3):433–443. PMID:25409100

Examining Dark Triad traits in relation to sleep disturbances, anxiety sensitivity and intolerance of uncertainty in young adults.

PubMed

Sabouri, Sarah; Gerber, Markus; Lemola, Sakari; Becker, Stephen P; Shamsi, Mahin; Shakouri, Zeinab; Sadeghi Bahmani, Dena; Kalak, Nadeem; Holsboer-Trachsler, Edith; Brand, Serge

2016-07-01

The Dark Triad (DT) describes a set of three closely related personality traits, Machiavellianism, narcissism, and psychopathy. The aim of this study was to examine the associations between DT traits, sleep disturbances, anxiety sensitivity and intolerance of uncertainty. A total of 341 adults (M=29years) completed a series of questionnaires related to the DT traits, sleep disturbances, anxiety sensitivity, and intolerance of uncertainty. A higher DT total score was associated with increased sleep disturbances, and higher scores for anxiety sensitivity and intolerance of uncertainty. In regression analyses Machiavellianism and psychopathy were predictors of sleep disturbances, anxiety sensitivity, and intolerance of uncertainty. Results indicate that specific DT traits, namely Machiavellianism and psychopathy, are associated with sleep disturbances, anxiety sensitivity and intolerance of uncertainty in young adults. Copyright © 2016 Elsevier Inc. All rights reserved.

Heart Rate Variability for Evaluating Vigilant Attention in Partial Chronic Sleep Restriction

PubMed Central

Henelius, Andreas; Sallinen, Mikael; Huotilainen, Minna; Müller, Kiti; Virkkala, Jussi; Puolamäki, Kai

2014-01-01

Study Objectives: Examine the use of spectral heart rate variability (HRV) metrics in measuring sleepiness under chronic partial sleep restriction, and identify underlying relationships between HRV, Karolinska Sleepiness Scale ratings (KSS), and performance on the Psychomotor Vigilance Task (PVT). Design: Controlled laboratory study. Setting: Experimental laboratory of the Brain Work Research Centre of the Finnish Institute of Occupational Health, Helsinki, Finland. Participants: Twenty-three healthy young males (mean age ± SD = 23.77 ± 2.29). Interventions: A sleep restriction group (N = 15) was subjected to chronic partial sleep restriction with 4 h sleep for 5 nights. A control group (N = 8) had 8 h sleep on all nights. Measurements and Results: Based on a search over all HRV frequency bands in the range [0.00, 0.40] Hz, the band [0.01, 0.08] Hz showed the highest correlation for HRV–PVT (0.60, 95% confidence interval [0.49, 0.69]) and HRV–KSS (0.33, 95% confidence interval [0.16, 0.46]) for the sleep restriction group; no correlation was found for the control group. We studied the fraction of variance in PVT explained by HRV and a 3-component alertness model, containing circadian and homeostatic processes coupled with sleep inertia, respectively. HRV alone explained 33% of PVT variance. Conclusions: The findings suggest that HRV spectral power reflects vigilant attention in subjects exposed to partial chronic sleep restriction. Citation: Henelius A, Sallinen M, Huotilainen M, Müller K, Virkkala J, Puolamäki K. Heart rate variability for evaluating vigilant attention in partial chronic sleep restriction. SLEEP 2014;37(7):1257-1267. PMID:24987165

Impact of Sleep Restriction on Neurobehavioral Functioning of Children with Attention Deficit Hyperactivity Disorder

PubMed Central

Gruber, Reut; Wiebe, Sabrina; Montecalvo, Lisa; Brunetti, Bianca; Amsel, Rhonda; Carrier, Julie

2011-01-01

Study Objectives: The objective of this study was to assess the cumulative impact of 1 hour of nightly sleep restriction over the course of 6 nights on the neurobehavioral functioning (NBF) of children with attention deficit hyperactivity disorder (ADHD) and healthy controls. Design: Following 6 nights of actigraphic monitoring of sleep to determine baseline sleep duration, children were asked to restrict sleep duration by 1 hour for 6 consecutive nights. NBF was assessed at baseline (Day 6) and following sleep manipulation (Day 12). Setting: A quiet location within their home environments. Participants: Forty-three children (11 ADHD, 32 Controls, mean age = 8.7 years, SD = 1.3) between the ages of 7 and 11 years. Interventions: NA Measurements: Sleep was monitored using actigraphy. In addition, parents were asked to complete nightly sleep logs. Sleepiness was evaluated using a questionnaire. The Conners' Continuous Performance Test (CPT) was used to assess NBF. Results: Restricted sleep led to poorer CPT scores on two-thirds of CPT outcome measures in both healthy controls and children with ADHD. The performance of children with ADHD following sleep restriction deteriorated from subclinical levels to the clinical range of inattention on two-thirds of CPT outcome measures. Conclusions: Moderate sleep restriction leads to a detectable negative impact on the NBF of children with ADHD and healthy controls, leading to a clinical level of impairment in children with ADHD. Citation: Gruber R; Wiebe S; Montecalvo L; Brunetti B; Amsel R; Carrier J. Impact of sleep restriction on neurobehavioral functioning of children with attention deficit hyperactivity disorder. SLEEP 2011;34(3):315-323. PMID:21358848

Naturalistic Effects of Five Days of Bedtime Caffeine Use on Sleep, Next-Day Cognitive Performance, and Mood

PubMed Central

Tiplady, Brian; Priestley, Caroline M.; Rogers, Peter J.

2014-01-01

Background: Disruptive effects of caffeine on sleep have previously been reported, although measures of next-day mood and performance have rarely been included. The present study aims to evaluate the effects of caffeine on sleep and associated next-day effects in a naturalistic field setting. Methods: Nineteen participants (daily caffeine intake 0–141 mg), assessed as good sleepers, took part in a randomized, placebo-controlled, double-blind, 2-week crossover study to assess the effects of bedtime caffeine use (250 mg) on sleep and next-day cognitive performance and mood, which were assessed on a mobile phone in the morning and afternoon. Sleep was assessed objectively (actiwatch) and subjectively (sleep diary). Results: Caffeine's effects on sleep were largely restricted to the first day of administration, with actigraphically measured reduced sleep efficiency, increased activity score and fragmentation index, decreased self-rated sleep quality, and an increased occurrence of participants waking early; only decreased sleep efficiency remained over the week. Effects on next-day performance and mood were evident over the whole week, although despite disrupting sleep, accuracy on a working memory task was higher after caffeine than placebo administration. Conclusions: Caffeine disrupted sleep, although when assessing next-day performance, which may have been affected by the presence of residual caffeine, performance appeared better after caffeine compared to placebo, although this was most likely due to prevention of the effects of overnight withdrawal from caffeine rather than representing a net benefit. Furthermore, partial tolerance developed to the effects of caffeine on sleep. PMID:24868491

Comparison of Actigraphy Immobility Rules with Polysomnographic Sleep Onset Latency in Children and Adolescents

PubMed Central

Meltzer, Lisa J.; Walsh, Colleen M.; Peightal, Ashley A.

2015-01-01

Purpose While actigraphy has gained popularity in pediatric sleep research, questions remain about the validity of actigraphy as an estimate of sleep-wake patterns. In particular, there is little consistency in the field in terms of scoring rules used to determine sleep onset latency. The purpose of this study was to evaluate different criteria of immobility as a measure of sleep onset latency in children and adolescents. Methods Ninety-five youth (ages 3-17 years, 46% male) wore both the Ambulatory-Monitoring Inc. Motionlogger Sleep Watch (AMI) and the Philips Respironics Mini-Mitter Actiwatch-2 (PRMM) during overnight polysomnography in a pediatric sleep lab. We examined different sleep onset latency scoring rules (3, 5, 10, 15, and 20 minutes of immobility) using different algorithms (Sadeh and Cole-Kripke) and sensitivity settings (Low, Medium, High) for the devices. Comparisons were also made across age groups (preschoolers, school-aged, adolescents) and sleep disordered breathing status (no obstructive sleep apnea [OSA], mild OSA, clinically significant OSA). Results For the AMI device, shorter scoring rules performed best for children and longer scoring rules were better for adolescents, with shorter scoring rules best across sleep disordered breathing groups. For the PRMM device, medium to longer scoring rules performed best across age and sleep disordered breathing groups. Conclusions Researchers are encouraged to determine the scoring rule that best fits their population of interest. Future studies are needed with larger samples of children and adolescents to further validate actigraphic immobility as a proxy for sleep onset latency. PMID:25687438

Sleep-Disordered Breathing in Neuromuscular Disease: Diagnostic and Therapeutic Challenges.

PubMed

Aboussouan, Loutfi S; Mireles-Cabodevila, Eduardo

2017-10-01

Normal sleep-related rapid eye movement sleep atonia, reduced lung volumes, reduced chemosensitivity, and impaired airway dilator activity become significant vulnerabilities in the setting of neuromuscular disease. In that context, the compounding effects of respiratory muscle weakness and disease-specific features that promote upper airway collapse or cause dilated cardiomyopathy contribute to various sleep-disordered breathing events. The reduction in lung volumes with neuromuscular disease is further compromised by sleep and the supine position, exaggerating the tendency for upper airway collapse and desaturation with sleep-disordered breathing events. The most commonly identified events are diaphragmatic/pseudo-central, due to a decrease in the rib cage contribution to the tidal volume during phasic rapid eye movement sleep. Obstructive and central sleep apneas are also common. Noninvasive ventilation can improve survival and quality of sleep but should be used with caution in the context of dilated cardiomyopathy or significant bulbar symptoms. Noninvasive ventilation can also trigger sleep-disordered breathing events, including ineffective triggering, autotriggering, central sleep apnea, and glottic closure, which compromise the potential benefits of the intervention by increasing arousals, reducing adherence, and impairing sleep architecture. Polysomnography plays an important diagnostic and therapeutic role by correctly categorizing sleep-disordered events, identifying sleep-disordered breathing triggered by noninvasive ventilation, and improving noninvasive ventilation settings. Optimal management may require dedicated hypoventilation protocols and a technical staff well versed in the identification and troubleshooting of respiratory events. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Polysomnographic Findings and Clinical Correlates in Huntington Disease: A Cross-Sectional Cohort Study

PubMed Central

Piano, Carla; Losurdo, Anna; Della Marca, Giacomo; Solito, Marcella; Calandra-Buonaura, Giovanna; Provini, Federica; Bentivoglio, Anna Rita; Cortelli, Pietro

2015-01-01

Study Objectives: To evaluate the sleep pattern and the motor activity during sleep in a cohort of patients affected by Huntington disease (HD). Design: Cross-sectional cohort study. Setting: Sleep laboratory. Patients: Thirty HD patients, 16 women and 14 men (mean age 57.3 ± 12.2 y); 30 matched healthy controls (mean age 56.5 ± 11.8 y). Interventions: Subjective sleep evaluation: Epworth Sleepiness Scale (ESS); Berlin's Questionnaire, interview for restless legs syndrome (RLS), questionnaire for REM sleep behavior disorder (RBD). Clinical evaluation: disease duration, clinical severity (unified Huntington disease motor rating scale [UHDMRS]), genetic tests. Laboratory-based full-night attended video-polysomnography (V-PSG). Measurements and Results: The duration of the disease was 9.4 ± 4.4 y, UHMDRS score was 55.5 ± 23.4, CAG repeats were 44.3 ± 4.1. Body mass index was 21.9 ± 4.0 kg/m2. No patients or caregivers reported poor sleep quality. Two patients reported symptoms of RLS. Eight patients had an ESS score ≥ 9. Eight patients had high risk of obstructive sleep apnea. At the RBD questionnaire, two patients had a pathological score. HD patients, compared to controls, showed shorter sleep, reduced sleep efficiency index, and increased arousals and awakenings. Four patients presented with sleep disordered breathing (SDB). Periodic limb movements (PLMs) during wake and sleep were observed in all patients. No episode of RBD was observed in the V-PSG recordings, and no patients showed rapid eye movement (REM) sleep without atonia. The disease duration correlated with ESS score (P < 0.02). UHMDRS correlated positively with the ESS score (P < 0.005), and negatively with the percentage of REM sleep. Conclusions: Patients with Huntington disease showed a severe sleep disruption and a high prevalence of periodic limb movements, but no evidence of sleep disordered breathing or REM sleep behavior disorder. Citation: Piano C, Losurdo A, Della Marca G, Solito M, Calandra-Buonaura G, Provini F, Bentivoglio AR, Cortelli P. Polysomnographic findings and clinical correlates in Huntington disease: a cross-sectional cohort study. SLEEP 2015;38(9):1489–1495. PMID:25845698

Donepezil Improves Episodic Memory in Young Individuals Vulnerable to the Effects of Sleep Deprivation

PubMed Central

Chuah, Lisa Y.M.; Chong, Delise L.; Chen, Annette K.; Rekshan, William R.; Tan, Jiat-Chow; Zheng, Hui; Chee, Michael W.L.

2009-01-01

Study Objectives: We investigated if donepezil, a long-acting orally administered cholinesterase inhibitor, would reduce episodic memory deficits associated with 24 h of sleep deprivation. Design: Double-blind, placebo-controlled, crossover study involving 7 laboratory visits over 2 months. Participants underwent 4 functional MRI scans; 2 sessions (donepezil or placebo) followed a normal night's sleep, and 2 sessions followed a night of sleep deprivation. Setting: The study took place in a research laboratory. Participants: 26 young, healthy volunteers with no history of any sleep, psychiatric, or neurologic disorders. Interventions: 5 mg of donepezil was taken once daily for approximately 17 days. Measurements and Results: Subjects were scanned while performing a semantic judgment task and tested for word recognition outside the scanner 45 minutes later. Sleep deprivation increased the frequency of non-responses at encoding and impaired delayed recognition. No benefit of donepezil was evident when participants were well rested. When sleep deprived, individuals who showed greater performance decline improved with donepezil, whereas more resistant individuals did not benefit. Accompanying these behavioral effects, there was corresponding modulation of task-related activation in functionally relevant brain regions. Brain regions identified in relation to donepezil-induced alteration in non-response rates could be distinguished from regions relating to improved recognition memory. This suggests that donepezil can improve delayed recognition in sleep-deprived persons by improving attention as well as enhancing memory encoding. Conclusions: Donepezil reduced decline in recognition performance in individuals vulnerable to the effects of sleep deprivation. Additionally, our findings demonstrate the utility of combined fMRI–behavior evaluation in psychopharmacological studies. Citation: Chuah LYM; Chong DL; Chen AK; Rekshan WR; Tan JC; Zheng H; Chee MWL. Donepezil improves episodic memory in young individuals vulnerable to the effects of sleep deprivation. SLEEP 2009;32(8):999-1010. PMID:19725251

Sleep in the modern family: protective family routines for child and adolescent sleep

PubMed Central

Buxton, Orfeu M.; Chang, Anne-Marie; Spilsbury, James C.; Bos, Taylor; Emsellem, Helene; Knutson, Kristen L.

2015-01-01

Study objectives The overall objective of the 2014 National Sleep Foundation Sleep in America Poll “Sleep in the Modern Family” was to obtain a current picture of sleep in families with at least 1 school-aged child. Design Cross-sectional poll. Setting Internet-based interview. Participants Nationally representative Internet panel of US households with a child 6–17 years. Measurements and results Primary measures included parental perception of the importance of sleep, parental and child sleep quality, child sleep duration and habits, technology in bedroom, and family rules. Parents/guardians (n= 1103; mean age, 42; 54% female) completed the survey. Although the majority of parents endorsed the importance of sleep, 90% of children obtain less sleep than recommended. Significant predictors of age-adjusted sufficient sleep duration (estimated conservatively as ≥9 hours for ages 6–11 years and ≥8 hours for ages 12–17 years) included parent education, regular enforcement of rules about caffeine, and whether children left technology on in their bedroom overnight. Significant predictors of excellent sleep quality included whether a bedtime was always enforced and whether children left technology on overnight. Conclusions Children generally have better age-appropriate sleep in the presence of household rules and regular sleep-wake routines. Sufficient sleep quantity and adequate sleep quality were protected by well-established rules of sleep hygiene (limited caffeine and regular bedtime). In contrast, sleep deficiency was more likely to be present when parents and children had electronic devices on in the bedroom after bedtime. Public health intervention goals for sleep health might focus on reducing the encroachment of technology and media into time for sleep and supporting well-known sleep hygiene principles. PMID:26779564

Auditory Inhibition of Rapid Eye Movements and Dream Recall from REM Sleep

PubMed Central

Stuart, Katrina; Conduit, Russell

2009-01-01

Study Objectives: There is debate in dream research as to whether ponto-geniculo-occipital (PGO) waves or cortical arousal during sleep underlie the biological mechanisms of dreaming. This study comprised 2 experiments. As eye movements (EMs) are currently considered the best noninvasive indicator of PGO burst activity in humans, the aim of the first experiment was to investigate the effect of low-intensity repeated auditory stimulation on EMs (and inferred PGO burst activity) during REM sleep. It was predicted that such auditory stimuli during REM sleep would have a suppressive effect on EMs. The aim of the second experiment was to examine the effects of this auditory stimulation on subsequent dream reporting on awakening. Design: Repeated measures design with counterbalanced order of experimental and control conditions across participants. Setting: Sleep laboratory based polysomnography (PSG) Participants: Experiment 1: 5 males and 10 females aged 18-35 years (M = 20.8, SD = 5.4). Experiment 2: 7 males and 13 females aged 18-35 years (M = 23.3, SD = 5.5). Interventions: Below-waking threshold tone presentations during REM sleep compared to control REM sleep conditions without tone presentations. Measurements and Results: PSG records were manually scored for sleep stages, EEG arousals, and EMs. Auditory stimulation during REM sleep was related to: (a) an increase in EEG arousal, (b) a decrease in the amplitude and frequency of EMs, and (c) a decrease in the frequency of visual imagery reports on awakening. Conclusions: The results of this study provide phenomenological support for PGO-based theories of dream reporting on awakening from sleep in humans. Citation: Stuart K; Conduit R. Auditory inhibition of rapid eye movements and dream recall from REM sleep. SLEEP 2009;32(3):399–408. PMID:19294960

Free Recall of Word Lists under Total Sleep Deprivation and after Recovery Sleep

PubMed Central

de Almeida Valverde Zanini, Gislaine; Tufik, Sérgio; Andersen, Monica Levy; da Silva, Raquel Cristina Martins; Bueno, Orlando Francisco Amodeo; Rodrigues, Camila Cruz; Pompéia, Sabine

2012-01-01

Study Objectives: One task that has been used to assess memory effects of prior total sleep deprivation (TSD) is the immediate free recall of word lists; however, results have been mixed. A possible explanation for this is task impurity, since recall of words from different serial positions reflects use of distinct types of memory (last words: short-term memory; first and intermediate words: episodic memory). Here we studied the effects of 2 nights of TSD on immediate free recall of semantically unrelated word lists considering the serial position curve. Design: Random allocation to a 2-night TSD protocol followed by one night of recovery sleep or to a control group. Setting: Study conducted under continuous behavioral monitoring. Participants: 24 young, healthy male volunteers. Intervention: 2 nights of total sleep deprivation (TSD) and one night of recovery sleep. Measurements and Results: Participants were shown five 15 unrelated word-lists at baseline, after one and 2 nights of TSD, and after one night of recovery sleep. We also investigated the development of recall strategies (learning) and susceptibility to interference from previous lists. No free recall impairment occurred during TSD, irrespective of serial position. Interference was unchanged. Both groups developed recall strategies, but task learning occurred earlier in controls and was evident in the TSD group only after sleep recovery. Conclusion: Prior TSD spared episodic memory, short-term phonological memory, and interference, allowed the development of recall strategies, but may have decreased the advantage of using these strategies, which returned to normal after recovery sleep. Citation: Zanini GAV; Tufik S; Andersen ML; da Silva RCM; Bueno OFA; Rodrigues CC; Pompéia S. Free recall of word lists under total sleep deprivation and after recovery sleep. SLEEP 2012;35(2):223-230. PMID:22294812

Environmental characteristics and sleep in two-month-old infants.

PubMed

Kelmanson, I A; Adulas, E I

2004-01-01

The study aimed at assessing possible relationship between the quality of infant environment and maternal reported behavioural features during sleep in 2-month-old infants. It comprised 115 randomly selected, apparently healthy infants (50 boys, 65 girls) from community setting who were singletons born at term with normal birth weight in St. Petersburg in 2001-2002. Quality of infant care was estimated using the "PROCESS" (Paediatric Review of Children's Environment Support and Stimulation) inventory enabling to measure infant's developmental stimulation and organisation. Infant's behaviour during sleep was assessed using an adapted version of the Children's Sleep Habits Questionnaire (CSHQ). The babies facing more developmental stimulation and from more organised environment less often fell asleep in parents bed (P = 0.036). Infants from more organised environment were more often put to sleep at the same time at night, more often were ready to go to sleep at bedtime and less often struggled at bed; it was more common with them to have right amount of sleep and to have about a same amount of sleep each day; less often they moved a lot during sleep and woke up in sleep. These associations remained significant after adjustment has been made for each of such potential confounders as infant's gender, weight at birth and at study, gestational age, Apgar score at 1 and 5 minutes, birth order, maternal age and education, maternal marital status, infant's feeding at birth and at study, as well as to their simultaneous effects. Lower environmental organisation and developmental stimulation may be associated with specific disadvantageous infant behavioural features during sleep. Infants with parentally reported sleep problems should be carefully considered for possible flaws in the quality of environment.

Prevalence and Correlates of Alpha-Delta Sleep in Major Depressive Disorders

PubMed Central

Jaimchariyatam, Nattapong; Rodriguez, Carlos L.

2011-01-01

Objective. Major depressive disorder is associated with sleep disturbances. An electroencephalographic pattern of alpha wave intrusion in delta wave sleep (alpha-delta sleep) is observed in some subjects with major depressive disorder. The treatment-resistant symptoms in major depressive disorder, nonrestorative sleep and fatigue, are associated with alpha-delta sleep. The objective of this study is to identify the prevalence and clinical correlates of alpha-delta sleep in major depressive disorder. Design. Retrospective study Setting. Sleep Disorders Center, Cleveland Clinic, Cleveland, Ohio Participants. Polysomnograms were conducted on 150 subjects 18 years of age or older (75 with and 75 without major depressive disorder) were reviewed. Measurements. The percent of delta waves with alpha intrusion was collected and analyzed. Results. Subjects with major depressive disorder compared to nondepressed subjects had a higher sleep efficiency (83.0±9.6; 78.1±8.2%), shorter rapid eye movement latency (85.0±44.5; 189.9±25.6 min), less slow wave sleep (8.3±3.0; 13.5±6.2%), and greater rapid eye movement (24.7±7.0; 19.2±8.2%), and all of these findings were statistically significant. Patients with major depressive disorder had higher alpha-delta sleep (23.4±14.2%; 2.3±6.7%, p<0.01). Patients with major depressive disorder were categorized into high and low alpha-delta sleep based on percentage of alpha-delta sleep present in slow wave sleep (alpha-delta sleep was present ≥15% or ≤15% of slow wave sleep, respectively). Patients with major depressive disorder with high alpha-delta sleep were at 3.15 greater odds (1.22–8.14; p=0.018) to have excessive daytime sleepiness. Conclusion. Patients with major depressive disorder have a higher prevalence of alpha-delta sleep. Alpha-delta sleep is associated with daytime sleepiness in patients with major depressive disorder. Study limitations include the retrospective nature of the project and the fact that the principle investigator, who scored and interpreted alpha intrusion, was not blind to group membership. PMID:21860844

Sleep Quality and Vigilance Differ Among Inpatient Nurses Based on the Unit Setting and Shift Worked.

PubMed

Surani, Salim; Hesselbacher, Sean; Guntupalli, Bharat; Surani, Sara; Subramanian, Shyam

2015-12-01

Sleepiness in nurses has been shown to impact patient care and safety. The objectives of this study are to measure sleep quality, sleepiness, fatigue, and vigilance in inpatient nurses and to assess how setting (intensive care unit versus the general floor) and shift worked (day versus night) affect these measures. Nurses from both the ICU and floor were included in the study. Participants completed questionnaires assessing self-reported sleep quality (Pittsburgh Sleep Quality Index, PSQI), sleepiness (Stanford Sleepiness Scale and Epworth Sleepiness Scale, ESS), and fatigue (Fatigue Severity Scale, FSS). Vigilance was measured by means of the psychomotor vigilance test (PVT), before and after a 12-hour duty shift. The ESS was abnormal in 22% of all nurses, the FSS was abnormal in 33%, and the global PSQI was abnormal in 63%. More ICU nurses than floor nurses reported abnormal sleep quality (component 5) on the PSQI. Sleep medication use (PSQI component 6) was higher in night shift nurses. The FSS was greater in night shift nurses. On preshift PVT testing, day-shift nurses overall provided faster mean reaction time (RT) than night-shift nurses. ICU nurses working the day shift made more than twice as many total errors and false starts than day shift floor nurses. Floor nurses demonstrated a significant decrease from preshift to postshift in the mean of the fastest 10% RT. Our data indicate that a significant number of inpatient nurses have impaired sleep quality, excessive sleepiness, and abnormal fatigue, which may place them at a greater risk of making medical errors and harming patients; these problems are especially pronounced in night shift workers. PVT results were inconsistent, but floor and day shift nurses performed better on some tasks than ICU and night shift nurses.

Factors that Influence Weekday Sleep Duration in European Children

PubMed Central

Hense, Sabrina; Barba, Gianvincenzo; Pohlabeln, Hermann; De Henauw, Stefaan; Marild, Staffan; Molnar, Dénes; Moreno, Luis A.; Hadjigeorgiou, Charalampos; Veidebaum, Toomas; Ahrens, Wolfgang

2011-01-01

Study Objectives: To compare nocturnal sleep duration in children from 8 European countries and identify its determinants. Design: Cross-sectional. Setting: Primary schools and preschools participating in the IDEFICS study. Participants: 8,542 children aged 2 to 9 years from 8 European countries with complete information on nocturnal sleep duration. Interventions: Not applicable. Measurements: Nocturnal sleep duration was assessed by means of a computer based parental 24-h recall. Data on personal, social, environmental, and behavioral factors were collected by means of standardized parental questionnaire. Physical activity was surveyed with accelerometers. Results: Nocturnal sleep duration in the participating countries ranged from 9.5 h (SD 0.8) in Estonia to 11.2 h (SD 0.7) in Belgium and differed significantly between countries (P < 0.001) in univariate as well as in multivariate analyses, with children from northern countries sleeping the longest. Sleep duration decreased by about 6 min with each year of age over all countries. No effect of season, daylight duration, overweight, parental education level, or lifestyle factors could be seen. Conclusion: Sleep duration differs significantly between countries. Our findings allow for the conclusion that regional affiliation, including culture and environmental characteristics, seems to overlay individual determinants of sleep duration. Citation: Hense S; Barba G; Pohlabeln H; De Henauw S; Marild S; Molnar D; Moreno LA; Hadjigeorgiou C; Veidebaum T; Ahrens W. Factors that influence weekday sleep duration in European children. SLEEP 2011;34(5):633-639. PMID:21532957

Oropharyngeal exercises in the treatment of obstructive sleep apnoea: our experience.

PubMed

Verma, Roshan K; Johnson J, Jai Richo; Goyal, Manoj; Banumathy, N; Goswami, Upendra; Panda, Naresh K

2016-12-01

Oropharyngeal exercises are new, non-invasive, cost effective treatment modality for the treatment of mild to moderate obstructive sleep apnoea. It acts by increasing the tone of pharyngeal muscles, is more physiological, and effects are long lasting. The aim of our present study was to evaluate the effect of oropharyngeal exercises in the treatment of mild to moderate obstructive sleep apnoea. Twenty patients of mild to moderate obstructive sleep apnoea syndrome (OSAS) were given oropharyngeal exercise therapy for 3 months divided into three phases in graded level of difficulty. Each exercise had to be repeated 10 times, 5 sets per day at their home. Oropharyngeal exercises were derived from speech-language pathology and included soft palate, tongue, and facial muscle exercises. Anthropometric measurements, snoring frequency, intensity, Epworth daytime sleepiness and Berlin sleep questionnaire, and full polysomnography were performed at baseline and at study conclusion. Body mass index (25.6 ± 3.1) did not change significantly at the end of the study period. There was significant reduction in the neck circumference (38.4 ± 1.3 to 37.8 ± 1.6) at the end of the study. Significant improvement was seen in symptoms of daytime sleepiness, witnessed apnoea, and snoring intensity. Significant improvement was also seen in sleep indices like minimum oxygen saturation, time duration of Sao2 < 90 %, sleep efficiency, arousal index, and total sleep time N3 stage of sleep at the end of study. Graded oropharyngeal exercise therapy increases the compliance and also reduces the severity of mild to moderate OSAS.

Sleep Architecture and NREM Alterations in Children and Adolescents with Asperger Syndrome

PubMed Central

Bruni, Oliviero; Ferri, Raffaele; Vittori, Elena; Novelli, Luana; Vignati, Manuela; Porfirio, Maria C.; Aricò, Debora; Bernabei, Paola; Curatolo, Paolo

2007-01-01

Study Objectives: To analyze sleep in children with Asperger syndrome (AS) by means of standard sleep questionnaires, to evaluate sleep architecture and NREM sleep alterations by means of cyclic alternating pattern (CAP) and to correlate objective sleep parameters with cognitive behavioral measures. Design: Cross-sectional study involving validated sleep questionnaires, neuropsychological scales, and PSG recording. Setting: Sleep medicine center. Participants: Eight children with AS, 10 children with autism, and 12 healthy control children. Interventions: N/A Measurements and Results: Children with AS had a higher prevalence of problems of initiating sleep and daytime sleepiness. Sleep architecture parameters showed minor differences between the 3 groups. CAP parameters showed an increased percentage of A1 and a decreased percentage of A2 subtypes in subjects with AS vs. controls. All A subtype indexes (number per hour of NREM sleep) were decreased, mostly in sleep stage 2 but not in SWS. With respect to children with autism, subjects with AS showed increased CAP rate in SWS and A1 percentage. In subjects with AS, verbal IQ had a significant positive correlation with total CAP rate and CAP rate in SWS and with global and SWS A1 index. The percentage of A2 negatively correlated with full scale IQ, verbal and performance IQ. CBCL total score correlated positively with CAP rate and A1 index while externalizing score correlated negatively with A3%. Conclusions: This study shows peculiar CAP modifications in children with AS and represents an attempt to correlate the quantification of sleep EEG oscillations with the degree of mental ability/disability. Citation: Bruni O; Ferri R; Vittori E; Novelli L; Vignati M; Porfirio MC; Aricò D; Bernabei P; Curatolo P. Sleep architecture and NREM alterations in children and adolescents with asperger syndrome. SLEEP 2007;30(11):1577-1585. PMID:18041490

Sleep Disorders and their Association with Laboratory Pain Sensitivity in Temporomandibular Joint Disorder

PubMed Central

Smith, Michael T.; Wickwire, Emerson M.; Grace, Edward G.; Edwards, Robert R.; Buenaver, Luis F.; Peterson, Stephen; Klick, Brendan; Haythornthwaite, Jennifer A.

2009-01-01

Study Objectives: We characterized sleep disorder rates in temporomandibular joint disorder (TMD) and evaluated possible associations between sleep disorders and laboratory measures of pain sensitivity. Design: Research diagnostic examinations were conducted, followed by two consecutive overnight polysomnographic studies with morning and evening assessments of pain threshold. Setting: Orofacial pain clinic and inpatient sleep research facility Participants: Fifty-three patients meeting research diagnostic criteria for myofascial TMD. Interventions: N/A Measurements and Results: We determined sleep disorder diagnostic rates and conducted algometric measures of pressure pain threshold on the masseter and forearm. Heat pain threshold was measured on the forearm; 75% met self-report criteria for sleep bruxism, but only 17% met PSG criteria for active sleep bruxism. Two or more sleep disorders were diagnosed in 43% of patients. Insomnia disorder (36%) and sleep apnea (28.4%) demonstrated the highest frequencies. Primary insomnia (PI) (26%) comprised the largest subcategory of insomnia. Even after controlling for multiple potential confounds, PI was associated with reduced mechanical and thermal pain thresholds at all sites (P < 0.05). Conversely, the respiratory disturbance index was associated with increased mechanical pain thresholds on the forearm (P < 0.05). Conclusions: High rates of PI and sleep apnea highlight the need to refer TMD patients complaining of sleep disturbance for polysomnographic evaluation. The association of PI and hyperalgesia at a non-orofacial site suggests that PI may be linked with central sensitivity and could play an etiologic role in idiopathic pain disorders. The association between sleep disordered breathing and hypoalgesia requires further study and may provide novel insight into the complex interactions between sleep and pain-regulatory processes. Citation: Smith MT; Wickwire EM; Grace EG; Edwards RR; Buenaver LF; Peterson S; Klick B; Haythornthwaite JA. Sleep disorders and their association with laboratory pain sensitivity in temporomandibular joint disorder. SLEEP 2009;32(6):779–790. PMID:19544755

Patient Aggression and the Wellbeing of Nurses: A Cross-Sectional Survey Study in Psychiatric and Non-Psychiatric Settings

PubMed Central

Willman, Laura; Virtanen, Marianna; Kivimäki, Mika; Vahtera, Jussi; Välimäki, Maritta

2017-01-01

Wellbeing of nurses is associated with patient aggression. Little is known about the differences in these associations between nurses working in different specialties. We aimed to estimate and compare the prevalence of patient aggression and the associations between patient aggression and the wellbeing of nurses in psychiatric and non-psychiatric specialties (medical and surgical, and emergency medicine). A sample of 5288 nurses (923 psychiatric nurses, 4070 medical and surgical nurses, 295 emergency nurses) participated in the study. Subjective measures were used to assess both the occurrence of patient aggression and the wellbeing of nurses (self-rated health, sleep disturbances, psychological distress and perceived work ability). Binary logistic regression with interaction terms was used to compare the associations between patient aggression and the wellbeing of nurses. Psychiatric nurses reported all types of patient aggression more frequently than medical and surgical nurses, whereas nurses working in emergency settings reported physical violence and verbal aggression more frequently than psychiatric nurses. Psychiatric nurses reported poor self-rated health and reduced work ability more frequently than both of the non-psychiatric nursing groups, whereas medical and surgical nurses reported psychological distress and sleep disturbances more often. Psychiatric nurses who had experienced at least one type of patient aggression or mental abuse in the previous year, were less likely to suffer from psychological distress and sleep disturbances compared to medical and surgical nurses. Psychiatric nurses who had experienced physical assaults and armed threats were less likely to suffer from sleep disturbances compared to nurses working in emergency settings. Compared to medical and surgical nurses, psychiatric nurses face patient aggression more often, but certain types of aggression are more common in emergency settings. Psychiatric nurses have worse subjective health and work ability than both of the non-psychiatric nursing groups, while their psychiatric wellbeing is better and they have less sleep problems compared to medical and surgical nurses. Psychiatric nurses maintain better psychiatric wellbeing and experience fewer sleep problems than non-psychiatric nurses after events of exposure to patient aggression. This suggest that more attention should be given to non-psychiatric settings for maintaining the wellbeing of nurses after exposure to patient aggression. PMID:29057802

Periodontitis and Sleep Disordered Breathing in the Hispanic Community Health Study/Study of Latinos

PubMed Central

Sanders, Anne E.; Essick, Greg K.; Beck, James D.; Cai, Jianwen; Beaver, Shirley; Finlayson, Tracy L.; Zee, Phyllis C.; Loredo, Jose S.; Ramos, Alberto R.; Singer, Richard H.; Jimenez, Monik C.; Barnhart, Janice M.; Redline, Susan

2015-01-01

Study Objectives: To investigate the association between sleep disordered breathing (SDB) and severe chronic periodontitis. Design: Cross-sectional data analysis from the Hispanic Community Health Study/Study of Latinos. Setting: Community-based setting with probability sampling from four urban US communities. Participants: 12,469 adults aged 18–74 y. Interventions: None. Measurements and Results: Severe chronic periodontitis was defined using the Centers for Disease Control and Prevention/American Academy of Periodontology case classification based on full-mouth periodontal assessments performed by calibrated dentists. SDB was evaluated in standardized home sleep tests, and defined as the number of apnea plus hypopnea events associated with ≥ 3% desaturation, per hour of estimated sleep. SDB was quantified using categories of the apnea-hypopnea index (AHI): 0.0 events (nonapneic); 0.1–4.9 (subclinical); 5.0–14.9 (mild); and ≥ 15 (moderate/severe). Covariates were demographic characteristics and established periodontitis risk factors. C-reactive protein was a potential explanatory variable. Using survey estimation, multivariable binary logistic regression estimated odds ratios (OR) and 95% confidence limits (CL). Following adjustment for confounding, the SDB and periodontitis relationship remained statistically significant, but was attenuated in strength and no longer dose-response. Compared with the nonapneic referent, adjusted odds of severe periodontitis were 40% higher with subclinical SDB (OR = 1.4, 95% CL: 1.0, 1.9), 60% higher with mild SDB (OR = 1.6, 95% CL: 1.1, 2.2) and 50% higher with moderate/severe SDB (OR = 1.5, 95% CL: 1.0, 2.3) demonstrating an independent association between SDB and severe periodontitis. Conclusions: This study identifies a novel association between mild sleep disordered breathing and periodontitis that was most pronounced in young adults. Citation: Sanders AE, Essick GK, Beck JD, Cai J, Beaver S, Finlayson TL, Zee PC, Loredo JS, Ramos AR, Singer RH, Jimenez MC, Barhart JM, Redline S. Periodontitis and sleep disordered breathing in the Hispanic Community Health Study/Study of Latinos. SLEEP 2015;38(8):1195–1203. PMID:25669183

Etiologies and evaluation of sleep disturbances in adolescence.

PubMed

Owens, Judith A

2010-12-01

The etiologies of sleep disturbances in adolescents are varied and include biological, environmental, and sociocultural factors. Health care practitioners need to have a basic understanding of normal sleep development in adolescents and the risk factors for inadequate sleep, as well as an appreciation for the myriad potential consequences of insufficient sleep (ie, mood dysregulation, academic failure, and obesity). This chapter provides a systematic approach to screening and evaluating adolescent sleep complaints in the clinical setting and provides suggestions for anticipatory guidance regarding healthy sleep, which should be part of standard adolescent health care.

Relationship between Sleep Disturbance and Functional Outcomes in Daily Life Habits of Children with Down Syndrome

PubMed Central

Churchill, Shervin S.; Kieckhefer, Gail M.; Bjornson, Kristie F.; Herting, Jerald R.

2015-01-01

Objectives: The goal of this study was to describe sleep patterns and accomplishment of daily life habits in children with Down syndrome (DS) and to investigate the relationship between subjective indicators of sleep disturbance with functional outcomes in daily life. Design: Cross-sectional study with an Internet sample Setting: Online survey filled out at home Participants: 110 parents of children with DS and 29 parents of children with typical development (TD), age 5 to 18 years. Interventions: N/A. Measurements and Results: Children's Sleep Habits Questionnaire was employed to collect information about sleep disturbances in 8 domains (subscales) and a total score. The Life Habits questionnaire (Life-H) sampled information about daily life habits in 11 domains. Multivariable regression modeling was used to assess the associations between sleep disturbances and the accomplishment of daily life habits. Sleep disordered breathing (SDB) was a significant explanatory factor in 10 of 11 daily life habits and the total Life-H score. Sleep anxiety and parasomnias significantly influenced the accomplishment of life habits in children with DS as compared to children with typical development. When evaluated in multivariable models in conjunction with the other 7 domains of sleep disturbances, SDB was the most dominant explanatory factor for accomplishment of life habits. Conclusions: Sleep disturbances are negatively related to accomplishment of daily life functions. Prevention and treatment of sleep problems, particularly sleep disordered breathing, in children with Down syndrome may lead to enhanced accomplishment of daily life habits and activities. Citation: Churchill SS, Kieckhefer GM, Bjornson KF, Herting JR. Relationship between sleep disturbance and functional outcomes in daily life habits of children with Down syndrome. SLEEP 2015;38(1):61–71. PMID:25325444

Vascular Compliance Limits during Sleep Deprivation and Recovery Sleep

PubMed Central

Phillips, Derrick J.; Schei, Jennifer L.; Rector, David M.

2013-01-01

Study Objectives: Our previous studies showed that evoked hemodynamic responses are smaller during wake compared to sleep; suggesting neural activity is associated with vascular expansion and decreased compliance. We explored whether prolonged activity during sleep deprivation may exacerbate vascular expansion and blunt hemodynamic responses. Design: Evoked auditory responses were generated with periodic 65dB speaker clicks over a 72-h period and measured with cortical electrodes. Evoked hemodynamic responses were measured simultaneously with optical techniques using three light-emitting diodes, and a photodiode. Setting: Animals were housed in separate 30×30×80cm enclosures, tethered to a commutator system and maintained on a 12-h light/dark cycle. Food and water were available ad libitum. Patients or Participants: Seven adult female Sprague-Dawley rats. Interventions: Following a 24-h baseline recording, sleep deprivation was initiated for 0 to 10 h by gentle handling, followed by a 24-h recovery sleep recording. Evoked electrical and hemodynamic responses were measured before, during, and after sleep deprivation. Measurements and Results: Following deprivation, evoked hemodynamic amplitudes were blunted. Steady-state oxyhemoglobin concentration increased during deprivation and remained high during the initial recovery period before returning to baseline levels after approximately 9-h. Conclusions: Sleep deprivation resulted in blood vessel expansion and decreased compliance while lower basal neural activity during recovery sleep may allow blood vessel compliance to recover. Chronic sleep restriction or sleep deprivation could push the vasculature to critical levels, limiting blood delivery, and leading to metabolic deficits with the potential for neural trauma. Citation: Phillips DJ; Schei JL; Rector DM. Vascular compliance limits during sleep deprivation and recovery sleep. SLEEP 2013;36(10):1459-1470. PMID:24082305

Sleep quality and covariates as predictors of pain intensity among the general population in rural China.

PubMed

Liu, Xiao-Kun; Xiao, Shui-Yuan; Zhou, Liang; Hu, Mi; Zhou, Wei; Liu, Hui-Ming

2018-01-01

The aims of this study were to investigate the distribution of sleep quality and its relationship with the prevalence of pain among rural Chinese people and to explore the association between sleep quality and pain intensity among the general population in real-life settings. This cross-sectional survey included a total of 2052 adults from rural areas in Liuyang, Hunan Province, recruited through random multistage sampling. The distributions of sleep quality and pain prevalence among the participants over a 4-week period were described. Because of multicollinearity among variables, the influence of self-rated sleep quality and psychosocial covariates on pain intensity was explored using a ridge regression model. The data showed that participants reporting all categories of sleep quality experienced some degree of pain. Sleep quality, along with physical and mental health, was a negative predictor of pain intensity among the general population. Symptoms of depression positively predicted pain intensity. Poor sleep quality increased pain intensity among the participants. Both previous research and the present data suggest that improving sleep quality may significantly decrease pain intensity in the general population. The relationship between sleep and pain may be bidirectional. This finding also suggests that treatment for sleep disorders and insomnia should be addressed in future efforts to alleviate pain intensity.

Associations of Self-Reported Sleep Quality with Circulating Interferon Gamma-Inducible Protein 10, Interleukin 6, and High-Sensitivity C-Reactive Protein in Healthy Menopausal Women

PubMed Central

Chang, Chia-Chu; Kor, Chew-Teng; Chen, Ting-Yu; Wu, Hung-Ming

2017-01-01

Introduction Sleep disturbance is very common in menopausal women and poor sleep quality has been linked to systemic inflammation. However, the impact of poor sleep quality on health outcomes of menopausal women remains unclear. This study evaluated the relationships between sleep quality and inflammation in menopausal women. Participants and design This cross-sectional study enrolled 281 healthy women aged 45 to 60 years. The Pittsburgh Sleep Quality Index (PSQI) was used to measure quality of sleep. Multiplex assays were used to measure the levels of 9 cytokines in morning fasting plasma samples. Other variables measured in this study included clinical characteristics and high-sensitivity C-reactive protein (hs-CRP). Setting The study was performed at a medical center. Results The 281 participants comprised 79 (28%) perimenopausal women and 202 (72%) postmenopausal women. Global PSQI scores were positively correlated with plasma hs-CRP levels (P = 0.012) and were marginally associated with interferon gamma-inducible protein-10 (IP10), interleukin 6 (IL6), and macrophage inflammatory protein-1beta (MIP-1β) levels. After adjusting for age, body mass index, menopause duration, and follicle stimulating hormone, multiple linear regression analysis revealed that high PSQI scores and sleep efficiency < 65% were associated with elevated plasma levels of hs-CRP, IP10, and IL6. In addition, sleep duration < 5 hours was associated with high hs-CRP levels. Conclusion Our data show that poor sleep quality and low sleep efficiency are associated with elevated levels of circulating inflammatory factors IP10, IL6 and hs-CRP and that short sleep duration is associated with high levels of hs-CRP in menopausal women. These findings provide novel evidence that poor sleep quality is linked to low-grade systemic inflammation in menopausal women. PMID:28060925

Sleep and Sickness Absence: A Nationally Representative Register-Based Follow-Up Study

PubMed Central

Lallukka, Tea; Kaikkonen, Risto; Härkänen, Tommi; Kronholm, Erkki; Partonen, Timo; Rahkonen, Ossi; Koskinen, Seppo

2014-01-01

Study Objectives: We aimed to examine various sleep measures as determinants of sickness absence while considering confounders. Design: Nationally representative Health 2000 Survey linked with sickness absence data from the Finnish Social Insurance Institution. Setting: Finland. Participants: Working-aged women (n = 1,875) and men (n = 1,885). Interventions: N/A. Measurements and Results: Insomnia-related symptoms, early morning awakenings, being more tired during daytime than other people of same age, use of sleeping pills, excessive daytime sleepiness, probable sleep apnea (4 items about snoring/apnea), and reporting that sleep duration varies between different seasons were examined as determinants of sickness absence over a 7.2 year follow-up. Poisson and gamma regression models were fitted. After adjusting age, all examined sleep disturbances except excessive daytime sleepiness were associated with sickness absence among men (RRs 1.3-2.5). Among women, after adjusting for age, insomnia-related symptoms, early morning awakenings, being more tired than others, and use of sleeping pills were associated with sickness absence (RRs 1.4-1.8). After further adjustments for education, working conditions, health behaviors, and objectively measured mental and somatic health, the associations somewhat attenuated but mainly remained. The optimal sleep duration with the lowest risk of sickness absence was 7.6 hours for women and 7.8 hours for men. Although persistence of other health problems could affect the estimates, direct costs due to sickness absence could decrease by up to 28% if sleep disturbances could be fully addressed. Conclusions: This study highlights the need for prevention of sleep disturbances and promotion of optimal sleep length to prevent sickness absence. Citation: Lallukka T, Kaikkonen R, Härkänen T, Kronholm E, Partonen T, Rahkonen O, Koskinen S. Sleep and sickness absence: a nationally representative register-based follow-up study. SLEEP 2014;37(9):1413-1425. PMID:25142569

Sleep Loss Exacerbates Fatigue, Depression, and Pain in Rheumatoid Arthritis

PubMed Central

Irwin, Michael R.; Olmstead, Richard; Carrillo, Carmen; Sadeghi, Nina; FitzGerald, John D.; Ranganath, Veena K.; Nicassio, Perry M.

2012-01-01

Study Objectives: Disturbances of sleep are hypothesized to contribute to pain. However, experimental data are limited to healthy pain-free individuals. This study evaluated the effect of sleep loss during part of the night on daytime mood symptoms and pain perceptions in patients with rheumatoid arthritis in comparison with control subjects. Design: A between-groups laboratory study with assessment of mood symptoms and pain perception before and after partial night sleep deprivation (PSD; awake 23:00 hr to 03:00 hr). Setting: General clinical research center. Participants: Patients with rheumatoid arthritis (n = 27) and volunteer comparison control subjects (n = 27). Measurements: Subjective reports of sleep, mood symptoms and pain, polysomnographic assessment of sleep continuity, and subjective and objective assessment of rheumatoid arthritis-specific joint pain. Results: PSD induced differential increases in self-reported fatigue (P < 0.09), depression (P < 0.04), anxiety (P < 0.04), and pain (P < 0.01) in patients with rheumatoid arthritis compared with responses in control subjects, in whom differential increases of self-reported pain were independent of changes in mood symptoms, subjective sleep quality, and objective measures of sleep fragmentation. In the patients with rheumatoid arthritis, PSD also induced increases in disease-specific activity as indexed by self-reported pain severity (P < 0.01) and number of painful joints (P < 0.02) as well as clinician-rated joint counts (P < 0.03). Conclusion: This study provides the first evidence of an exaggerated increase in symptoms of mood and pain in patients with rheumatoid arthritis after sleep loss, along with an activation of rheumatoid arthritis-related joint pain. Given the reciprocal relationship between sleep disturbances and pain, clinical management of pain in patients with rheumatoid arthritis should include an increased focus on the prevention and treatment of sleep disturbance in this clinical population. Citation: Irwin MR; Olmstead R; Carrillo C; Sadeghi N; FitzGerald JD; Ranganath VK; Nicassio PM. Sleep loss exacerbates fatigue, depression, and pain in rheumatoid arthritis. SLEEP 2012;35(4):537-543. PMID:22467992

The Multidimensional Aspects of Sleep Spindles and Their Relationship to Word-Pair Memory Consolidation

PubMed Central

Lustenberger, Caroline; Wehrle, Flavia; Tüshaus, Laura; Achermann, Peter; Huber, Reto

2015-01-01

Study Objectives: Several studies proposed a link between sleep spindles and sleep dependent memory consolidation in declarative learning tasks. In addition to these state-like aspects of sleep spindles, they have also trait-like characteristics, i.e., were related to general cognitive performance, an important distinction that has often been neglected in correlative studies. Furthermore, from the multitude of different sleep spindle measures, often just one specific aspect was analyzed. Thus, we aimed at taking multidimensional aspects of sleep spindles into account when exploring their relationship to word-pair memory consolidation. Design: Each subject underwent 2 study nights with all-night high-density electroencephalographic (EEG) recordings. Sleep spindles were automatically detected in all EEG channels. Subjects were trained and tested on a word-pair learning task in the evening, and retested in the morning to assess sleep related memory consolidation (overnight retention). Trait-like aspects refer to the mean of both nights and state-like aspects were calculated as the difference between night 1 and night 2. Setting: Sleep laboratory. Participants: Twenty healthy male subjects (age: 23.3 ± 2.1 y) Measurements and Results: Overnight retention was negatively correlated with trait-like aspects of fast sleep spindle density and positively with slow spindle density on a global level. In contrast, state-like aspects were observed for integrated slow spindle activity, which was positively related to the differences in overnight retention in specific regions. Conclusion: Our results demonstrate the importance of a multidimensional approach when investigating the relationship between sleep spindles and memory consolidation and thereby provide a more complete picture explaining divergent findings in the literature. Citation: Lustenberger C, Wehrle F, Tüshaus L, Achermann P, Huber R. The multidimensional aspects of sleep spindles and their relationship to word-pair memory consolidation. SLEEP 2015;38(7):1093–1103. PMID:25845686

Measuring Sleep: Accuracy, Sensitivity, and Specificity of Wrist Actigraphy Compared to Polysomnography

PubMed Central

Marino, Miguel; Li, Yi; Rueschman, Michael N.; Winkelman, J. W.; Ellenbogen, J. M.; Solet, J. M.; Dulin, Hilary; Berkman, Lisa F.; Buxton, Orfeu M.

2013-01-01

Objectives: We validated actigraphy for detecting sleep and wakefulness versus polysomnography (PSG). Design: Actigraphy and polysomnography were simultaneously collected during sleep laboratory admissions. All studies involved 8.5 h time in bed, except for sleep restriction studies. Epochs (30-sec; n = 232,849) were characterized for sensitivity (actigraphy = sleep when PSG = sleep), specificity (actigraphy = wake when PSG = wake), and accuracy (total proportion correct); the amount of wakefulness after sleep onset (WASO) was also assessed. A generalized estimating equation (GEE) model included age, gender, insomnia diagnosis, and daytime/nighttime sleep timing factors. Setting: Controlled sleep laboratory conditions. Participants: Young and older adults, healthy or chronic primary insomniac (PI) patients, and daytime sleep of 23 night-workers (n = 77, age 35.0 ± 12.5, 30F, mean nights = 3.2). Interventions: N/A. Measurements and Results: Overall, sensitivity (0.965) and accuracy (0.863) were high, whereas specificity (0.329) was low; each was only slightly modified by gender, insomnia, day/night sleep timing (magnitude of change < 0.04). Increasing age slightly reduced specificity. Mean WASO/night was 49.1 min by PSG compared to 36.8 min/night by actigraphy (β = 0.81; CI = 0.42, 1.21), unbiased when WASO < 30 min/night, and overestimated when WASO > 30 min/night. Conclusions: This validation quantifies strengths and weaknesses of actigraphy as a tool measuring sleep in clinical and population studies. Overall, the participant-specific accuracy is relatively high, and for most participants, above 80%. We validate this finding across multiple nights and a variety of adults across much of the young to midlife years, in both men and women, in those with and without insomnia, and in 77 participants. We conclude that actigraphy is overall a useful and valid means for estimating total sleep time and wakefulness after sleep onset in field and workplace studies, with some limitations in specificity. Citation: Marino M; Li Y; Rueschman MN; Winkelman JW; Ellenbogen JM; Solet JM; Dulin H; Berkman LF; Buxton OM. Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. SLEEP 2013;36(11):1747-1755. PMID:24179309

Associations of Objectively and Subjectively Measured Sleep Quality with Subsequent Cognitive Decline in Older Community-Dwelling Men: The MrOS Sleep Study

PubMed Central

Blackwell, Terri; Yaffe, Kristine; Laffan, Alison; Ancoli-Israel, Sonia; Redline, Susan; Ensrud, Kristine E.; Song, Yeonsu; Stone, Katie L.

2014-01-01

Study Objectives: To examine associations of objectively and subjectively measured sleep with subsequent cognitive decline. Design: A population-based longitudinal study. Setting: Six centers in the United States. Participants: Participants were 2,822 cognitively intact community-dwelling older men (mean age 76.0 ± 5.3 y) followed over 3.4 ± 0.5 y. Interventions: None. Measurements and Results: Objectively measured sleep predictors from wrist actigraphy: total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), number of long wake episodes (LWEP). Self-reported sleep predictors: sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daytime sleepiness (Epworth Sleepiness Scale [ESS]), TST. Clinically significant cognitive decline: five-point decline on the Modified Mini-Mental State examination (3MS), change score for the Trails B test time in the worse decile. Associations of sleep predictors and cognitive decline were examined with logistic regression and linear mixed models. After multivariable adjustment, higher levels of WASO and LWEP and lower SE were associated with an 1.4 to 1.5-fold increase in odds of clinically significant decline (odds ratio 95% confidence interval) Trails B test: SE < 70% versus SE ≥ 70%: 1.53 (1.07, 2.18); WASO ≥ 90 min versus WASO < 90 min: 1.47 (1.09, 1.98); eight or more LWEP versus fewer than eight: 1.38 (1.02, 1.86). 3MS: eight or more LWEP versus fewer than eight: 1.36 (1.09, 1.71), with modest relationships to linear change in cognition over time. PSQI was related to decline in Trails B performance (3 sec/y per standard deviation increase). Conclusions: Among older community-dwelling men, reduced sleep efficiency, greater nighttime wakefulness, greater number of long wake episodes, and poor self-reported sleep quality were associated with subsequent cognitive decline. Citation: Blackwell T; Yaffe K; Laffan A; Ancoli-Israel S; Redline S; Ensrud KE; Song Y; Stone KL. Associations of objectively and subjectively measured sleep quality with subsequent cognitive decline in older community-dwelling men: the MrOS sleep study. SLEEP 2014;37(4):655-663. PMID:24899757

Regional Reductions in Sleep Electroencephalography Power in Obstructive Sleep Apnea: A High-Density EEG Study

PubMed Central

Jones, Stephanie G.; Riedner, Brady A.; Smith, Richard F.; Ferrarelli, Fabio; Tononi, Giulio; Davidson, Richard J.; Benca, Ruth M.

2014-01-01

Study Objectives: Obstructive sleep apnea (OSA) is associated with significant alterations in neuronal integrity resulting from either hypoxemia and/or sleep loss. A large body of imaging research supports reductions in gray matter volume, alterations in white matter integrity and resting state activity, and functional abnormalities in response to cognitive challenge in various brain regions in patients with OSA. In this study, we used high-density electroencephalography (hdEEG), a functional imaging tool that could potentially be used during routine clinical care, to examine the regional distribution of neural activity in a non-clinical sample of untreated men and women with moderate/severe OSA. Design: Sleep was recorded with 256-channel EEG in relatively healthy subjects with apnea-hypopnea index (AHI) > 10, as well as age-, sex-, and body mass index-matched controls selected from a research population initially recruited for a study on sleep and meditation. Setting: Sleep laboratory. Patients or Participants: Nine subjects with AHI > 10 and nine matched controls. Interventions: N/A. Measurements and Results: Topographic analysis of hdEEG data revealed a broadband reduction in EEG power in a circumscribed region overlying the parietal cortex in OSA subjects. This parietal reduction in neural activity was present, to some extent, across all frequency bands in all stages and episodes of nonrapid eye movement sleep. Conclusion: This investigation suggests that regional deficits in electroencephalography (EEG) power generation may be a useful clinical marker for neural disruption in obstructive sleep apnea, and that high-density EEG may have the sensitivity to detect pathological cortical changes early in the disease process. Citation: Jones SG; Riedner BA; Smith RF; Ferrarelli F; Tononi G; Davidson RJ; Benca RM. Regional reductions in sleep electroencephalography power in obstructive sleep apnea: a high-density EEG study. SLEEP 2014;37(2):399-407. PMID:24497668

The Effect of Acute Sleep Deprivation on Visual Evoked Potentials in Professional Drivers

PubMed Central

Jackson, Melinda L.; Croft, Rodney J.; Owens, Katherine; Pierce, Robert J.; Kennedy, Gerard A.; Crewther, David; Howard, Mark E.

2008-01-01

Study Objectives: Previous studies have demonstrated that as little as 18 hours of sleep deprivation can cause deleterious effects on performance. It has also been suggested that sleep deprivation can cause a “tunnel-vision” effect, in which attention is restricted to the center of the visual field. The current study aimed to replicate these behavioral effects and to examine the electrophysiological underpinnings of these changes. Design: Repeated-measures experimental study. Setting: University laboratory. Patients or Participants: Nineteen professional drivers (1 woman; mean age = 45.3 ± 9.1 years). Interventions: Two experimental sessions were performed; one following 27 hours of sleep deprivation and the other following a normal night of sleep, with control for circadian effects. Measurements & Results: A tunnel-vision task (central versus peripheral visual discrimination) and a standard checkerboard-viewing task were performed while 32-channel EEG was recorded. For the tunnel-vision task, sleep deprivation resulted in an overall slowing of reaction times and increased errors of omission for both peripheral and foveal stimuli (P < 0.05). These changes were related to reduced P300 amplitude (indexing cognitive processing) but not measures of early visual processing. No evidence was found for an interaction effect between sleep deprivation and visual-field position, either in terms of behavior or electrophysiological responses. Slower processing of the sustained parvocellular visual pathway was demonstrated. Conclusions: These findings suggest that performance deficits on visual tasks during sleep deprivation are due to higher cognitive processes rather than early visual processing. Sleep deprivation may differentially impair processing of more-detailed visual information. Features of the study design (eg, visual angle, duration of sleep deprivation) may influence whether peripheral visual-field neglect occurs. Citation: Jackson ML; Croft RJ; Owens K; Pierce RJ; Kennedy GA; Crewther D; Howard ME. The effect of acute sleep deprivation on visual evoked potentials in professional drivers. SLEEP 2008;31(9):1261-1269. PMID:18788651

Cognitive flexibility: A distinct element of performance impairment due to sleep deprivation.

PubMed

Honn, K A; Hinson, J M; Whitney, P; Van Dongen, H P A

2018-03-14

In around-the-clock operations, reduced alertness due to circadian misalignment and sleep loss causes performance impairment, which can lead to catastrophic errors and accidents. There is mounting evidence that performance on different tasks is differentially affected, but the general principles underlying this differentiation are not well understood. One factor that may be particularly relevant is the degree to which tasks require executive control, that is, control over the initiation, monitoring, and termination of actions in order to achieve goals. A key aspect of this is cognitive flexibility, i.e., the deployment of cognitive control resources to adapt to changes in events. Loss of cognitive flexibility due to sleep deprivation has been attributed to "feedback blunting," meaning that feedback on behavioral outcomes has reduced salience - and that feedback is therefore less effective at driving behavior modification under changing circumstances. The cognitive mechanisms underlying feedback blunting are as yet unknown. Here we present data from an experiment that investigated the effects of sleep deprivation on performance after an unexpected reversal of stimulus-response mappings, requiring cognitive flexibility to maintain good performance. Nineteen healthy young adults completed a 4-day in-laboratory study. Subjects were randomized to either a total sleep deprivation condition (n = 11) or a control condition (n = 8). Athree-phase reversal learning decision task was administered at baseline, and again after 30.5 h of sleep deprivation, or matching well-rested control. The task was based on a go/no go task paradigm, in which stimuli were assigned to either a go (response) set or a no go (no response) set. Each phase of the task included four stimuli (two in the go set and two in the no go set). After each stimulus presentation, subjects could make a response within 750 ms or withhold their response. They were then shown feedback on the accuracy of their response. In phase 1 of the task, subjects were explicitly told which stimuli were assigned to the go and no go sets. In phases 2 and 3, new stimuli were used that were different from those used in phase 1. Subjects were not explicitly told the go/no go mappings and were instead required to use accuracy feedback to learn which stimuli were in the go and nogo sets. Phase 3 continued directly from phase 2 and retained the same stimuli as in phase 2, but there was an unannounced reversal of the stimulus-response mappings. Task results confirmed that sleep deprivation resulted in loss of cognitive flexibility through feedback blunting, and that this effect was not produced solely by (1) general performance impairment because of overwhelming sleep drive; (2) reduced working memory resources available to perform the task; (3) incomplete learning of stimulus-response mappings before the unannounced reversal; or (4) interference with stimulus identification through lapses in vigilant attention. Overall, the results suggest that sleep deprivation causes a fundamental problem with dynamic attentional control. This element of performance impairment due to sleep deprivation appears to be distinct from vigilant attention deficits, and represents a particularly significant challenge for fatigue risk management. Copyright © 2018. Published by Elsevier Ltd.

A study protocol: a community pharmacy-based intervention for improving the management of sleep disorders in the community settings

PubMed Central

2014-01-01

Background Sleep disorders are very common in the community and are estimated to affect up to 45% of the world’s population. Pharmacists are in a position to give advice and provide appropriate services to individuals who are unable to easily access medical care. The purpose of this study is to develop an intervention to improve the management of sleep disorders in the community. The aims are– (1) to evaluate the effectiveness of a community pharmacy-based intervention in managing sleep disorders, (2) to evaluate the role of actigraph as an objective measure in monitoring certain sleep disorders and (3) to evaluate the extended role of community pharmacists in managing sleep disorders. This intervention is developed to monitor individuals undergoing treatment and overcome the difficulties in validating self-reported feedback. Method/design This is a community-based intervention, prospective, controlled trial, with one intervention group and one control group, comparing individuals receiving a structured intervention with those receiving usual care for sleep-related disorders at community pharmacies. Discussion This study will demonstrate the utilisation and efficacy of community pharmacy-based intervention to manage sleep disorders in the community, and will assess the possibility of implementing this intervention into the community pharmacy workflow. Trial registration Australian New Zealand Clinical Trial Registry: ACTRN12612000825853 PMID:24533916

Sustained Sleep Fragmentation Induces Sleep Homeostasis in Mice

PubMed Central

Baud, Maxime O.; Magistretti, Pierre J.; Petit, Jean-Marie

2015-01-01

Study Objectives: Sleep fragmentation (SF) is an integral feature of sleep apnea and other prevalent sleep disorders. Although the effect of repetitive arousals on cognitive performance is well documented, the effects of long-term SF on electroencephalography (EEG) and molecular markers of sleep homeostasis remain poorly investigated. To address this question, we developed a mouse model of chronic SF and characterized its effect on EEG spectral frequencies and the expression of genes previously linked to sleep homeostasis including clock genes, heat shock proteins, and plasticity-related genes. Design: N/A. Setting: Animal sleep research laboratory. Participants : Sixty-six C57BL6/J adult mice. Interventions: Instrumental sleep disruption at a rate of 60/h during 14 days Measurements and Results: Locomotor activity and EEG were recorded during 14 days of SF followed by recovery for 2 days. Despite a dramatic number of arousals and decreased sleep bout duration, SF minimally reduced total quantity of sleep and did not significantly alter its circadian distribution. Spectral analysis during SF revealed a homeostatic drive for slow wave activity (SWA; 1–4 Hz) and other frequencies as well (4–40 Hz). Recordings during recovery revealed slow wave sleep consolidation and a transient rebound in SWA, and paradoxical sleep duration. The expression of selected genes was not induced following chronic SF. Conclusions: Chronic sleep fragmentation (SF) increased sleep pressure confirming that altered quality with preserved quantity triggers core sleep homeostasis mechanisms. However, it did not induce the expression of genes induced by sleep loss, suggesting that these molecular pathways are not sustainably activated in chronic diseases involving SF. Citation: Baud MO, Magistretti PJ, Petit JM. Sustained sleep fragmentation induces sleep homeostasis in mice. SLEEP 2015;38(4):567–579. PMID:25325477

Sleep medicine knowledge, attitudes, and practices among medical students in Guangzhou, China.

PubMed

Luo, Miao; Feng, Yuan; Li, Taoping

2013-05-01

This study aimed to describe the knowledge, attitudes, and practices of Chinese medical students towards sleep medicine. The authors surveyed medical students at Southern Medical University in 2009. Students completed a questionnaire before and after attending a 3-h sleep disorders course. All 324 questionnaires were returned. Less than one half of the students were aware that restless legs syndrome, somniloquy, and teeth grinding are sleep disorders. Only a small percentage of students knew that sleep disorders are related to diabetes, anemia, hyperlipidemia, and attention deficit syndrome. After the 3-h sleep disorders course, the percentage of students who regarded snoring, restless legs syndrome, nightmares, and somniloquy as sleep disorders increased from 64.9 to 92.7 %, 40.8 to 64.4 %, 48.0 to 60.3 %, and 33.5 to 59.9 % (P < 0.001), respectively. Sleep problems were considered to be a significant issue by 93.8 % of the students. The students thought that people with sleep disorders should seek treatment. Of the students, 81.3 % were interested in sleep medicine. The students considered that it is necessary to set up specialized sleep medicine departments to manage sleep disorders. Of the students, 76.8 % thought they or their friends had sleep problems, and 44.8 % consulted physicians about sleep problems. Greater than two thirds of the students (67.1 %) did not have formal education about sleep medicine. Few students were aware of medical schools offering a course in sleep medicine. Most of the students liked learning in the form of elective courses, lectures, or online course. The students also realized that having sleep medicine knowledge is needed as a physician. Chinese medical students attached importance to sleep disorders, but knew little about sleep disorders. Knowledge of sleep medicine can be improved with a short training course.

Sleep disturbance induces neuroinflammation and impairment of learning and memory.

PubMed

Zhu, Biao; Dong, Yuanlin; Xu, Zhipeng; Gompf, Heinrich S; Ward, Sarah A P; Xue, Zhanggang; Miao, Changhong; Zhang, Yiying; Chamberlin, Nancy L; Xie, Zhongcong

2012-12-01

Hospitalized patients can develop cognitive function decline, the mechanisms of which remain largely to be determined. Sleep disturbance often occurs in hospitalized patients, and neuroinflammation can induce learning and memory impairment. We therefore set out to determine whether sleep disturbance can induce neuroinflammation and impairment of learning and memory in rodents. Five to 6-month-old wild-type C57BL/6J male mice were used in the studies. The mice were placed in rocking cages for 24 h, and two rolling balls were present in each cage. The mice were tested for learning and memory function using the Fear Conditioning Test one and 7 days post-sleep disturbance. Neuroinflammation in the mouse brain tissues was also determined. Of the Fear Conditioning studies at one day and 7 days after sleep disturbance, twenty-four hour sleep disturbance decreased freezing time in the context test, which assesses hippocampus-dependent learning and memory; but not the tone test, which assesses hippocampus-independent learning and memory. Sleep disturbance increased pro-inflammatory cytokine IL-6 levels and induced microglia activation in the mouse hippocampus, but not the cortex. These results suggest that sleep disturbance induces neuroinflammation in the mouse hippocampus, and impairs hippocampus-dependent learning and memory in mice. Pending further studies, these findings suggest that sleep disturbance-induced neuroinflammation and impairment of learning and memory may contribute to the development of cognitive function decline in hospitalized patients. Copyright © 2012 Elsevier Inc. All rights reserved.

Epigenomics of Total Acute Sleep Deprivation in Relation to Genome-Wide DNA Methylation Profiles and RNA Expression.

PubMed

Nilsson, Emil K; Boström, Adrian E; Mwinyi, Jessica; Schiöth, Helgi B

2016-06-01

Despite an established link between sleep deprivation and epigenetic processes in humans, it remains unclear to what extent sleep deprivation modulates DNA methylation. We performed a within-subject randomized blinded study with 16 healthy subjects to examine the effect of one night of total sleep deprivation (TSD) on the genome-wide methylation profile in blood compared with that in normal sleep. Genome-wide differences in methylation between both conditions were assessed by applying a paired regression model that corrected for monocyte subpopulations. In addition, the correlations between the methylation of genes detected to be modulated by TSD and gene expression were examined in a separate, publicly available cohort of 10 healthy male donors (E-GEOD-49065). Sleep deprivation significantly affected the DNA methylation profile both independently and in dependency of shifts in monocyte composition. Our study detected differential methylation of 269 probes. Notably, one CpG site was located 69 bp upstream of ING5, which has been shown to be differentially expressed after sleep deprivation. Gene set enrichment analysis detected the Notch and Wnt signaling pathways to be enriched among the differentially methylated genes. These results provide evidence that total acute sleep deprivation alters the methylation profile in healthy human subjects. This is, to our knowledge, the first study that systematically investigated the impact of total acute sleep deprivation on genome-wide DNA methylation profiles in blood and related the epigenomic findings to the expression data.

[Status of cardiorespiratory polysomnographic diagnosis in the sleep laboratory].

PubMed

Penzel, T

1995-03-01

The different types of sleep related breathing and cardiovascular disorders are well known and defined nowadays. Thereby it is possible to present a configuration by which a cardiorespiratory sleep laboratory is enabled to perform a complete differential diagnosis. This configuration consists of the function sleep with EEG, EOG and EMG, the function respiration with respiratory effort, respiratory flow and oxygen saturation, and the cardiovascular function with ECG and blood pressure if indicated. Continuous monitoring by videocamera and a patient call system with a technician present during the entire recording time must be assured. Recording and evaluation of all signals can be done with chart polygraphs or with computer systems if they provide a high-resolution graphic monitor. Automatic sleep analysis systems support evaluation of polysomnograms. But automatic analysis of sleep stages as well as automatic analysis of respiratory disorders needs visual counterchecking before results can be accepted. On the basis of today's knowledge recommendation for the setting of a sleep laboratory were set and new sleep labs are controlled on a voluntary basis by a commission of the German society for sleep research and sleep medicine. This first step of quality control is introduced to establish a procedure to keep quality of diagnosis and treatment on a high level in this medical specialty.

Effectiveness of Group Cognitive Behavioral Therapy for Insomnia (CBT-I) in a Primary Care Setting.

PubMed

Davidson, Judith R; Dawson, Samantha; Krsmanovic, Adrijana

2017-05-02

Primary care is where many patients with insomnia first ask for professional help. Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia. Although CBT-I's efficacy is well established, its effectiveness in real-life primary care has seldom been investigated. We examined the effectiveness of CBT-I as routinely delivered in a Canadian primary care setting. The patients were 70 women and 11 men (mean age = 57.0 years, SD = 12.3); 83% had medical comorbidity. For the first 81 patients who took the six-session group program we compared initial and postprogram sleep diaries, sleep medication use, Insomnia Severity Index (ISI), the Hospital Anxiety and Depression Scale (HADS), and visits to the family physician. Sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, and ISI scores improved significantly (p < .001). Mood ratings also improved (p < .001). Use of sleep medication decreased (p < .001). Effect sizes were medium to large. Eighty-eight percent of patients no longer had clinically significant insomnia (ISI score ≤ 14) by the last session; 61% showed at least "moderate" improvement (ISI score reduction > 7). Wait-list data from 42 patients showed minimal sleep and mood improvements with the passage of time. Number of visits to the family physician six months postprogram decreased, although not significantly (p = .108). The CBT-I program was associated with improvement on all sleep and mood measures. Effect sizes were similar to, or larger than, those found in randomized controlled trials, demonstrating the real-world effectiveness of CBT-I in an interdisciplinary primary care setting.

MiDas: Automatic Extraction of a Common Domain of Discourse in Sleep Medicine for Multi-center Data Integration

PubMed Central

Sahoo, Satya S.; Ogbuji, Chimezie; Luo, Lingyun; Dong, Xiao; Cui, Licong; Redline, Susan S.; Zhang, Guo-Qiang

2011-01-01

Clinical studies often use data dictionaries with controlled sets of terms to facilitate data collection, limited interoperability and sharing at a local site. Multi-center retrospective clinical studies require that these data dictionaries, originating from individual participating centers, be harmonized in preparation for the integration of the corresponding clinical research data. Domain ontologies are often used to facilitate multi-center data integration by modeling terms from data dictionaries in a logic-based language, but interoperability among domain ontologies (using automated techniques) is an unresolved issue. Although many upper-level reference ontologies have been proposed to address this challenge, our experience in integrating multi-center sleep medicine data highlights the need for an upper level ontology that models a common set of terms at multiple-levels of abstraction, which is not covered by the existing upper-level ontologies. We introduce a methodology underpinned by a Minimal Domain of Discourse (MiDas) algorithm to automatically extract a minimal common domain of discourse (upper-domain ontology) from an existing domain ontology. Using the Multi-Modality, Multi-Resource Environment for Physiological and Clinical Research (Physio-MIMI) multi-center project in sleep medicine as a use case, we demonstrate the use of MiDas in extracting a minimal domain of discourse for sleep medicine, from Physio-MIMI’s Sleep Domain Ontology (SDO). We then extend the resulting domain of discourse with terms from the data dictionary of the Sleep Heart and Health Study (SHHS) to validate MiDas. To illustrate the wider applicability of MiDas, we automatically extract the respective domains of discourse from 6 sample domain ontologies from the National Center for Biomedical Ontologies (NCBO) and the OBO Foundry. PMID:22195180

MiDas: automatic extraction of a common domain of discourse in sleep medicine for multi-center data integration.

PubMed

Sahoo, Satya S; Ogbuji, Chimezie; Luo, Lingyun; Dong, Xiao; Cui, Licong; Redline, Susan S; Zhang, Guo-Qiang

2011-01-01

Clinical studies often use data dictionaries with controlled sets of terms to facilitate data collection, limited interoperability and sharing at a local site. Multi-center retrospective clinical studies require that these data dictionaries, originating from individual participating centers, be harmonized in preparation for the integration of the corresponding clinical research data. Domain ontologies are often used to facilitate multi-center data integration by modeling terms from data dictionaries in a logic-based language, but interoperability among domain ontologies (using automated techniques) is an unresolved issue. Although many upper-level reference ontologies have been proposed to address this challenge, our experience in integrating multi-center sleep medicine data highlights the need for an upper level ontology that models a common set of terms at multiple-levels of abstraction, which is not covered by the existing upper-level ontologies. We introduce a methodology underpinned by a Minimal Domain of Discourse (MiDas) algorithm to automatically extract a minimal common domain of discourse (upper-domain ontology) from an existing domain ontology. Using the Multi-Modality, Multi-Resource Environment for Physiological and Clinical Research (Physio-MIMI) multi-center project in sleep medicine as a use case, we demonstrate the use of MiDas in extracting a minimal domain of discourse for sleep medicine, from Physio-MIMI's Sleep Domain Ontology (SDO). We then extend the resulting domain of discourse with terms from the data dictionary of the Sleep Heart and Health Study (SHHS) to validate MiDas. To illustrate the wider applicability of MiDas, we automatically extract the respective domains of discourse from 6 sample domain ontologies from the National Center for Biomedical Ontologies (NCBO) and the OBO Foundry.

Effects of experimental sleep deprivation on anxiety-like behavior in animal research: Systematic review and meta-analysis.

PubMed

Pires, Gabriel Natan; Bezerra, Andréia Gomes; Tufik, Sergio; Andersen, Monica Levy

2016-09-01

Increased acute anxiety is a commonly reported behavioral consequence of sleep deprivation in humans. However, rodent studies conducted so far produced inconsistent results, failing to reproduce the same sleep deprivation induced-anxiety observed in clinical experiments. While some presented anxiogenesis as result of sleep deprivation, others reported anxiolysis. In face of such inconsistencies, this article explores the effects of experimental sleep deprivation on anxiety-like behavior in animal research through a systematic review and a series of meta-analyses. A total of 50 of articles met our inclusion criteria, 30 on mice, 19 on rats and one on Zebrafish. Our review shows that sleep deprivation induces a decrease in anxiety-like behavior in preclinical models, which is opposite to results observed in human settings. These results were corroborated in stratified analyses according to species, sleep deprivation method and anxiety measurement technique. In conclusion, the use of animal models for the evaluation of the relationship between sleep deprivation lacks translational applicability and new experimental tools are needed to properly evaluate sleep deprivation-induced anxiogenesis in rodents. Copyright © 2016 Elsevier Ltd. All rights reserved.

Metric learning for automatic sleep stage classification.

PubMed

Phan, Huy; Do, Quan; Do, The-Luan; Vu, Duc-Lung

2013-01-01

We introduce in this paper a metric learning approach for automatic sleep stage classification based on single-channel EEG data. We show that learning a global metric from training data instead of using the default Euclidean metric, the k-nearest neighbor classification rule outperforms state-of-the-art methods on Sleep-EDF dataset with various classification settings. The overall accuracy for Awake/Sleep and 4-class classification setting are 98.32% and 94.49% respectively. Furthermore, the superior accuracy is achieved by performing classification on a low-dimensional feature space derived from time and frequency domains and without the need for artifact removal as a preprocessing step.

Determinants of compliance with nasal continuous positive airway pressure treatment applied in a community setting.

PubMed

Ball, E M.; Banks, M B.

2001-05-01

Objectives: To assess determinants of nasal continuous positive airway pressure (CPAP) compliance when applied in a community setting.Background: One-third of obstructive sleep apnea patients eventually refuse CPAP therapy. Treatment outcomes may be improved by identifying predictors of CPAP failure, including whether management by primary care physicians without sleep consultation affects results.Methods: Polysomnogram, chart review, and questionnaire results for regular CPAP users (n=123) were compared with those returning the CPAP machine (n=26).Results: Polysomnographic data and the presence of multiple sleep disorders were only modestly predictive of CPAP compliance. Striking differences in questionnaire responses separated CPAP users from non-users, who reported less satisfaction with all phases of their diagnosis and management. Rates of CPAP use were not significantly different between patients managed solely by their primary care physician or by a sleep consultant.Conclusions: Polysomnographic findings are unlikely to identify eventual CPAP non-compliers in a cost-effective fashion. Improvements in sleep apnea management may result from addressing the role of personality factors and multiple sleep disorders in determining compliance. In this practice setting, management by primary care physicians did not significantly degrade CPAP compliance.

Cues of Fatigue: Effects of Sleep Deprivation on Facial Appearance

PubMed Central

Sundelin, Tina; Lekander, Mats; Kecklund, Göran; Van Someren, Eus J. W.; Olsson, Andreas; Axelsson, John

2013-01-01

Study Objective: To investigate the facial cues by which one recognizes that someone is sleep deprived versus not sleep deprived. Design: Experimental laboratory study. Setting: Karolinska Institutet, Stockholm, Sweden. Participants: Forty observers (20 women, mean age 25 ± 5 y) rated 20 facial photographs with respect to fatigue, 10 facial cues, and sadness. The stimulus material consisted of 10 individuals (five women) photographed at 14:30 after normal sleep and after 31 h of sleep deprivation following a night with 5 h of sleep. Measurements: Ratings of fatigue, fatigue-related cues, and sadness in facial photographs. Results: The faces of sleep deprived individuals were perceived as having more hanging eyelids, redder eyes, more swollen eyes, darker circles under the eyes, paler skin, more wrinkles/fine lines, and more droopy corners of the mouth (effects ranging from b = +3 ± 1 to b = +15 ± 1 mm on 100-mm visual analog scales, P < 0.01). The ratings of fatigue were related to glazed eyes and to all the cues affected by sleep deprivation (P < 0.01). Ratings of rash/eczema or tense lips were not significantly affected by sleep deprivation, nor associated with judgements of fatigue. In addition, sleep-deprived individuals looked sadder than after normal sleep, and sadness was related to looking fatigued (P < 0.01). Conclusions: The results show that sleep deprivation affects features relating to the eyes, mouth, and skin, and that these features function as cues of sleep loss to other people. Because these facial regions are important in the communication between humans, facial cues of sleep deprivation and fatigue may carry social consequences for the sleep deprived individual in everyday life. Citation: Sundelin T; Lekander M; Kecklund G; Van Someren EJW; Olsson A; Axelsson J. Cues of fatigue: effects of sleep deprivation on facial appearance. SLEEP 2013;36(9):1355-1360. PMID:23997369

Sleep Patterns as Predictors for Disability Pension Due to Low Back Diagnoses: A 23-Year Longitudinal Study of Finnish Twins

PubMed Central

Ropponen, Annina; Silventoinen, Karri; Hublin, Christer; Svedberg, Pia; Koskenvuo, Markku; Kaprio, Jaakko

2013-01-01

Study Objectives: Impaired sleep patterns are known to be associated with many chronic conditions and ultimately they may lead to permanent work incapacity. Less is known about the associations between sleep patterns and cause-specific disability pensions, such as low back diagnoses, or whether familial factors (genetics and family environment) can affect the associations. The objective of this study was to investigate sleep patterns as predictors of disability pension due to low back diagnoses with a 23-year follow-up. Design and Setting: A prospective cohort study with comprehensive mailed questionnaires about sleep patterns, e.g., quality and length of sleep in 1975 and 1981. Follow-up from the national disability pension register data until 2004. Interventions: Not applicable. Participants: There were 18,979 individuals (7,722 complete twin pairs) born before 1958. Measurements and Results: Cox proportional hazards regression was used to calculate hazard ratios (HR) with 95% confidence intervals (95% CI). Disability pension due to low back diagnoses had been granted to 467 individuals during the follow-up. Sleeping moderately well (HR 1.25; 95% CI 1.02, 1.53), or fairly poorly/poorly (HR 2.05; 95% CI 1.53, 2.73) at baseline predicted a significantly higher risk for disability pension. Stable patterns of sleeping either fairly well (HR 1.29; 95% CI 1.01, 1.64), or stably fairly poorly/poorly (HR 2.29; 95% CI 1.49, 3.52) between 1975 and 1981 were associated with a higher risk as compared to a stable pattern of sleeping well. Furthermore, a decrease in quality of sleep from 1975 to 1981 was associated (HR 1.34; 95% CI 1.03, 1.76) with an increased risk of disability pension. Conclusions: Sleep quality and changes in sleep quality appear to be early predictors for disability pension due to low back diagnoses independently from other confounding factors. Citation: Ropponen A; Silventoinen K; Hublin C; Svedberg P; Koskenvuo M; Kaprio J. Sleep patterns as predictors for disability pension due to low back diagnoses: a 23-year longitudinal study of Finnish twins. SLEEP 2013;36(6):891-897. PMID:23729932

Alexithymia Associated with Nightmare Distress in Idiopathic REM Sleep Behavior Disorder

PubMed Central

Godin, Isabelle; Montplaisir, Jaques; Gagnon, Jean-François; Nielsen, Tore

2013-01-01

Study Objectives: Idiopathic REM sleep behavior disorder (iRBD) is characterized by atypical REM sleep motor activity, vivid dreams and nightmares, and dream-enacting behaviors that can result in injuries to the patient and bed partner. It is also a known predictor of Parkinson disease (PD). Alexithymia has been associated with disturbances in sleep and dreaming (e.g., nightmares) and is a non-motor symptom of PD. We assessed alexithymia and disturbed dreaming in iRBD patients with the aim of determining if these two factors are elevated and interrelated among this population. Design: Questionnaire study of clinically diagnosed patients. Setting: Clinical sleep disorders center. Patients or participants: Thirty-two iRBD patients and 30 healthy age- and sex-matched control participants. Measurements and Results: Participants completed the 20-item Toronto Alexithymia Scale (TAS-20), the Dream Questionnaire, and the Beck Depression Inventory. iRBD patients obtained higher TAS-20 total scores (62.16 ± 13.90) than did controls (52.84 ± 7.62; F1,59 = 10.44, P < 0.01), even when controlling for depressive symptoms, and more frequently attained the suggested cutoff for alexithymia than did controls (P < 0.01). iRBD patients obtained higher scores on the Difficulty Identifying Feelings alexithymia subscale. For both iRBD and control groups, the Difficulty Indentifying Feelings subscale correlated positively with the Nightmare Distress scale of the Dream Questionnaire. Conclusions: Elevated alexithymia scores among idiopathic rapid eye movement sleep behavior disorder patients, and especially a difficulty in identifying feelings, parallels evidence of dysautonomia in this population. The higher incidence of distressing nightmares and the association of nightmares with alexithymia further extend similar findings for both clinical and non-clinical samples and suggest that an affect regulation disturbance may be common to the two sets of symptoms. Citation: Godin I; Montplaisir J; Gagnon JF; Nielsen T. Alexithymia associated with nightmare distress in idiopathic REM sleep behavior disorder. SLEEP 2013;36(12):1957-1962. PMID:24293771

Relationship between polysomnographic sleep architecture and behavior in medication-free children with TS, ADHD, TS and ADHD, and controls.

PubMed

Stephens, Robyn J; Chung, Sharon A; Jovanovic, Dragana; Guerra, Randy; Stephens, Brandon; Sandor, Paul; Shapiro, Colin M

2013-01-01

To describe the relationship between sleep architecture and behavioral measures in unmedicated children and adolescents with Tourette syndrome (TS), attention-deficit hyperactivity disorder (ADHD), TS and comorbid ADHD (TS + ADHD), and healthy controls. The study also set out to examine differences in sleep architecture with each diagnosis. A cross-sectional, 2-night consecutive polysomnographic sleep study was conducted in 90 children. All participants were matched for age, gender, and level of intelligence. Scores on the Child Behavior Checklist delinquency measure were modestly but significantly correlated with the number of movements during REM sleep (r = .36, p = .003). Significant correlations were also noted among the number of total arousals and arousals from slow wave sleep (SWS), and scores on the measures of conduct disorder, hyperactivity/immaturity, and restless/disorganized behaviors. There were a few significant differences in sleep architecture among the diagnostic groups. The ADHD-only group exhibited a significantly higher number of total arousals (p < .01) and arousals from SWS (p < .01) compared with the other three study groups. Our findings indicate that children with TS and/or ADHD and who have more arousals from sleep are significantly more likely to have issues with conduct disorder, hyperactivity/immaturity, and restless/disorganized behavior. It was also noted that having ADHD, alone or comorbid with TS, is associated with a significantly greater number of movements during both non-REM and REM sleep. This study underscores the compelling need for the diagnosis and treatment of any sleep disorders in children with TS and/or ADHD so as to facilitate better management of problem behaviors.

An investigation into the prevalence of sleep disturbances in primary Sjögren’s syndrome: a systematic review of the literature

PubMed Central

Gotts, Zoe M.; Ellis, Jason; Deary, Vincent; Rapley, Tim; Ng, Wan-Fai; Newton, Julia L.; Deane, Katherine H. O.

2017-01-01

Abstract Objectives. To identify whether sleep disturbances are more prevalent in primary SS (pSS) patients compared with the general population and to recognize which specific sleep symptoms are particularly problematic in this population. Methods. Electronic searches of the literature were conducted in PubMed, Medline (Ovid), Embase (Ovid), PsychINFO (Ovid) and Web of Science and the search strategy registered a priori. Titles and abstracts were reviewed by two authors independently against a set of prespecified inclusion/exclusion criteria, reference lists were examined and a narrative synthesis of the included articles was conducted. Results. Eight whole-text papers containing nine separate studies met the inclusion criteria and were included in the narrative analysis. Few of these studies met all of the quality assessment criteria. The studies used a range of self-reported measures and objective measures, including polysomnography. Mixed evidence was obtained for some of the individual sleep outcomes, but overall compared with controls, pSS patients reported greater subjective sleep disturbances and daytime somnolence and demonstrated more night awakenings and pre-existing obstructive sleep apnoea. Conclusions. A range of sleep disturbances are commonly reported in pSS patients. Further polysomnography studies are recommended to confirm the increased prevalence of night awakenings and obstructive sleep apnoea in this patient group. pSS patients with excessive daytime somnolence should be screened for co-morbid sleep disorders and treated appropriately. Interventions targeted at sleep difficulties in pSS, such as cognitive behavioural therapy for insomnia and nocturnal humidification devices, have the potential to improve quality of life in this patient group and warrant further investigation. PMID:28013207

An investigation into the prevalence of sleep disturbances in primary Sjögren's syndrome: a systematic review of the literature.

PubMed

Hackett, Katie L; Gotts, Zoe M; Ellis, Jason; Deary, Vincent; Rapley, Tim; Ng, Wan-Fai; Newton, Julia L; Deane, Katherine H O

2017-04-01

To identify whether sleep disturbances are more prevalent in primary SS (pSS) patients compared with the general population and to recognize which specific sleep symptoms are particularly problematic in this population. Electronic searches of the literature were conducted in PubMed, Medline (Ovid), Embase (Ovid), PsychINFO (Ovid) and Web of Science and the search strategy registered a priori . Titles and abstracts were reviewed by two authors independently against a set of prespecified inclusion/exclusion criteria, reference lists were examined and a narrative synthesis of the included articles was conducted. Eight whole-text papers containing nine separate studies met the inclusion criteria and were included in the narrative analysis. Few of these studies met all of the quality assessment criteria. The studies used a range of self-reported measures and objective measures, including polysomnography. Mixed evidence was obtained for some of the individual sleep outcomes, but overall compared with controls, pSS patients reported greater subjective sleep disturbances and daytime somnolence and demonstrated more night awakenings and pre-existing obstructive sleep apnoea. A range of sleep disturbances are commonly reported in pSS patients. Further polysomnography studies are recommended to confirm the increased prevalence of night awakenings and obstructive sleep apnoea in this patient group. pSS patients with excessive daytime somnolence should be screened for co-morbid sleep disorders and treated appropriately. Interventions targeted at sleep difficulties in pSS, such as cognitive behavioural therapy for insomnia and nocturnal humidification devices, have the potential to improve quality of life in this patient group and warrant further investigation. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.

Setting Adolescents up for Success: Promoting a Policy to Delay High School Start Times

ERIC Educational Resources Information Center

Barnes, Margaux; Davis, Krista; Mancini, Mackenzie; Ruffin, Jasmine; Simpson, Tina; Casazza, Krista

2016-01-01

Background: A unique biological shift in sleep cycles occurs during adolescence causing later sleep and wake times. This shift is not matched by a concurrent modification in school start times, resulting in sleep curtailment for a large majority of adolescents. Chronic inadequate sleep is associated with poor academic performance including…

Short Blue Light Pulses (30 Min) in the Morning Support a Sleep-Advancing Protocol in a Home Setting.

PubMed

Geerdink, Moniek; Walbeek, Thijs J; Beersma, Domien G M; Hommes, Vanja; Gordijn, Marijke C M

2016-10-01

Many people in our modern civilized society sleep later on free days compared to work days. This discrepancy in sleep timing will lead to so-called 'social jetlag' on work days with negative consequences for performance and health. Light therapy in the morning is often proposed as the most effective method to advance the circadian rhythm and sleep phase. However, most studies focus on direct effects on the circadian system and not on posttreatment effects on sleep phase and sleep integrity. In this placebo-controlled home study we investigated if blue light, rather than amber light therapy, can phase shift the sleep phase along with the circadian rhythm with preservation of sleep integrity and performance. We selected 42 participants who suffered from 'social jetlag' on workdays. Participants were randomly assigned to either high-intensity blue light exposure or amber light exposure (placebo) with similar photopic illuminance. The protocol consisted of 14 baseline days without sleep restrictions, 9 treatment days with either 30-min blue light pulses or 30-min amber light pulses in the morning along with a sleep advancing scheme and 7 posttreatment days without sleep restrictions. Melatonin samples were taken at days 1, 7, 14 (baseline), day 23 (effect treatment), and day 30 (posttreatment). Light exposure was recorded continuously. Sleep was monitored through actigraphy. Performance was measured with a reaction time task. As expected, the phase advance of the melatonin rhythm from day 14 to day 23 was significantly larger in the blue light exposure group, compared to the amber light group (84 min ± 51 (SD) and 48 min ± 47 (SD) respectively; t36 = 2.23, p < 0.05). Wake-up time during the posttreatment days was slightly earlier compared to baseline in the blue light group compared to slightly later in the amber light group (-21 min ± 33 (SD) and +12 min ± 33 (SD) respectively; F1,35 = 9.20, p < 0.01). The number of sleep bouts was significantly higher in the amber light group compared to the blue light group during sleep in the treatment period (F1,32 = 4.40, p < 0.05). Performance was significantly worse compared to baseline at all times during (F1,13 = 10.1, p < 0.01) and after amber light treatment (F1,13 = 17.1, p < 0.01), while only in the morning during posttreatment in the blue light condition (F1,10 = 9.8, p < 0.05). The data support the conclusion that blue light was able to compensate for the sleep integrity reduction and to a large extent for the performance decrement that was observed in the amber light condition, both probably as a consequence of the advancing sleep schedule. This study shows that blue light therapy in the morning, applied in a home setting, supports a sleep advancing protocol by phase advancing the circadian rhythm as well as sleep timing. © 2016 The Author(s).

Cognitive, Behavioral, and Functional Consequences of Inadequate Sleep in Children and Adolescents

PubMed Central

Beebe, Dean W.

2011-01-01

Synopsis During the past few decades, studies using multiple research designs have examined whether sleep during childhood and adolescence is related to cognition, behavior, and other aspects of daytime functioning. This paper summarizes recent correlational, case-control, quasi-experimental, and experimental studies, highlighting how the strengths and limitations of each research design are complementary, thereby allowing one to more confidently draw conclusions when viewing the research literature as a whole. Viewed in this manner, published findings suggest that inadequate sleep quality and/or quantity can cause sleepiness, inattention and, very likely, other cognitive and behavioral deficits that significantly impact children and adolescents in important functional settings (e.g., school). This paper then integrates findings from longitudinal studies within a developmental psychopathology model. In this model, inadequate sleep is viewed as a noxious exposure that can, over time, fundamentally alter a child or adolescent's development, resulting in poorer long-term outcomes. Important research questions remain, but the available evidence supports the integration of sleep screening and interventions into routine clinical care and also supports advocacy for public policy changes to improve the sleep of children and adolescents. PMID:21600347

Assessment of Sleep Quantity and Sleep Disturbances During Recovery From Sports-Related Concussion in Youth Athletes.

PubMed

Murdaugh, Donna L; Ono, Kim E; Reisner, Andrew; Burns, Thomas G

2018-05-01

To determine the relation between sleep quantity and sleep disturbances on symptoms and neurocognitive ability during the acute phase (<7d) and after sports-related concussion (SRC; >21d). Prospective inception cohort study. General community setting of regional middle and high schools. A sample (N=971) including youth athletes with SRC (n=528) and controls (n=443) (age, 10-18y). Not applicable. Athletes completed the Immediate Post-Concussion Assessment and Cognitive Testing battery. Partial correlation analyses and independent t tests were conducted to assess sleep quantity the night before testing. Multivariate analysis of covariance was used to assess sleep disturbances and their interaction with age. Less sleep quantity was correlated with greater report of cognitive (P=.001) and neuropsychological (P=.024) symptoms specific to prolonged recovery from SRC. Sleep disturbances significantly affect each migraine, cognitive, and neuropsychological symptoms (P<.001). A significant interaction was found between sleep disturbances and age (P=.04) at >21 days post-SRC. Findings emphasize that the continued presence of low sleep quantity and sleep disturbances in youth athletes with SRC should be a specific indicator to health professionals that these athletes are at an increased risk of protracted recovery. Further research should identify additional factors that may interact with sleep to increase the risk of protracted recovery. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The reliability of the German version of the Richards Campbell Sleep Questionnaire.

PubMed

Krotsetis, Susanne; Richards, Kathy C; Behncke, Anja; Köpke, Sascha

2017-07-01

The assessment of sleep quality in critically ill patients is a relevant factor of high-quality care. Despite the fact that sleep disturbances and insufficient sleep management contain an increased risk of severe morbidity for these patients, a translated and applicable instrument to evaluate sleep is not available for German-speaking intensive care settings. This study aimed to translate the Richards Campbell Sleep Questionnaire (RCSQ), a simple and validated instrument eligible for measuring sleep quality in critically ill patients, and subsequently to evaluate the internal consistency of the German version of the RCSQ. Furthermore, it also aimed to inquire into the perception of sleep in a sample of critically ill patients. The RCSQ was translated following established methodological standards. Data were collected cross-sectionally in a sample of 51 patients at 3 intensive care units at a university hospital in Germany. The German version of the RCSQ showed an overall internal consistency (Cronbach's alpha) of 0·88. The mean of the RSCQ in the sample was 47·00 (SD ± 27·57). Depth of sleep was rated the lowest and falling asleep again the highest of the RCSQ sleep items. The study demonstrated very good internal consistency of the German version of the RCSQ, allowing for its application in practice and research in German-speaking countries. Quality of sleep perception was generally low in this sample, emphasizing the need for enhanced care concepts regarding the sleep management of critically ill patients. Relevance to clinical practice Assessment of self-perception of sleep is crucial in order to plan an individually tailored care process. © 2017 British Association of Critical Care Nurses.

Cognitive Replay of Visuomotor Learning at Sleep Onset: Temporal Dynamics and Relationship to Task Performance

PubMed Central

Wamsley, Erin J.; Perry, Karen; Djonlagic, Ina; Babkes Reaven, Laura; Stickgold, Robert

2010-01-01

Study Objectives: Studies of neural activity in animals and humans suggest that experiences are “replayed” in cortical and hippocampal networks during NREM sleep. Here, we examine whether memory reactivation in sleeping humans might also be evident within reports of concomitant subjective experience (i.e., dreaming). Design: Participants were trained on an engaging visuomotor learning task across a period of one or more days, and sleep onset mentation was collected at variable intervals using the “Nightcap” home-monitoring device. Verbal reports of sleep onset mentation were obtained either at the beginning of the night, or following 2 h of initial sleep. Setting: Data were collected in participants' home environments, via the Nightcap monitoring system, and at The Center for Sleep and Cognition, Beth Israel Deaconess Medical Center, Boston MA. Participants: 43 healthy, medication-free college students (16 males, age 18-25 years). Interventions: N/A Measurements and Results: The learning task exerted a powerful, direct effect on verbal reports of mentation during light NREM sleep (stages 1 and 2). On post-training nights, a full 30% of all verbal reports were related to the task. The nature of this cognitive “replay” effect was altered with increasing durations of sleep, becoming more abstracted from the original experience as time into sleep increased. Conclusions: These observations are interpreted in light of memory consolidation theory, and demonstrate that introspective reports can provide a valuable window on cognitive processing in the sleeping brain. Citation: Wamsley EJ; Perry K; Djonlagic I; Babkes Reaven L; Stickgold R. Cognitive replay of visuomotor learning at sleep onset: temporal dynamics and relationship to task performance. SLEEP 2010;33(1):59-68. PMID:20120621

Ecology and Neurophysiology of Sleep in Two Wild Sloth Species

PubMed Central

Voirin, Bryson; Scriba, Madeleine F.; Martinez-Gonzalez, Dolores; Vyssotski, Alexei L.; Wikelski, Martin; Rattenborg, Niels C.

2014-01-01

Study Objectives: Interspecific variation in sleep measured in captivity correlates with various physiological and environmental factors, including estimates of predation risk in the wild. However, it remains unclear whether prior comparative studies have been confounded by the captive recording environment. Herein we examine the effect of predation pressure on sleep in sloths living in the wild. Design: Comparison of two closely related sloth species, one exposed to predation and one free from predation. Setting: Panamanian mainland rainforest (predators present) and island mangrove (predators absent). Participants: Mainland (Bradypus variegatus, five males and four females) and island (Bradypus pygmaeus, six males) sloths. Interventions: None. Measurements and Results: Electroencephalographic (EEG) and electromyographic (EMG) activity was recorded using a miniature data logger. Although both species spent between 9 and 10 h per day sleeping, the mainland sloths showed a preference for sleeping at night, whereas island sloths showed no preference for sleeping during the day or night. Standardized EEG activity during nonrapid eye movement (NREM) sleep showed lower low-frequency power, and increased spindle and higher frequency power in island sloths when compared to mainland sloths. Conclusions: In sloths sleeping in the wild, predation pressure influenced the timing of sleep, but not the amount of time spent asleep. The preference for sleeping at night in mainland sloths may be a strategy to avoid detection by nocturnal cats. The pronounced differences in the NREM sleep EEG spectrum remain unexplained, but might be related to genetic or environmental factors. Citation: Voirin B; Scriba MF; Martinez-Gonzalez D; Vyssotski AL; Wikelski M; Rattenborg NC. Ecology and neurophysiology of sleep in two wild sloth species. SLEEP 2014;37(4):753-761. PMID:24899764

Motor Events during Healthy Sleep: A Quantitative Polysomnographic Study

PubMed Central

Frauscher, Birgit; Gabelia, David; Mitterling, Thomas; Biermayr, Marlene; Bregler, Deborah; Ehrmann, Laura; Ulmer, Hanno; Högl, Birgit

2014-01-01

Study Objectives: Many sleep disorders are characterized by increased motor activity during sleep. In contrast, studies on motor activity during physiological sleep are largely lacking. We quantitatively investigated a large range of motor phenomena during polysomnography in physiological sleep. Design: Prospective polysomnographic investigation. Setting: Academic referral sleep laboratory. Participants: One hundred healthy sleepers age 19-77 y were strictly selected from a representative population sample by a two-step screening procedure. Interventions: N/A. Measurements and Results: Polysomnography according to American Academy of Sleep Medicine (AASM) standards was performed, and quantitative normative values were established for periodic limb movements in sleep (PLMS), high frequency leg movements (HFLM), fragmentary myoclonus (FM), neck myoclonus (NM), and rapid eye movement (REM)-related electromyographic (EMG) activity. Thirty-six subjects had a PLMS index > 5/h, 18 had a PLMS index > 15/h (90th percentile: 24.8/h). Thirty-three subjects had HFLM (90th percentile: four sequences/night). All subjects had FM (90th percentile 143.7/h sleep). Nine subjects fulfilled AASM criteria for excessive FM. Thirty-five subjects had NM (90th percentile: 8.8/h REM sleep). For REM sleep, different EMG activity measures for the mentalis and flexor digitorum superficialis muscles were calculated: the 90th percentile for phasic mentalis EMG activity for 30-sec epochs according to AASM recommendation was 15.6%, and for tonic mentalis EMG activity 2.6%. Twenty-five subjects exceeded the recently proposed phasic mentalis cutoff of 11%. None of the subjects exceeded the tonic mentalis cutoff of 9.6%. Conclusion: Quantification of motor phenomena is a basic prerequisite to develop normative values, and is a first step toward a more precise description of the various motor phenomena present during sleep. Because rates of motor events were unexpectedly high even in physiological sleep, the future use of normative values for both research and clinical routine is essential. Citation: Frauscher B; Gabelia D; Mitterling T; Biermayr M; Bregler D; Ehrmann L; Ulmer H; Högl B. Motor events during healthy sleep: a quantitative polysomnographic study. SLEEP 2014;37(4):763-773. PMID:24744455

Early Blood Lead Levels and Sleep Disturbance in Preadolescence

PubMed Central

Liu, Jianghong; Liu, Xianchen; Pak, Victoria; Wang, Yingjie; Yan, Chonghuai; Pinto-Martin, Jennifer; Dinges, David

2015-01-01

Study Objectives: Little is known about the effect of lead exposure on children's sleep. This study examined the association between blood lead levels (BLL) and sleep problems in a longitudinal study of children. Setting: Four community-based elementary schools in Jintan City, China. Participants: 1,419 Chinese children. Measurement and Results: BLL were measured when children were aged 3–5 y, and sleep was assessed at ages 9–13 y. Sleep was assessed by both parents' report, using the Children's Sleep Habits Questionnaire (CSHQ), and children's report, using an adolescent sleep questionnaire. A total of 665 children with complete data on BLL and sleep at both ages were included in the current study. Mean age of the sample at BLL assessment was 4.74 y (standard deviation [SD] = 0.89) and at sleep assessment was 11.05 y (SD = 0.88). Mean BLL was 6.26 μg/dL (SD = 2.54). There were significant positive correlations between BLL and 3 CSHQ subscales: Sleep onset delay (r = 0.113, P < 0.01), sleep duration (r = 0.139, P < 0.001), and night waking (r = 0.089, P < 0.05). Excessive daytime sleepiness (EDS) (26.1% versus 9.0%, P < 0.001) and use of sleeping pills (6.5% versus 1.8%, P = 0.03) were more prevalent in children BLL ≥ 10.0 μg/dL than in those children BLL < 10.0 μg/dL. After adjusting for demographics, BLL ≥ 10.0 μg/dL was significantly associated with increased risk for insomnia symptoms (odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.03–3.95) and EDS (OR = 2.90, 95% CI = 1.27–6.61). Conclusion: The findings indicate that elevated blood lead levels in early childhood are associated with increased risk for sleep problems and excessive daytime sleepiness in later childhood. Citation: Liu J, Liu X, Pak V, Wang Y, Yan C, Pinto-Martin J, Dinges D. Early blood lead levels and sleep disturbance in preadolescence. SLEEP 2015;38(12):1869–1874. PMID:26194570

In-Flight Sleep of Flight Crew During a 7-hour Rest Break: Implications for Research and Flight Safety

PubMed Central

Signal, T. Leigh; Gander, Philippa H.; van den Berg, Margo J.; Graeber, R. Curtis

2013-01-01

Study Objectives: To assess the amount and quality of sleep that flight crew are able to obtain during flight, and identify factors that influence the sleep obtained. Design: Flight crew operating flights between Everett, WA, USA and Asia had their sleep recorded polysomnographically for 1 night in a layover hotel and during a 7-h in-flight rest opportunity on flights averaging 15.7 h. Setting: Layover hotel and in-flight crew rest facilities onboard the Boeing 777-200ER aircraft. Participants: Twenty-one male flight crew (11 Captains, mean age 48 yr and 10 First Officers, mean age 35 yr). Interventions: N/A. Measurements and Results: Sleep was recorded using actigraphy during the entire tour of duty, and polysomnographically in a layover hotel and during the flight. Mixed model analysis of covariance was used to determine the factors affecting in-flight sleep. In-flight sleep was less efficient (70% vs. 88%), with more nonrapid eye movement Stage 1/Stage 2 and more frequent awakenings per h (7.7/h vs. 4.6/h) than sleep in the layover hotel. In-flight sleep included very little slow wave sleep (median 0.5%). Less time was spent trying to sleep and less sleep was obtained when sleep opportunities occurred during the first half of the flight. Multivariate analyses suggest age is the most consistent factor affecting in-flight sleep duration and quality. Conclusions: This study confirms that even during long sleep opportunities, in-flight sleep is of poorer quality than sleep on the ground. With longer flight times, the quality and recuperative value of in-flight sleep is increasingly important for flight safety. Because the age limit for flight crew is being challenged, the consequences of age adversely affecting sleep quantity and quality need to be evaluated. Citation: Signal TL; Gander PH; van den Berg MJ; Graeber RC. In-flight sleep of flight crew during a 7-hour rest break: implications for research and flight safety. SLEEP 2013;36(1):109–115. PMID:23288977

A Novel BHLHE41 Variant is Associated with Short Sleep and Resistance to Sleep Deprivation in Humans

PubMed Central

Pellegrino, Renata; Kavakli, Ibrahim Halil; Goel, Namni; Cardinale, Christopher J.; Dinges, David F.; Kuna, Samuel T.; Maislin, Greg; Van Dongen, Hans P.A.; Tufik, Sergio; Hogenesch, John B.; Hakonarson, Hakon; Pack, Allan I.

2014-01-01

Study Objectives: Earlier work described a mutation in DEC2 also known as BHLHE41 (basic helix-loophelix family member e41) as causal in a family of short sleepers, who needed just 6 h sleep per night. We evaluated whether there were other variants of this gene in two well-phenotyped cohorts. Design: Sequencing of the BHLHE41 gene, electroencephalographic data, and delta power analysis and functional studies using cell-based luciferase. Results: We identified new variants of the BHLHE41 gene in two cohorts who had either acute sleep deprivation (n = 200) or chronic partial sleep deprivation (n = 217). One variant, Y362H, at another location in the same exon occurred in one twin in a dizygotic twin pair and was associated with reduced sleep duration, less recovery sleep following sleep deprivation, and fewer performance lapses during sleep deprivation than the homozygous twin. Both twins had almost identical amounts of non rapid eye movement (NREM) sleep. This variant reduced the ability of BHLHE41 to suppress CLOCK/BMAL1 and NPAS2/BMAL1 transactivation in vitro. Another variant in the same exome had no effect on sleep or response to sleep deprivation and no effect on CLOCK/BMAL1 transactivation. Random mutagenesis identified a number of other variants of BHLHE41 that affect its function. Conclusions: There are a number of mutations of BHLHE41. Mutations reduce total sleep while maintaining NREM sleep and provide resistance to the effects of sleep loss. Mutations that affect sleep also modify the normal inhibition of BHLHE41 of CLOCK/BMAL1 transactivation. Thus, clock mechanisms are likely involved in setting sleep length and the magnitude of sleep homeostasis. Citation: Pellegrino R, Kavakli IH, Goel N, Cardinale CJ, Dinges DF, Kuna ST, Maislin G, Van Dongen HP, Tufik S, Hogenesch JB, Hakonarson H, Pack AI. A novel BHLHE41 variant is associated with short sleep and resistance to sleep deprivation in humans. SLEEP 2014;37(8):1327-1336. PMID:25083013

Alcohol and Sleep Restriction Combined Reduces Vigilant Attention, Whereas Sleep Restriction Alone Enhances Distractibility

PubMed Central

Lee, James; Manousakis, Jessica; Fielding, Joanne; Anderson, Clare

2015-01-01

Study Objectives: Alcohol and sleep loss are leading causes of motor vehicle crashes, whereby attention failure is a core causal factor. Despite a plethora of data describing the effect of alcohol and sleep loss on vigilant attention, little is known about their effect on voluntary and involuntary visual attention processes. Design: Repeated-measures, counterbalanced design. Setting: Controlled laboratory setting. Participants: Sixteen young (18–27 y; M = 21.90 ± 0.60 y) healthy males. Interventions: Participants completed an attention test battery during the afternoon (13:00–14:00) under four counterbalanced conditions: (1) baseline; (2) alcohol (0.05% breath alcohol concentration); (3) sleep restriction (02:00–07:00); and (4) alcohol/sleep restriction combined. This test battery included a Psychomotor Vigilance Task (PVT) as a measure of vigilant attention, and two ocular motor tasks—visually guided and antisaccade—to measure the involuntary and voluntary allocation of visual attention. Measurements and Results: Only the combined condition led to reductions in vigilant attention characterized by slower mean reaction time, fastest 10% responses, and increased number of lapses (P < 0.05) on the PVT. In addition, the combined condition led to a slowing in the voluntary allocation of attention as reflected by increased antisaccade latencies (P < 0.05). Sleep restriction alone however increased both antisaccade inhibitory errors [45.8% errors versus < 28.4% all others; P < 0.001] and the involuntary allocation of attention, as reflected by faster visually guided latencies (177.7 msec versus > 185.0 msec all others) to a peripheral target (P < 0.05). Conclusions: Our data reveal specific signatures for sleep related attention failure: the voluntary allocation of attention is impaired, whereas the involuntary allocation of attention is enhanced. This provides key evidence for the role of distraction in attention failure during sleep loss. Citation: Lee J, Manousakis J, Fielding J, Anderson C. Alcohol and sleep restriction combined reduces vigilant attention, whereas sleep restriction alone enhances distractibility. SLEEP 2015;38(5):765–775. PMID:25515101

Menopause related sleep disorders.

PubMed

Eichling, Philip S; Sahni, Jyotsna

2005-07-15

Sleep difficulty is one of the hallmarks of menopause. Following recent studies showing no cardiac benefit and increased breast cancer, the question of indications for hormonal therapy has become even more pertinent. Three sets of sleep disorders are associated with menopause: insomnia/depression, sleep disordered breathing and fibromyalgia. The primary predictor of disturbed sleep architecture is the presence of vasomotor symptoms. This subset of women has lower sleep efficiency and more sleep complaints. The same group is at higher risk of insomnia and depression. The "domino theory" of sleep disruption leading to insomnia followed by depression has the most scientific support. Estrogen itself may also have an antidepressant as well as a direct sleep effect. Treatment of insomnia in responsive individuals may be a major remaining indication for hormone therapy. Sleep disordered breathing (SDB) increases markedly at menopause for reasons that include both weight gain and unclear hormonal mechanisms. Due to the general under-recognition of SDB, health care providers should not assume sleep complaints are due to vasomotor related insomnia/depression without considering SDB. Fibromyalgia has gender, age and probably hormonal associations. Sleep complaints are almost universal in FM. There are associated polysomnogram (PSG) findings. FM patients have increased central nervous system levels of the nociceptive neuropeptide substance P (SP) and lower serotonin levels resulting in a lower pain threshold to normal stimuli. High SP and low serotonin have significant potential to affect sleep and mood. Treatment of sleep itself seems to improve, if not resolve FM. Menopausal sleep disruption can exacerbate other pre-existing sleep disorders including RLS and circadian disorders.

Dietary Intake Following Experimentally Restricted Sleep in Adolescents

PubMed Central

Beebe, Dean W.; Simon, Stacey; Summer, Suzanne; Hemmer, Stephanie; Strotman, Daniel; Dolan, Lawrence M.

2013-01-01

Study Objective: To examine the relationship between sleep and dietary intake in adolescents using an experimental sleep restriction protocol. Design: Randomized crossover sleep restriction-extension paradigm. Setting: Sleep obtained and monitored at home, diet measured during an office visit. Participants: Forty-one typically developing adolescents age 14-16 years. Interventions: The 3-week protocol consisting of a baseline week designed to stabilize the circadian rhythm, followed randomly by 5 consecutive nights of sleep restriction (6.5 hours in bed Monday-Friday) versus healthy sleep duration (10 hours in bed), a 2-night washout period, and a 5-night crossover period. Measurements: Sleep was monitored via actigraphy and teens completed validated 24-hour diet recall interviews following each experimental condition. Results: Paired-sample t-tests examined differences between conditions for consumption of key macronutrients and choices from dietary categories. Compared with the healthy sleep condition, sleep-restricted adolescents' diets were characterized by higher glycemic index and glycemic load and a trend toward more calories and carbohydrates, with no differences in fat or protein consumption. Exploratory analyses revealed the consumption of significantly more desserts and sweets during sleep restriction than healthy sleep. Conclusions: Chronic sleep restriction during adolescence appears to cause increased consumption of foods with a high glycemic index, particularly desserts/sweets. The chronic sleep restriction common in adolescence may cause changes in dietary behaviors that increase risk of obesity and associated morbidity. Citation: Beebe DW; Simon S; Summer S; Hemmer S; Strotman D; Dolan LM. Dietary intake following experimentally restricted sleep in adolescents. SLEEP 2013;36(6):827-834. PMID:23729925

Nurses' views of factors affecting sleep for hospitalized children and their families: A focus group study.

PubMed

Stremler, Robyn; Adams, Sherri; Dryden-Palmer, Karen

2015-08-01

Light, noise, and interruptions from hospital staff lead to frequent awakenings and detrimental changes to sleep quantity and quality for children who are hospitalized and their parents who stay with them overnight. An understanding of nurses' views on how care affects sleep for the hospitalized child and parent is crucial to the development of strategies to decrease sleep disturbance in hospital. The purpose of this descriptive qualitative study was to gain an understanding of nurses' views on their role in and influence on sleep for families; perceived barriers and facilitators of patient and parent sleep at night; strategies nurses use to preserve sleep; the distribution, between parent and nurse, of care for the child at night; views of the parent as a recipient of nursing care at night; and the nature of interactions between nurses and families at night. Thirty registered nurses from general pediatric and critical care units participated in one of four semi-structured focus groups. Four main influences on sleep were identified: child factors; environmental factors; nurse-parent interaction factors; and nursing care factors. Some of these restricted nurses' ability to optimize sleep, but many factors were amenable to intervention. Balancing strategies to preserve sleep with the provision of nursing assessment and intervention was challenging and complicated by the difficult nature of work outside of usual waking hours. Nurses highlighted the need for formal policy and mentoring related to provision of nursing care at night in pediatric settings. © 2015 Wiley Periodicals, Inc.

A Novel Approach to Prediction of Mild Obstructive Sleep Disordered Breathing in a Population-Based Sample: The Sleep Heart Health Study

PubMed Central

Caffo, Brian; Diener-West, Marie; Punjabi, Naresh M.; Samet, Jonathan

2010-01-01

This manuscript considers a data-mining approach for the prediction of mild obstructive sleep disordered breathing, defined as an elevated respiratory disturbance index (RDI), in 5,530 participants in a community-based study, the Sleep Heart Health Study. The prediction algorithm was built using modern ensemble learning algorithms, boosting in specific, which allowed for assessing potential high-dimensional interactions between predictor variables or classifiers. To evaluate the performance of the algorithm, the data were split into training and validation sets for varying thresholds for predicting the probability of a high RDI (≥ 7 events per hour in the given results). Based on a moderate classification threshold from the boosting algorithm, the estimated post-test odds of a high RDI were 2.20 times higher than the pre-test odds given a positive test, while the corresponding post-test odds were decreased by 52% given a negative test (sensitivity and specificity of 0.66 and 0.70, respectively). In rank order, the following variables had the largest impact on prediction performance: neck circumference, body mass index, age, snoring frequency, waist circumference, and snoring loudness. Citation: Caffo B; Diener-West M; Punjabi NM; Samet J. A novel approach to prediction of mild obstructive sleep disordered breathing in a population-based sample: the Sleep Heart Health Study. SLEEP 2010;33(12):1641-1648. PMID:21120126

Sleep Problems and Hospitalization for Self-Harm: A 15-Year Follow-Up of 9,000 Norwegian Adolescents. The Young-HUNT Study

PubMed Central

Junker, Asbjørn; Bjørngaard, Johan Håkon; Gunnell, David; Bjerkeset, Ottar

2014-01-01

Objectives: To investigate the association between sleeping problems in adolescence and subsequent hospital admission for self-harm (SH). Design: Prospective cohort study, linking health survey information on sleep problems to hospital-based patient records. Setting: Residents of Nord-Trøndelag County, Norway, aged 13-19 years in 1995-97. Patients or Participants: 10,202 adolescents were invited to participate in the Young-HUNT study; 8,983 (88%) completed the health survey. Measurements and Results: 10% of participants reported difficulties initiating sleep, 4% reported early morning wakening. Ninety-eight participants (27% male) were hospitalized following SH over a mean 12 years follow-up. Difficulties initiating sleep/early morning wakening were associated with increased risk of SH (HR 2.11, 95% CI 1.29-3.46, sex- and age-adjusted) compared with no problems, yet coexistent symptoms of combined anxiety/depression explained most of the association with sleep problems (fully adjusted HR 1.19, 95% CI 0.66-2.16). The HR of combined difficulties initiating sleep/early morning wakening differed in those with and without anxiety/depression at baseline (P interaction = 0.03); among those without caseness symptoms of anxiety/depression it was 5.58 (95% CI 2.02-15.40), while in those with caseness symptoms of anxiety/ depression it was 0.82 (95% CI 0.19-3.44). Conclusions: Sleep problems are common among Norwegian adolescents. The strong association between sleep problems and subsequent hospitalization for self-harm could mainly be related to coexistent symptoms of anxiety and depression. Prevention of adolescent sleep problems, anxiety and depression should be targeted when seeking to reduce and prevent self-harm. Citation: Junker A; Bjørngaard JH; Gunnell D; Bjerkeset O. Sleep problems and hospitalization for self-harm: a 15-year follow-up of 9,000 Norwegian adolescents. the Young-HUNT study. SLEEP 2014;37(3):579-585. PMID:24587581

Amount and quality of sleep: exploring the role of stress and work experience in a sample of obstetrician-gynecologists.

PubMed

Taouk, Laura; Farrow, Victoria A; Schulkin, Jay

2017-05-02

Sufficient sleep is necessary for optimal performance and the delivery of safe and effective health care. To establish an empirical understanding of physician fatigue, the present study investigated the factors that contributed to the amount and the quality of sleep among obstetricians and gynecologists (ob-gyns). A survey of personal and work experiences was sent to 495 eligible physicians belonging to the American College of Obstetricians and Gynecologists (ACOG). Data were obtained from 287 ob-gyns for a response rate of 58.0%. Associations between sleep-related items and measures of stress and work-related factors were explored. Ob-gyns in our sample reported sleeping an average of 6.5 hours a night with 29.2% indicating that they received very or fairly bad quality of sleep. Average amount and quality of sleep were found to be independently related to the hours worked weekly, colleague support for a work-home balance, practice setting, perceived work-control, physician-specific stressors and perceived stress. In summary models, hours worked and perceived stress scores consistently emerged as predictors of amount of sleep. Overall, findings explained a small portion of the variance in sleep. Considering the multitude of factors that contribute to sleep, subtle associations warrant further investigation.

Sleep-Wake Patterns and Sleep Disturbance among Hong Kong Chinese Adolescents

PubMed Central

Chung, Ka-Fai; Cheung, Miao-Miao

2008-01-01

Study objectives: To determine sleep-wake patterns and evaluate sleep disturbance in Hong Kong adolescents; to identify factors that are associated with sleep disturbance; and to examine the relationship of sleep-wake variables and academic performance. Design and Setting: A school-based cross-sectional survey. Participants: Sample included 1629 adolescents aged 12 to 19 years. Measurements and Results: Self-report questionnaires, including sleep-wake habit questionnaire, Sleep Quality Index, Morningness/Eveningness scale, Epworth Sleepiness Scale, Perceived Stress Scale, academic performance, and personal data were administered. The average school-night bedtime was 23:24, and total sleep time was 7.3 hr. During weekends, the average bedtime and rise time was delayed by 64 min and 195 min, respectively. The prevalence of sleep disturbances occurring ≥3 days per week in the preceding 3 months were: difficulty falling asleep (5.6%), waking up during the night (7.2%), and waking up too early in the morning (10.4%). The prevalence of ≥1 of these three symptoms was 19.1%. Stepwise regression analyses revealed that circadian phase preference was the most significant predictor for school night bedtime, weekend oversleep, and daytime sleepiness. Perceived stress was the most significant risk factor for sleep disturbance. Students with marginal academic performance reported later bedtimes and shorter sleep during school nights, greater weekend delays in bedtime, and more daytime sleepiness than those with better grades. Conclusion: The prevalence of sleep deprivation and sleep disturbance among Hong Kong adolescents is comparable to those found in other countries. An intervention program for sleep problems in adolescents should be considered. Citation: Chung KF; Cheung MM. Sleep-wake patterns and sleep disturbance among Hong Kong Chinese adolescents. SLEEP 2008;31(2):185–194. PMID:18274265

Polysomnographic measures of sleep in cocaine dependence and alcohol dependence: Implications for age‐related loss of slow wave, stage 3 sleep

PubMed Central

Bjurstrom, Martin F.; Olmstead, Richard

2016-01-01

Abstract Background and aims Sleep disturbance is a prominent complaint in cocaine and alcohol dependence. This controlled study evaluated differences of polysomnographic (PSG) sleep in cocaine‐ and alcohol‐dependent subjects, and examined whether substance dependence interacts with age to alter slow wave sleep and rapid eye movement (REM) sleep. Design Cross‐sectional comparison. Setting Los Angeles and San Diego, CA, USA. Participants Abstinent cocaine‐dependent subjects (n = 32), abstinent alcohol‐dependent subjects (n = 73) and controls (n = 108); mean age 40.3 years recruited 2005–12. Measurements PSG measures of sleep continuity and sleep architecture primary outcomes of Stage 3 sleep and REM sleep. Covariates included age, ethnicity, education, smoking, body mass index and depressive symptoms. Findings Compared with controls, both groups of substance dependent subjects showed loss of Stage 3 sleep (P < 0.001). A substance dependence × age interaction was found in which both cocaine‐ and alcohol‐dependent groups showed loss of Stage 3 sleep at an earlier age than controls (P < 0.05 for all), and cocaine‐dependent subjects showed loss of Stage 3 sleep at an earlier age than alcoholics (P < 0.05). Compared with controls, REM sleep was increased in both substance‐dependent groups (P < 0.001), and cocaine and alcohol dependence were associated with earlier age‐related increase in REM sleep (P < 0.05 for all). Conclusions Cocaine and alcohol dependence appear to be associated with marked disturbances of sleep architecture, including increased rapid eye movement sleep and accelerated age‐related loss of slow wave, Stage 3 sleep. PMID:26749502

African Genetic Ancestry is Associated with Sleep Depth in Older African Americans

PubMed Central

Halder, Indrani; Matthews, Karen A.; Buysse, Daniel J.; Strollo, Patrick J.; Causer, Victoria; Reis, Steven E.; Hall, Martica H.

2015-01-01

Study Objectives: The mechanisms that underlie differences in sleep characteristics between European Americans (EA) and African Americans (AA) are not fully known. Although social and psychological processes that differ by race are possible mediators, the substantial heritability of sleep characteristics also suggests genetic underpinnings of race differences. We hypothesized that racial differences in sleep phenotypes would show an association with objectively measured individual genetic ancestry in AAs. Design: Cross sectional. Setting: Community-based study. Participants: Seventy AA adults (mean age 59.5 ± 6.7 y; 62% female) and 101 EAs (mean age 60.5 ± 7 y, 39% female). Measurements and Results: Multivariate tests were used to compare the Pittsburgh Sleep Quality Index (PSQI) and in-home polysomnographic measures of sleep duration, sleep efficiency, apnea-hypopnea index (AHI), and indices of sleep depth including percent visually scored slow wave sleep (SWS) and delta EEG power of EAs and AAs. Sleep duration, efficiency, and sleep depth differed significantly by race. Individual % African ancestry (%AF) was measured in AA subjects using a panel of 1698 ancestry informative genetic markers and ranged from 10% to 88% (mean 67%). Hierarchical linear regression showed that higher %AF was associated with lower percent SWS in AAs (β (standard error) = −4.6 (1.5); P = 0.002), and explained 11% of the variation in SWS after covariate adjustment. A similar association was observed for delta power. No association was observed for sleep duration and efficiency. Conclusion: African genetic ancestry is associated with indices of sleep depth in African Americans. Such an association suggests that part of the racial differences in slow-wave sleep may have genetic underpinnings. Citation: Halder I, Matthews KA, Buysse DJ, Strollo PJ, Causer V, Reis SE, Hall MH. African genetic ancestry is associated with sleep depth in older African Americans. SLEEP 2015;38(8):1185–1193. PMID:25845688

Sleep's Influence on a Reflexive Form of Memory That Does Not Require Voluntary Attention

PubMed Central

Sheth, Bhavin R.; Serranzana, Andrew; Anjum, Syed F.; Khan, Murtuza

2012-01-01

Study Objectives: Studies to date have examined the influence of sleep on forms of memory that require voluntary attention. The authors examine the influence of sleep on a form of memory that is acquired by passive viewing. Design: Induction of the McCollough effect, and measurement of perceptual color bias before and after induction, and before and after intervening sleep, wake, or visual deprivation. Setting: Sound-attenuated sleep research room. Participants: 13 healthy volunteers (mean age = 23 years; age range = 18–31 years) with normal or corrected-to-normal vision. Interventions: N/A. Measurements and Results:) Encoding: sleep preceded adaptation. On separate nights, each participant slept for an average of 0 (wake), 1, 2, 4, or 7 hr (complete sleep). Upon awakening, the participant's baseline perceptual color bias was measured. Then, he or she viewed an adapter consisting of alternating red/horizontal and green/vertical gratings for 5 min. Color bias was remeasured. The strength of the aftereffect is the postadaptation color bias relative to baseline. A strong orientation contingent color aftereffect was observed in all participants, but total sleep duration (TSD) prior to the adaptation did not modulate aftereffect strength. Further, prior sleep provided no benefit over prior wake. Retention: sleep followed adaptation. The procedure was similar except that adaptation preceded sleep. Postadaptation sleep, irrespective of its duration (1, 3, 5, or 7 hr), arrested aftereffect decay. By contrast, aftereffect decay was arrested during subsequent wake only if the adapted eye was visually deprived. Conclusions: Sleep as well as passive sensory deprivation enables the retention of a color aftereffect. Sleep shelters this reflexive form of memory in a manner akin to preventing sensory interference. Citation: Sheth BR; Serranzana A; Anjum SF; Khan M. Sleep's influence on a reflexive form of memory that does not require voluntary attention. SLEEP 2012;35(5):657-666. PMID:22547892

The Children's Report of Sleep Patterns (CRSP): A Self-Report Measure of Sleep for School-Aged Children

PubMed Central

Meltzer, Lisa J.; Avis, Kristin T.; Biggs, Sarah; Reynolds, Amy C.; Crabtree, Valerie McLaughlin; Bevans, Katherine B.

2013-01-01

Study Objectives: (1) Present preliminary psychometrics for the Children's Report of Sleep Patterns (CRSP), a three-module measure of Sleep Patterns, Sleep Hygiene, and Sleep Disturbance; and (2) explore whether the CRSP provides information about a child's sleep above and beyond parental report. Methods: A multi-method, multi-reporter approach was used to validate the CRSP with 456 children aged 8-12 years (inclusive). Participants were recruited from pediatricians' offices, sleep clinics/laboratories, children's hospitals, schools, and the general population. Participants completed measures of sleep habits, sleep hygiene, anxiety, and sleepiness, with actigraphy and polysomnography used to provide objective measures of child sleep. Results: The CRSP demonstrated good reliability and validity. Differences in sleep hygiene and sleep disturbances were found for children presenting to a sleep clinic/laboratory (vs. community population); for younger children (vs. older children); and for children who slept less than 8 hours or had a sleep onset later than 22:00 on actigraphy. Further, significant associations were found between the CRSP and child-reported anxiety or sleepiness. Notably, approximately 40% of parents were not aware of child reported difficulties with sleep onset latency, night wakings, or poor sleep quality. Conclusions: The three modules of the CRSP can be used together or independently, providing a reliable and valid self-report measure of sleep patterns, sleep hygiene, and sleep disturbances for children ages 8-12 years. Children not only provide valid information about their sleep, but may provide information that would not be otherwise captured in both clinical and research settings if relying solely on parental report. Citation: Meltzer LJ; Avis KT; Biggs S; Reynolds AC; Crab-tree VM; Bevans KB. The Children's Report of Sleep Patterns (CRSP): a self-report measure of sleep for school-aged children. J Clin Sleep Med 2013;9(3):235-245. PMID:23493949

Acute Cardiopulmonary Failure From Sleep-Disordered Breathing

PubMed Central

Carr, Gordon E.; Mokhlesi, Babak

2012-01-01

Sleep-disordered breathing (SDB) comprises a diverse set of disorders marked by abnormal respiration during sleep. Clinicians should realize that SDB may present as acute cardiopulmonary failure in susceptible patients. In this review, we discuss three clinical phenotypes of acute cardiopulmonary failure from SDB: acute ventilatory failure, acute congestive heart failure, and sudden death. We review the pathophysiologic mechanisms and recommend general principles for management. Timely recognition of, and therapy for, SDB in the setting of acute cardiopulmonary failure may improve short- and long-term outcomes. PMID:22396567

Understanding the role of sleep in suicide risk: qualitative interview study

PubMed Central

Kyle, Simon D; Pratt, Daniel; Peters, Sarah

2016-01-01

Objective Sleep problems are associated with increased risk of suicide, independent of depression. This analysis explores narrative accounts of the role of sleep in relation to suicidal thoughts and behaviours. Design Qualitative study, based on in-depth semistructured interviews which were analysed with an inductive, latent thematic analysis. Participants A maximum variation sample of 18 people with experience of a major depressive episode, and suicidal thoughts and behaviours. Setting Primary care, North West England. Results Respondents emphasised the importance of sleep for recovery and management of their mental well-being. Moreover, three inter-related pathways were identified, whereby beliefs about sleep contributed to suicidal thoughts and behaviours. First, being awake during the biological night heightened risk of suicidal behaviours, as this was perceived to be an opportune time for a suicide attempt due to the decreased chances that a friend of family member would intervene during a suicide attempt. Additionally, the reduction in available support at night added to suicide risk. Second, failure to achieve good sleep was perceived to make life harder through contributing to core features of depression, such as negative thinking, attention difficulties and inactivity. Third, sleep acted as an alternative to suicide, by providing an escape from problems, including mental health problems, in waking life. However, this desire to sleep to escape was associated with excessive daytime sleeping, which subsequently may reinforce disturbed sleeping patterns. Conclusions Sleep problems should be an important treatment target when working with suicidal clients. More broadly, night-time service provision should be considered when developing suicide prevention initiatives. PMID:27550652

The association of sleep duration and depressive symptoms in rural communities of southeastern Missouri, Tennessee, and Arkansas

PubMed Central

JJ, Chang; J, Salas; K, Habicht; GW, Pien; KA, Stamatakis; RC, Brownson

2012-01-01

Purpose To determine the association between sleep duration and depressive symptoms in a rural setting. Methods We conducted a cross-sectional study using data from Wave 3 of the Walk the Ozarks to Wellness Project including 12 rural communities in Missouri, Arkansas, and Tennessee (N = 1,204). Sleep duration was defined based on average weeknight and weekend hours per day: short (< 7), optimal (7-8), and long (> 8). The primary outcome was self-reported elevated depressive symptoms. Multivariable logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (95% CI). Findings Elevated depressive symptoms were common in this rural population (17%). Depressive symptoms were more prevalent among subjects with short (26.1%) and long (24%) sleep duration compared to those with optimal (11.8%) sleep duration. After adjusting for age, gender, race, education, employment status, income, and BMI, short sleep duration was associated with increased odds of elevated depressive symptoms (aPOR=2.12, 95% CI: 1.49, 3.01), compared to optimal sleep duration. Conversely, the association between long sleep duration and depressive symptoms was not statistically significant after covariate adjustment. Similar findings were observed when we excluded individuals with insomnia symptoms for analysis. Conclusions This study suggests that short sleep duration (<7 hours per night) and depressive symptoms are common among rural populations. Short sleep duration is positively associated with elevated depressive symptoms. The economic and healthcare burden of depression may be more overwhelming among rural populations, necessitating the need to target modifiable behaviors such as sleep habits to improve mental health. PMID:22757951

Separating the Contribution of Glucocorticoids and Wakefulness to the Molecular and Electrophysiological Correlates of Sleep Homeostasis

PubMed Central

Mongrain, Valérie; Hernandez, Susana A.; Pradervand, Sylvain; Dorsaz, Stéphane; Curie, Thomas; Hagiwara, Grace; Gip, Phung; Heller, H. Craig; Franken, Paul

2010-01-01

Study Objectives: The sleep-deprivation–induced changes in delta power, an electroencephalographical correlate of sleep need, and brain transcriptome profiles have importantly contributed to current hypotheses on sleep function. Because sleep deprivation also induces stress, we here determined the contribution of the corticosterone component of the stress response to the electrophysiological and molecular markers of sleep need in mice. Design: N/A Settings: Mouse sleep facility. Participants: C57BL/6J, AKR/J, DBA/2J mice. Interventions: Sleep deprivation, adrenalectomy (ADX). Measurements and Results: Sleep deprivation elevated corticosterone levels in 3 inbred strains, but this increase was larger in DBA/2J mice; i.e., the strain for which the rebound in delta power after sleep deprivation failed to reach significance. Elimination of the sleep-deprivation–associated corticosterone surge through ADX in DBA/2J mice did not, however, rescue the delta power rebound but did greatly reduce the number of transcripts affected by sleep deprivation. Genes no longer affected by sleep deprivation cover pathways previously implicated in sleep homeostasis, such as lipid, cholesterol (e.g., Ldlr, Hmgcs1, Dhcr7, −24, Fkbp5), energy and carbohydrate metabolism (e.g., Eno3, G6pc3, Mpdu1, Ugdh, Man1b1), protein biosynthesis (e.g., Sgk1, Alad, Fads3, Eif2c2, −3, Mat2a), and some circadian genes (Per1, −3), whereas others, such as Homer1a, remained unchanged. Moreover, several microRNAs were affected both by sleep deprivation and ADX. Conclusions: Our findings indicate that corticosterone contributes to the sleep-deprivation–induced changes in brain transcriptome that have been attributed to wakefulness per se. The study identified 78 transcripts that respond to sleep loss independent of corticosterone and time of day, among which genes involved in neuroprotection prominently feature, pointing to a molecular pathway directly relevant for sleep function. Citation: Mongrain V; Hernandez SA; Pradervand S; Dorsaz S; Curie T; Hagiwara G; Gip P; Heller HC; Franken P. Separating the contribution of glucocorticoids and wakefulness to the molecular and electrophysiological correlates of sleep homeostasis. SLEEP 2010;33(9):1147-1157. PMID:20857860

Dynamic Sensor Networks

DTIC Science & Technology

2004-03-01

turned off. SLEEP Set the timer for 30 seconds before scheduled transmit time, then sleep the processor. WAKE When timer trips, power up the processor...slots where none of its neighbors are schedule to transmit. This allows the sensor nodes to perform a simple power man- agement scheme that puts the...routing This simple case study highlights the following crucial observation: optimal traffic scheduling in energy constrained networks requires future

Measuring sleep habits without using a diary: the sleep timing questionnaire

NASA Technical Reports Server (NTRS)

Monk, Timothy H.; Buysse, Daniel J.; Kennedy, Kathy S.; Pods, Jaime M.; DeGrazia, Jean M.; Miewald, Jean M.

2003-01-01

STUDY OBJECTIVES: To develop a single-administration instrument yielding equivalent measures of sleep to those obtained from a formal (2-week) sleep diary. DESIGN & SETTING: A single-administration Sleep riming Questionnaire (STQ) is described (and reproduced in the Appendix). Test-retest reliability was examined in 40 subjects who were given the STQ on two occasions separated by less than 1 year. Convergent validity was measured both by comparing STO-derived measures with objective measures derived from wrist actigraphy (n=23) and by comparing STQ-derived measures with other subjective measures derived from a detailed 2-week sleep diary in two nonoverlapping samples (n=101, 93). Correlations of STQ measures with age and momingness-eveningness (chronotype) were also examined. SUBJECTS: The analyses used sample sizes of 40, 23, 101, and 93 (both genders, overall age range 20y-89y). Most subjects were healthy volunteers; some Study 4 subjects were patients (enrolled in research protocols). RESULTS: Test-retest reliability for the STQ was demonstrated for estimates of bedtime (r = 0.705, p < 0.001) and waketime (r = 0.826, p < 0.001). Convergent validity using wrist actigraphy was demonstrated by correlations of 0.592 (p < 0.005) for bedtime, and of 0.769 (p < 0.001) for waketime. Diary studies indicated STQ bedtime and waketime data to be highly correlated (at about 0.8) with those obtained from a formal 2-week sleep diary. The STQ also provided data on estimated sleep latency and wake after sleep onset (WASO), which correlated reliably (at about 0.7) with average nightly ratings of these variables from a 2-week sleep diary. Mean estimated values of sleep latency and WASO from the two instruments were within 1 minute of each other. ST-derived bedtimes and waketimes correlated with both age and chronotype in the expected direction (older subjects earlier, morning types earlier). CONCLUSION: The STQ may be a reliable valid measure of sleep timing that could provide a time-efficient alternative to traditional sleep diaries.

Sleep, Glucose, and Daytime Functioning in Youth with Type 1 Diabetes

PubMed Central

Perfect, Michelle M.; Patel, Priti G.; Scott, Roxanne E.; Wheeler, Mark D.; Patel, Chetanbabu; Griffin, Kurt; Sorensen, Seth T.; Goodwin, James L.; Quan, Stuart F.

2012-01-01

Study Hypotheses: 1) Youth with evidence of SDB (total apnea-hypopnea index [Total-AHI] ≥ 1.5) would have significantly worse glucose control than those without SDB; 2) Elevated self-reported sleepiness in youth with T1DM would be related to compromised psychosocial functioning; and 3) Youth with T1DM would have significantly less slow wave sleep (SWS) than controls. Design: The study utilized home-based polysomnography, actigraphy, and questionnaires to assess sleep, and continuous glucose monitors and hemoglobin A1C (HbA1C) values to assess glucose control in youth with T1DM. We compared sleep of youth with T1DM to sleep of a matched control sample. Setting: Diabetic participants were recruited in a pediatric endocrinology clinic. Participants: Participants were youth (10 through 16 years) with T1DM. Controls, matched for sex, age, and BMI percentile, were from the Tucson Children's Assessment of Sleep Apnea study. Results: Participants with a Total-AHI ≥ 1.5 had higher glucose levels. Sleepiness and/or poor sleep habits correlated with reduced quality of life, depressed mood, lower grades, and lower state standardized reading scores. Diabetic youth spent more time (%) in stage N2 and less time in stage N3. Findings related to sleep architecture included associations between reduced SWS and higher HbA1C, worse quality of life, and sleepiness. More time (%) spent in stage N2 related to higher glucose levels/hyperglycemia, behavioral difficulties, reduced quality of life, lower grades, depression, sleep-wake behavior problems, poor sleep quality, sleepiness, and lower state standardized math scores. Conclusions: Sleep should be routinely assessed as part of diabetes management in youth with T1DM. Citation: Perfect MM; Patel PG; Scott RE; Wheeler MD; Patel C; Griffin K; Sorensen ST; Goodwin JL; Quan SF. Sleep, glucose, and daytime functioning in youth with type 1 diabetes. SLEEP 2012;35(1):81-88. PMID:22215921

Discharge Patterns of Human Tensor Palatini Motor Units During Sleep Onset

PubMed Central

Nicholas, Christian L.; Jordan, Amy S.; Heckel, Leila; Worsnop, Christopher; Bei, Bei; Saboisky, Julian P.; Eckert, Danny J.; White, David P.; Malhotra, Atul; Trinder, John

2012-01-01

Study Objectives: Upper airway muscles such as genioglossus (GG) and tensor palatini (TP) reduce activity at sleep onset. In GG reduced muscle activity is primarily due to inspiratory modulated motor units becoming silent, suggesting reduced respiratory pattern generator (RPG) output. However, unlike GG, TP shows minimal respiratory modulation and presumably has few inspiratory modulated motor units and minimal input from the RPG. Thus, we investigated the mechanism by which TP reduces activity at sleep onset. Design: The activity of TP motor units were studied during relaxed wakefulness and over the transition from wakefulness to sleep. Setting: Sleep laboratory. Participants: Nine young (21.4 ± 3.4 years) males were studied on a total of 11 nights. Intervention: Sleep onset. Measurements and Results: Two TP EMGs (thin, hooked wire electrodes), and sleep and respiratory measures were recorded. One hundred twenty-one sleep onsets were identified (13.4 ± 7.2/subject), resulting in 128 motor units (14.3 ± 13.0/subject); 29% of units were tonic, 43% inspiratory modulated (inspiratory phasic 18%, inspiratory tonic 25%), and 28% expiratory modulated (expiratory phasic 21%, expiratory tonic 7%). There was a reduction in both expiratory and inspiratory modulated units, but not tonic units, at sleep onset. Reduced TP activity was almost entirely due to de-recruitment. Conclusions: TP showed a similar distribution of motor units as other airway muscles. However, a greater proportion of expiratory modulated motor units were active in TP and these expiratory units, along with inspiratory units, tended to become silent over sleep onset. The data suggest that both expiratory and inspiratory drive components from the RPG are reduced at sleep onset in TP. Citation: Nicholas CL; Jordan AS; Heckel L; Worsnop C; Bei B: Saboisky JP; Eckert DJ; White DP; Malhotra A; Trinder J. Discharge patterns of human tensor palatini motor units during sleep onset. SLEEP 2012;35(5):699-707. PMID:22547896

Rapid Eye Movement Sleep in Relation to Overweight in Children and Adolescents

PubMed Central

Liu, Xianchen; Forbes, Erika E.; Ryan, Neal D.; Rofey, Dana; Hannon, Tamara S.; Dahl, Ronald E.

2009-01-01

Context Short sleep duration is associated with obesity, but few studies have examined the relationship between obesity and specific physiological stages of sleep. Objective To examine specific sleep stages, including rapid eye movement (REM) sleep and stages 1 through 4 of non-REM sleep, in relation to overweight in children and adolescents. Design, Setting, and Participants A total of 335 children and adolescents (55.2% male; aged 7-17 years) underwent 3 consecutive nights of standard polysomnography and weight and height assessments as part of a study on the development of internalizing disorders (depression and anxiety). Main Outcome Measures Body mass index (calculated as weight in kilograms divided by height in meters squared) z score and weight status (normal, at risk for overweight, overweight) according to the body mass index percentile for age and sex. Results The body mass index z score was significantly related to total sleep time (β=-0.174), sleep efficiency (β=-0.027), and REM density (β=-0.256). Compared with normal-weight children, overweight children slept about 22 minutes less and had lower sleep efficiency, shorter REM sleep, lower REM activity and density, and longer latency to the first REM period. After adjustment for demographics, pubertal status, and psychiatric diagnosis, 1 hour less of total sleep was associated with approximately 2-fold increased odds of overweight (odds ratio=1.85), 1 hour less of REM sleep was associated with about 3-fold increased odds (odds ratio=2.91), and REM density and activity below the median increased the odds of overweight by 2-fold (odds ratio=2.18) and 3-fold (odds ratio=3.32), respectively. Conclusions Our results confirm previous epidemiological observations that short sleep time is associated with overweight in children and adolescents. A core aspect of the association between short sleep duration and overweight may be attributed to reduced REM sleep. Further studies are needed to investigate possible mechanisms underpinning the association between diminished REM sleep and endocrine and metabolic changes that may contribute to obesity. PMID:18678797

Responses in Rat Core Auditory Cortex are Preserved during Sleep Spindle Oscillations

PubMed Central

Sela, Yaniv; Vyazovskiy, Vladyslav V.; Cirelli, Chiara; Tononi, Giulio; Nir, Yuval

2016-01-01

Study Objectives: Sleep is defined as a reversible state of reduction in sensory responsiveness and immobility. A long-standing hypothesis suggests that a high arousal threshold during non-rapid eye movement (NREM) sleep is mediated by sleep spindle oscillations, impairing thalamocortical transmission of incoming sensory stimuli. Here we set out to test this idea directly by examining sensory-evoked neuronal spiking activity during natural sleep. Methods: We compared neuronal (n = 269) and multiunit activity (MUA), as well as local field potentials (LFP) in rat core auditory cortex (A1) during NREM sleep, comparing responses to sounds depending on the presence or absence of sleep spindles. Results: We found that sleep spindles robustly modulated the timing of neuronal discharges in A1. However, responses to sounds were nearly identical for all measured signals including isolated neurons, MUA, and LFPs (all differences < 10%). Furthermore, in 10% of trials, auditory stimulation led to an early termination of the sleep spindle oscillation around 150–250 msec following stimulus onset. Finally, active ON states and inactive OFF periods during slow waves in NREM sleep affected the auditory response in opposite ways, depending on stimulus intensity. Conclusions: Responses in core auditory cortex are well preserved regardless of sleep spindles recorded in that area, suggesting that thalamocortical sensory relay remains functional during sleep spindles, and that sensory disconnection in sleep is mediated by other mechanisms. Citation: Sela Y, Vyazovskiy VV, Cirelli C, Tononi G, Nir Y. Responses in rat core auditory cortex are preserved during sleep spindle oscillations. SLEEP 2016;39(5):1069–1082. PMID:26856904

Electroencephalogram spindle activity during dexmedetomidine sedation and physiological sleep.

PubMed

Huupponen, E; Maksimow, A; Lapinlampi, P; Särkelä, M; Saastamoinen, A; Snapir, A; Scheinin, H; Scheinin, M; Meriläinen, P; Himanen, S-L; Jääskeläinen, S

2008-02-01

Dexmedetomidine, a selective alpha(2)-adrenoceptor agonist, induces a unique, sleep-like state of sedation. The objective of the present work was to study human electroencephalogram (EEG) sleep spindles during dexmedetomidine sedation and compare them with spindles during normal physiological sleep, to test the hypothesis that dexmedetomidine exerts its effects via normal sleep-promoting pathways. EEG was continuously recorded from a bipolar frontopolar-laterofrontal derivation with Entropy Module (GE Healthcare) during light and deep dexmedetomidine sedation (target-controlled infusions set at 0.5 and 3.2 ng/ml) in 11 healthy subjects, and during physiological sleep in 10 healthy control subjects. Sleep spindles were visually scored and quantitatively analyzed for density, duration, amplitude (band-pass filtering) and frequency content (matching pursuit approach), and compared between the two groups. In visual analysis, EEG activity during dexmedetomidine sedation was similar to physiological stage 2 (S2) sleep with slight to moderate amount of slow-wave activity and abundant sleep spindle activity. In quantitative EEG analyses, sleep spindles were similar during dexmedetomidine sedation and normal sleep. No statistically significant differences were found in spindle density, amplitude or frequency content, but the spindles during dexmedetomidine sedation had longer duration (mean 1.11 s, SD 0.14 s) than spindles in normal sleep (mean 0.88 s, SD 0.14 s; P=0.0014). Analysis of sleep spindles shows that dexmedetomidine produces a state closely resembling physiological S2 sleep in humans, which gives further support to earlier experimental evidence for activation of normal non-rapid eye movement sleep-promoting pathways by this sedative agent.

Quantifying Leg Movement Activity During Sleep.

PubMed

Ferri, Raffaele; Fulda, Stephany

2016-12-01

Currently, 2 sets of similar rules for recording and scoring leg movement (LM) exist, including periodic LM during sleep (PLMS) and periodic LM during wakefulness. The former were published in 2006 by a task force of the International Restless Legs Syndrome Study Group, and the second in 2007 by the American Academy of Sleep Medicine. This article reviews the basic recording methods, scoring rules, and computer-based programs for PLMS. Less frequent LM activities, such as alternating leg muscle activation, hypnagogic foot tremor, high-frequency LMs, and excessive fragmentary myoclonus are briefly described. Copyright © 2016 Elsevier Inc. All rights reserved.

Automated Neuropsychological assessment Metrics Version 4 (ANAM4): Select Psychometric Properties and Administration Procedures

DTIC Science & Technology

2014-12-01

management structure set up for Study 4 - COMPLETED Task 17 (Months 37-48) Operationalize database for Study 4 analysis scheme – COMPLETED Task...Heaton, K.J., Laufer, A.S., Maule, A., Vincent, A.S. (abstract submitted). Effects of acute sleep deprivation on ANAM4 TBI Battery performance in...and visual tracking degradation during acute sleep deprivation in a military sample. Aviat Space Environ Med 2014; 85:497 – 503. Background: Fatigue

Evaluating Sleep Disturbance: A Review of Methods

NASA Technical Reports Server (NTRS)

Smith, Roy M.; Oyung, R.; Gregory, K.; Miller, D.; Rosekind, M.; Rosekind, Mark R. (Technical Monitor)

1996-01-01

There are three general approaches to evaluating sleep disturbance in regards to noise: subjective, behavioral, and physiological. Subjective methods range from standardized questionnaires and scales to self-report measures designed for specific research questions. There are two behavioral methods that provide useful sleep disturbance data. One behavioral method is actigraphy, a motion detector that provides an empirical estimate of sleep quantity and quality. An actigraph, worn on the non-dominant wrist, provides a 24-hr estimate of the rest/activity cycle. The other method involves a behavioral response, either to a specific probe or stimuli or subject initiated (e.g., indicating wakefulness). The classic, gold standard for evaluating sleep disturbance is continuous physiological monitoring of brain, eye, and muscle activity. This allows detailed distinctions of the states and stages of sleep, awakenings, and sleep continuity. Physiological delta can be obtained in controlled laboratory settings and in natural environments. Current ambulatory physiological recording equipment allows evaluation in home and work settings. These approaches will be described and the relative strengths and limitations of each method will be discussed.

Psychological Effect of an Analogue Traumatic Event Reduced by Sleep Deprivation

PubMed Central

Porcheret, Kate; Holmes, Emily A.; Goodwin, Guy M.; Foster, Russell G.; Wulff, Katharina

2015-01-01

Study Objective: To examine the effect of sleep deprivation compared to sleep, immediately after experimental trauma stimuli on the development of intrusive memories to that trauma stimuli. Design: Participants were exposed to a film with traumatic content (trauma film). The immediate response to the trauma film was assessed, followed by either total sleep deprivation (sleep deprived group, N = 20) or sleep as usual (sleep group, N = 22). Twelve hours after the film viewing the initial psychological effect of the trauma film was measured and for the subsequent 6 days intrusive emotional memories related to the trauma film were recorded in daily life. Setting: Academic sleep laboratory and participants' home environment. Participants: Healthy paid volunteers. Measurements and results: On the first day after the trauma film, the psychological effect as assessed by the Impact of Event Scale – Revised was lower in the sleep deprived group compared to the sleep group. In addition, the sleep deprived group reported fewer intrusive emotional memories (mean 2.28, standard deviation [SD] 2.91) compared to the sleep group (mean 3.76, SD 3.35). Because habitual sleep/circadian patterns, psychological health, and immediate effect of the trauma film were similar at baseline for participants of both groups, the results cannot be accounted for by pre-existing inequalities between groups. Conclusions: Our findings suggest that sleep deprivation on one night, rather than sleeping, reduces emotional effect and intrusive memories following exposure to experimental trauma. Citation: Porcheret K, Holmes EA, Goodwin GM, Foster RG, Wulff K. Psychological effect of an analogue traumatic event reduced by sleep deprivation. SLEEP 2015;38(7):1017–1025. PMID:26118556

Familiality and clinical outcomes of sleep disturbances in major depressive and bipolar disorders.

PubMed

Lai, Yin-Chieh; Huang, Ming-Chyi; Chen, Hsi-Chung; Lu, Ming-Kun; Chiu, Yi-Hang; Shen, Winston W; Lu, Ru-Band; Kuo, Po-Hsiu

2014-01-01

Sleep disturbances are frequently observed in major depressive (MDD) and bipolar disorder (BD). This study reported sleep profiles of patients and their relatives versus controls, and examined the familiality of sleep features in mood disorder families. We also evaluated the influences of sleep disturbance on patients' quality of life (QOL), functional impairment, and suicidality. We recruited 363 BD and 157 MDD patients, 521 first-degree relatives, and 235 healthy controls, which completed a diagnostic interview, Pittsburgh Sleep Quality Index (PSQI), and QOL questionnaire. The magnitude of heritability of sleep features was calculated and familiality was evaluated by mixed regression models and intraclass correlation coefficient (ICC). The associations between sleep problems and clinical outcomes were examined using multiple regression models. More than three-quarters of mildly-ill patients were classified as "poor sleepers". MDD patients had significantly worse sleep quality as compared to BD patients. Moderate but significant familial aggregation was observed in subjective sleep quality, sleep latency, disturbance, daytime dysfunction, and global score (ICC=0.10-0.21, P<.05). Significant heritability was found in sleep quality (0.45, P<.001) and sleep disturbance (0.23, P<.001). Patients with good sleep quality had better QOL and less functional impairment (P<.05) than poor sleepers. Poor sleep quality and nightmares further increased the risk for suicidal ideation (ORadj=2.8) and suicide attempts (ORadj=1.9-2.8). Subjectively measured sleep features demonstrated significant familiality. Poor sleep quality further impaired patients' daily function and QOL, in addition to increasing the risk of suicidality, and thus requires special attention in related clinical settings. Copyright © 2013 Elsevier Inc. All rights reserved.

Performance of Remotely Controlled Mandibular Protrusion Sleep Studies for Prediction of Oral Appliance Treatment Response

PubMed Central

Sutherland, Kate; Ngiam, Joachim; Cistulli, Peter A.

2017-01-01

Study Objectives: Mandibular protrusion during sleep monitoring has been proposed as a method to predict oral appliance treatment outcome. A commercial remotely controlled mandibular protrusion (RCMP) device has become available for this purpose with predictive accuracy demonstrated in an initial study. Our aim was to validate this RCMP method for oral appliance treatment outcome prediction in a clinical sleep laboratory setting. Methods: Forty-two obstructive sleep apnea (OSA) patients (apnea-hypopnea index [AHI] > 10 events/h) were recruited to undergo a RCMP sleep study before commencing oral appliance treatment. The RCMP study was used to make a prediction of treatment “Success” or “Failure” based on a rule of ≤ 1 respiratory event per 5 min supine rapid eye movement sleep. Oral appliance treatment response was verified by polysomonography and defined as treatment AHI < 10 events/h with 50% reduction. Results: Participants were on average middle-aged (57.1 ± 11.6 y) and overweight (29.6 ± 4.5 kg/m2) with baseline AHI 31.5 ± 20.5 events/h, 39% severe OSA (AHI > 30 events/h). Two participants (5%) were not able to tolerate the RCMP study. Oral appliance treatment outcome was verified in 33 participants (RCMP results: “Success” n = 10, “Failure” n = 15, “Inconclusive” n = 8). In those with a treatment outcome prediction (n = 25) the diagnostic characteristics of the RCMP test were sensitivity 81.8%, specificity 92.9%, positive predictive value 90%, and negative predictive value 86.7% (n = 3 misclassified). Conclusions: The RCMP device was well tolerated by patients and successfully used to perform mandibular protrusion sleep studies in our sleep laboratory. The RCMP sleep study showed good accuracy as a prediction technique for oral appliance treatment outcome, although there was a high rate of inconclusive tests. Citation: Sutherland K, Ngiam J, Cistulli PA. Performance of remotely controlled mandibular protrusion sleep studies for prediction of oral appliance treatment response. J Clin Sleep Med. 2017;13(3):411–417. PMID:27923436

Sustained Attention Performance during Sleep Deprivation Associates with Instability in Behavior and Physiologic Measures at Baseline

PubMed Central

Chua, Eric Chern-Pin; Yeo, Sing-Chen; Lee, Ivan Tian-Guang; Tan, Luuan-Chin; Lau, Pauline; Cai, Shiwei; Zhang, Xiaodong; Puvanendran, Kathiravelu; Gooley, Joshua J.

2014-01-01

Study Objectives: To identify baseline behavioral and physiologic markers that associate with individual differences in sustained attention during sleep deprivation. Design: In a retrospective study, ocular, electrocardiogram, and electroencephalogram (EEG) measures were compared in subjects who were characterized as resilient (n = 15) or vulnerable (n = 15) to the effects of total sleep deprivation on sustained attention. Setting: Chronobiology and Sleep Laboratory, Duke-NUS Graduate Medical School Singapore. Participants: Healthy volunteers aged 22-32 years from the general population. Interventions: Subjects were kept awake for at least 26 hours under constant environmental conditions. Every 2 hours, sustained attention was assessed using a 10-minute psychomotor vigilance task (PVT). Measurements and Results: During baseline sleep and recovery sleep, EEG slow wave activity was similar in resilient versus vulnerable subjects, suggesting that individual differences in vulnerability to sleep loss were not related to differences in homeostatic sleep regulation. Rather, irrespective of time elapsed since wake, subjects who were vulnerable to sleep deprivation exhibited slower and more variable PVT response times, lower and more variable heart rate, and higher and more variable EEG spectral power in the theta frequency band (6.0-7.5 Hz). Conclusions: Performance decrements in sustained attention during sleep deprivation associate with instability in behavioral and physiologic measures at baseline. Small individual differences in sustained attention that are present at baseline are amplified during prolonged wakefulness, thus contributing to large between-subjects differences in performance and sleepiness. Citation: Chua EC; Yeo SC; Lee IT; Tan LC; Lau P; Cai S; Zhang X; Puvanendran K; Gooley JJ. Sustained attention performance during sleep deprivation associates with instability in behavior and physiologic measures at baseline. SLEEP 2014;37(1):27-39. PMID:24470693

The sleep of children with attention deficit hyperactivity disorder on and off methylphenidate: a matched case-control study.

PubMed

Galland, Barbara C; Tripp, E Gail; Taylor, Barry J

2010-06-01

In the present study, we assessed the effects of regular use of methylphenidate medication in children diagnosed with attention deficit hyperactivity disorder (ADHD) on sleep timing, duration and sleep architecture. Twenty-seven children aged 6-12 years meeting diagnostic criteria for Diagnostic and Statistical Manual version IV ADHD and 27 control children matched for age (+/-3 months) and gender. Two nights of standard polysomnographic (PSG) recordings were conducted. ADHD children were allocated randomly to an on- or 48 h off-methylphenidate protocol for first or second recordings. Control children's recordings were matched for night, but no medication was used. Mixed modelling was employed in the analyses so that the full data set was used to determine the degree of medication effects. Methylphenidate in ADHD children prolonged sleep onset by an average of 29 min [confidence interval (CI) 11.6, 46.7], reduced sleep efficiency by 6.5% (CI 2.6, 10.3) and shortened sleep by 1.2 h (CI 0.65, 1.9). Arousal indices were preserved. Relative amounts of stages 1, 2 and slow wave sleep were unchanged by medication. Rapid eye movement sleep was reduced (-2.4%) on the medication night, an effect that became non-significant when control data were incorporated in the analyses. PSG data from ADHD children off-medication were similar to control data. Our findings suggest that methylphenidate reduces sleep quantity but does not alter sleep architecture in children diagnosed with ADHD. An adequate amount of sleep is integral to good daytime functioning, thus the sleep side effects of methylphenidate may affect adversely the daytime symptoms the drug is targeted to control.

Bedtime mobile phone use and sleep in adults.

PubMed

Exelmans, Liese; Van den Bulck, Jan

2016-01-01

The few studies that have investigated the relationship between mobile phone use and sleep have mainly been conducted among children and adolescents. In adults, very little is known about mobile phone usage in bed our after lights out. This cross-sectional study set out to examine the association between bedtime mobile phone use and sleep among adults. A sample of 844 Flemish adults (18-94 years old) participated in a survey about electronic media use and sleep habits. Self-reported sleep quality, daytime fatigue and insomnia were measured using the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Assessment Scale (FAS) and the Bergen Insomnia Scale (BIS), respectively. Data were analyzed using hierarchical and multinomial regression analyses. Half of the respondents owned a smartphone, and six out of ten took their mobile phone with them to the bedroom. Sending/receiving text messages and/or phone calls after lights out significantly predicted respondents' scores on the PSQI, particularly longer sleep latency, worse sleep efficiency, more sleep disturbance and more daytime dysfunction. Bedtime mobile phone use predicted respondents' later self-reported rise time, higher insomnia score and increased fatigue. Age significantly moderated the relationship between bedtime mobile phone use and fatigue, rise time, and sleep duration. An increase in bedtime mobile phone use was associated with more fatigue and later rise times among younger respondents (≤ 41.5 years old and ≤ 40.8 years old respectively); but it was related to an earlier rise time and shorter sleep duration among older respondents (≥ 60.15 years old and ≥ 66.4 years old respectively). Findings suggest that bedtime mobile phone use is negatively related to sleep outcomes in adults, too. It warrants continued scholarly attention as the functionalities of mobile phones evolve rapidly and exponentially. Copyright © 2015 Elsevier Ltd. All rights reserved.

Sleep disturbance effects of traffic noise—A laboratory study on after effects

NASA Astrophysics Data System (ADS)

Öhrström, E.; Rylander, R.

1982-09-01

Body movements during sleep and subjective sleep quality, as well as mood and performance were investigated after exposure to intermittent and continuous traffic noise during the night. In a first experiment, six young subjects slept in the laboratory for five nights; in a second experiment 12 subjects slept six consecutive nights in the laboratory. A good dose-response relationship was obtained between intermittent noise and subjective sleep quality: i.e., the higher the noise level, the poorer the sleep quality. A similar dose-response relationship was found for body movements immediately following noise peaks during nights with intermittent noise. Performance and mood tended to be worse after intermittent noise. However, these effects did not increase with an increase in noise levels. Compared with intermittent noise, continuous noise had a significantly smaller effect on sleep quality. Mood and performance were not worse after continuous noise. The results suggest that increased attention should be paid to peak noise levels when standards for nocturnal noise are set.

Accurate discrimination of the wake-sleep states of mice using non-invasive whole-body plethysmography.

PubMed

Bastianini, Stefano; Alvente, Sara; Berteotti, Chiara; Lo Martire, Viviana; Silvani, Alessandro; Swoap, Steven J; Valli, Alice; Zoccoli, Giovanna; Cohen, Gary

2017-01-31

A major limitation in the study of sleep breathing disorders in mouse models of pathology is the need to combine whole-body plethysmography (WBP) to measure respiration with electroencephalography/electromyography (EEG/EMG) to discriminate wake-sleep states. However, murine wake-sleep states may be discriminated from breathing and body movements registered by the WBP signal alone. Our goal was to compare the EEG/EMG-based and the WBP-based scoring of wake-sleep states of mice, and provide formal guidelines for the latter. EEG, EMG, blood pressure and WBP signals were simultaneously recorded from 20 mice. Wake-sleep states were scored based either on EEG/EMG or on WBP signals and sleep-dependent respiratory and cardiovascular estimates were calculated. We found that the overall agreement between the 2 methods was 90%, with a high Cohen's Kappa index (0.82). The inter-rater agreement between 2 experts and between 1 expert and 1 naïve sleep investigators gave similar results. Sleep-dependent respiratory and cardiovascular estimates did not depend on the scoring method. We show that non-invasive discrimination of the wake-sleep states of mice based on visual inspection of the WBP signal is accurate, reliable and reproducible. This work may set the stage for non-invasive high-throughput experiments evaluating sleep and breathing patterns on mouse models of pathophysiology.

Sleepless in Texas.

PubMed

Prehn, Ronald

2007-03-01

Dental sleep medicine is an exciting frontier in dentistry. It is regulated by a strict set of standards as outlined by the current governing board of the Academy of Dental Sleep Medicine. It is imperative for all dentists who desire to treat patients with sleep disorders to obtain the knowledge, then to set out to establish relationships with the medial profession in order to properly treat these patients. This relationship is necessary to treat patients with these sleep disorders. It calls for communication between two branches of the medical professions that has not been seen since my grandfather, who was a dentist, communicated about patients with his brother, who was a physician, while at family dinners! It is a great responsibility with great rewards.

Substance use associated with short sleep duration in patients with schizophrenia or schizoaffective disorder.

PubMed

Tang, Vivian K; Pato, Michele T; Sobell, Janet L; Hammond, Terese C; Valdez, Mark M; Lane, Christianne J; Pato, Carlos N

2016-06-01

To examine the association between substance use and short sleep duration in individuals with schizophrenia or schizoaffective disorder, depressive type (SADD). Cross-sectional, retrospective study. Urban, suburban, and rural centers across the United States. 2,462 consented, adult individuals with schizophrenia or schizoaffective disorder, depressive type (SADD). Participants included inpatients in acute or chronic care settings as well as outpatients and residents in community dwellings. Substance use was assessed with 10 questions adopted from well-validated measures (e.g., CAGE questionnaire) for alcohol, marijuana, and illicit drugs. Short sleep duration was defined as <6 hr of self-reported sleep per night. Close to 100% of our sample used nicotine while 83% used substances other than nicotine. More importantly, there was a significant association between substance use and short sleep duration. Interestingly, this association was strongest among African-Americans with schizophrenia or SADD. Because psychiatric medications often target chemical receptors involved with both sleep and substance use, understanding the association between short sleep duration and substance use in individuals with schizophrenia and SADD is important. Given that the majority of premature deaths in individuals with psychotic illness are due to medical conditions associated with modifiable risk factors, prospective studies designed to examine the effect of short sleep duration on behaviors like substance use should be undertaken. Finally, analyzing genetic and environmental data in a future study might help illuminate the strong association found between short sleep duration and substance use in African-Americans with schizophrenia and SADD. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Detection of Cardiopulmonary Activity and Related Abnormal Events Using Microsoft Kinect Sensor.

PubMed

Al-Naji, Ali; Chahl, Javaan

2018-03-20

Monitoring of cardiopulmonary activity is a challenge when attempted under adverse conditions, including different sleeping postures, environmental settings, and an unclear region of interest (ROI). This study proposes an efficient remote imaging system based on a Microsoft Kinect v2 sensor for the observation of cardiopulmonary-signal-and-detection-related abnormal cardiopulmonary events (e.g., tachycardia, bradycardia, tachypnea, bradypnea, and central apnoea) in many possible sleeping postures within varying environmental settings including in total darkness and whether the subject is covered by a blanket or not. The proposed system extracts the signal from the abdominal-thoracic region where cardiopulmonary activity is most pronounced, using a real-time image sequence captured by Kinect v2 sensor. The proposed system shows promising results in any sleep posture, regardless of illumination conditions and unclear ROI even in the presence of a blanket, whilst being reliable, safe, and cost-effective.

Detection of Cardiopulmonary Activity and Related Abnormal Events Using Microsoft Kinect Sensor

PubMed Central

Chahl, Javaan

2018-01-01

Monitoring of cardiopulmonary activity is a challenge when attempted under adverse conditions, including different sleeping postures, environmental settings, and an unclear region of interest (ROI). This study proposes an efficient remote imaging system based on a Microsoft Kinect v2 sensor for the observation of cardiopulmonary-signal-and-detection-related abnormal cardiopulmonary events (e.g., tachycardia, bradycardia, tachypnea, bradypnea, and central apnoea) in many possible sleeping postures within varying environmental settings including in total darkness and whether the subject is covered by a blanket or not. The proposed system extracts the signal from the abdominal-thoracic region where cardiopulmonary activity is most pronounced, using a real-time image sequence captured by Kinect v2 sensor. The proposed system shows promising results in any sleep posture, regardless of illumination conditions and unclear ROI even in the presence of a blanket, whilst being reliable, safe, and cost-effective. PMID:29558414

Sleep Disordered Breathing in Four Resource-Limited Settings in Peru: Prevalence, Risk Factors, and Association with Chronic Diseases

PubMed Central

Schwartz, Noah G.; Rattner, Adi; Schwartz, Alan R.; Mokhlesi, Babak; Gilman, Robert H.; Bernabe-Ortiz, Antonio; Miranda, J. Jaime; Checkley, William

2015-01-01

Study Objectives: Sleep disordered breathing (SDB) is a highly prevalent condition in high-income countries, with major consequences for cardiopulmonary health, public safety, healthcare utilization, and mortality. However, its prevalence and effect in low- and middle-income countries are less well known. We sought to determine the prevalence, risk factors, and comorbidities of SDB symptoms in four resource-limited settings. Design: Cross-sectional analysis of the CRONICAS Cohort, a population-based age- and sex-stratified sample. Setting: Four resource-limited settings in Peru varying in altitude, urbanization, and air pollution. Participants: There were 2,682 adults aged 35 to 92 y. Measurements and Results: Self-reported SDB symptoms (habitual snoring, observed apneas, Epworth Sleepiness Scale), sociodemographics, medical history, anthropometrics, spirometry, blood biomarkers were reported. We found a high prevalence of habitual snoring (30.2%, 95% confidence interval [CI] 28.5–32.0%), observed apneas (20.9%, 95% CI 19.4–22.5%) and excessive daytime sleepiness (18.6%, 95% CI 17.1–20.1%). SDB symptoms varied across sites; prevalence and adjusted odds for habitual snoring were greatest at sea level, whereas those for observed apneas were greatest at high altitude. In multivariable analysis, habitual snoring was associated with older age, male sex, body mass index (BMI), and higher socioeconomic status; observed apneas were associated with BMI; and excessive daytime sleepiness was associated with older age, female sex, and medium socioeconomic status. Adjusted odds of cardiovascular disease, depression, and hypertension and total chronic disease burden increased progressively with the number of SDB symptoms. A threefold increase in the odds of having an additional chronic comorbid disease (adjusted odds ratio 3.57, 95% CI 2.18–5.84) was observed in those with all three versus no SDB symptoms. Conclusions: Sleep disordered breathing symptoms were highly prevalent, varied widely across four resource-limited settings in Peru, and exhibited strong independent associations with chronic diseases. Citation: Schwartz NG, Rattner A, Schwartz AR, Mokhlesi B, Gilman RH, Bernabe-Ortiz A, Miranda JJ, Checkley W, CRONICAS Cohort Study Group. Sleep disordered breathing in four resource-limited settings in Peru: prevalence, risk factors, and association with chronic diseases. SLEEP 2015;38(9):1451–1459. PMID:25845694

Spontaneous Swallowing during All-Night Sleep in Patients with Parkinson Disease in Comparison with Healthy Control Subjects.

PubMed

Uludag, Irem Fatma; Tiftikcioglu, Bedile Irem; Ertekin, Cumhur

2016-04-01

Spontaneous saliva swallows (SS) appear especially during sleep. The rate of SS was rarely investigated in all-night sleep in patients with Parkinson disease (PD). Dysphagia is a frequent symptom in PD, but the rate of SS was never studied with an all-night sleep electroencephalogram (EEG). A total of 21 patients with PD and 18 age-matched healthy controls were included in the study. Frequencies of SS and coughing were studied in all-night sleep recordings of patients with PD and controls. During all-night sleep, video-EEG 12-channel recording was used including the electromyography (EMG) of the swallowing muscles, nasal airflow, and recording of vertical laryngeal movement using a pair of EEG electrodes over the thyroid cartilage. The total number of SS was increased while the mean duration of sleep was decreased in PD when compared to controls. Sialorrhea and clinical dysphagia, assessed by proper questionnaires, had no effect in any patient group. The new finding was the so-called salvo type of consecutive SS in one set of swallowing. The amount of coughing was significantly increased just after the salvo SS. In PD, the rate of SS was not sufficient to demonstrate the swallowing disorder, such as oropharyngeal dysphagia, but the salvo type of SS was quite frequent. This is a novel finding and may contribute to the understanding of swallowing problems in patients with dysphagic or nondysphagic PD. © 2016 Associated Professional Sleep Societies, LLC.

A pictorial Sleepiness and Sleep Apnoea Scale to recognize individuals with high risk for obstructive sleep apnea syndrome.

PubMed

Edelmann, Cathrin; Ghiassi, Ramesh; Vogt, Deborah R; Partridge, Martyn R; Khatami, Ramin; Leuppi, Jörg D; Miedinger, David

2017-01-01

The aim of this study was to evaluate the validity of a new pictorial form of a screening test for obstructive sleep apnea syndrome (OSAS) - the pictorial Sleepiness and Sleep Apnoea Scale (pSSAS). Validation was performed in a sample of patients admitted to sleep clinics in the UK and Switzerland. All study participants were investigated with objective sleep tests such as full-night-attended polysomnography or polygraphy. The pSSAS was validated by taking into account the individual result of the sleep study, sleep-related questionnaires and objective parameters such as body mass index (BMI) or neck circumference. Different scoring schemes of the pSSAS were evaluated, and an internal validation was undertaken. The full data set consisted of 431 individuals (234 patients from the UK, 197 patients from Switzerland). The pSSAS showed good predictive performance for OSAS with an area under the curve between 0.77 and 0.81 depending on which scoring scheme was used. The subscores of the pSSAS had a moderate-to-strong correlation with widely used screening questionnaires for OSAS or excessive daytime sleepiness as well as with BMI and neck circumference. The pSSAS can be used to select patients with a high probability of having OSAS. Due to its simple pictorial design with short questions, it might be suitable for screening in populations with low health literacy and in non-native English or German speakers.

Self-reported Napping, Sleep Duration and Quality in the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) Study

PubMed Central

Picarsic, Jennifer L.; Glynn, Nancy W.; Taylor, Christopher A.; Katula, Jeffery; Goldman, Suzanne E.; Studenski, Stephanie; Newman, Anne B.

2010-01-01

OBJECTIVES To determine the prevalence of self-reported napping and its association with subjective nighttime sleep duration and quality, as measured by sleep-onset latency and sleep efficiency. DESIGN Cross-sectional study. SETTING Lifestyle Interventions and Independence for Elder’s Pilot Study. PARTICIPANTS Community-dwelling older adults (N=414), aged 70 to 89 years. MEASUREMENTS Self-report questionnaire on napping and sleep, derived from the Pittsburgh Sleep Quality Index (PSQI) scale. RESULTS A total of 54 percent of participants reported napping with mean nap duration of 55 minutes, (SD 41.2 minutes). Compared to non-nappers, nappers were more often men (37.3% vs. 23.8%, P = .003), African American (20.4% vs.14.4%, P = .06), or diabetic (28% vs. 14.3%, P = .007). Nappers and non-nappers had similar nighttime sleep duration and quality, but nappers spent about 10 percent of their 24-hour sleep occupied in napping. In a multivariate model, the odds of napping were higher for diabetics (OR: 1.9; 95% CI: 1.2–3.0) and men (OR: 1.9; 95% CI: 1.2–3.0)). In nappers, diabetes mellitus (β = 12.3 minutes, P =.005), male gender (β = 9.0 minutes, P = .04), higher BMI (β = 0.8 minutes, P = .02), and lower MMSE (β = 2.2, P = .03) were independently associated with longer nap duration. CONCLUSION Napping was a common practice in community-dwelling older adults and did not detract from nighttime sleep duration or quality. Given its high prevalence and association with diabetes, napping behavior should be assessed as part of sleep behavior, both in future research and in clinical practice. PMID:18662202

Hypertension, Snoring, and Obstructive Sleep Apnea During Pregnancy: A Cohort Study

PubMed Central

O’Brien, Louise M.; Bullough, Alexandra S.; Chames, Mark C.; Shelgikar, Anita V.; Armitage, Roseanne; Guilleminualt, Christian; Sullivan, Colin E.; Johnson, Timothy R. B.; Chervin, Ronald D.

2014-01-01

Objective To assess the frequency of obstructive sleep apnea among women with and without hypertensive disorders of pregnancy. Design Cohort study. Setting Obstetric clinics at an academic medical center. Population Pregnant women with hypertensive disorders (chronic hypertension, gestational hypertension, or pre-eclampsia) and normotensive women. Methods Women completed a questionnaire about habitual snoring and underwent overnight ambulatory polysomnography. Main Outcome Measures The presence and severity of obstructive sleep apnea. Results Obstructive sleep apnoea was found among 21 of 51 women with hypertensive disorders (41%), but in only three of 16 women who were normotensive (19%, chi-square test, P = 0.005). Non-snoring hypertensive women typically had mild obstructive sleep apnea but >25% of snoring hypertensive women had moderate-to-severe obstructive sleep apnea. Among the hypertensive women, the mean apnea/hypopnea index was substantially higher in snorers than non-snorers (19.9±34.1 vs. 3.4±3.1, p=0.013) and the oxyhemoglobin saturation nadir was significantly lower (86.4±6.6 vs. 90.2±3.5, p=0.021). Among hypertensive women, after stratification by obesity the pooled relative risk for obstructive sleep apnea in snoring women with hypertension compared to non-snoring hypertension was 2.0 [95%CI 1.4–2.8]. Conclusions Pregnant women with hypertension are at high risk for unrecognised obstructive sleep apnea. While longitudinal and intervention studies are urgently needed, it would seem pertinent given the known relationship between obstructive sleep apnea and hypertension in the general population, that hypertensive pregnant women who snore should be tested for obstructive sleep apnea, a condition believed to cause or promote hypertension. PMID:24888772

Natural History of Excessive Daytime Sleepiness: Role of Obesity, Weight Loss, Depression, and Sleep Propensity

PubMed Central

Fernandez-Mendoza, Julio; Vgontzas, Alexandros N.; Kritikou, Ilia; Calhoun, Susan L.; Liao, Duanping; Bixler, Edward O.

2015-01-01

Study Objectives: Excessive daytime sleepiness (EDS) is highly prevalent in the general population and is associated with occupational and public safety hazards. However, no study has examined the clinical and polysomnographic (PSG) predictors of the natural history of EDS. Design: Representative longitudinal study. Setting: Sleep laboratory. Participants: From a random, general population sample of 1,741 individuals of the Penn State Adult Cohort, 1,395 were followed up after 7.5 years. Measurements and Results: Full medical evaluation and 1-night PSG at baseline and standardized telephone interview at follow-up. The incidence of EDS was 8.2%, while its persistence and remission were 38% and 62%, respectively. Obesity and weight gain were associated with the incidence and persistence of EDS, while weight loss was associated with its remission. Significant interactions between depression and PSG parameters on incident EDS showed that, in depressed individuals, incident EDS was associated with sleep disturbances, while in non-depressed individuals, incident EDS was associated with increased physiologic sleep propensity. Diabetes, allergy/asthma, anemia, and sleep complaints also predicted the natural history of EDS. Conclusions: Obesity, a disorder of epidemic proportions, is a major risk factor for the incidence and chronicity of excessive daytime sleepiness (EDS), while weight loss is associated with its remission. Interestingly, objective sleep disturbances predict incident EDS in depressed individuals, whereas physiologic sleep propensity predicts incident EDS in those without depression. Weight management and treatment of depression and sleep disorders should be part of public health policies. Citation: Fernandez-Mendoza J, Vgontzas AN, Kritikou I, Calhoun SL, Liao D, Bixler EO. Natural history of excessive daytime sleepiness: role of obesity, weight loss, depression, and sleep propensity. SLEEP 2015;38(3):351–360. PMID:25581913

Effects of night work, sleep loss and time on task on simulated threat detection performance.

PubMed

Basner, Mathias; Rubinstein, Joshua; Fomberstein, Kenneth M; Coble, Matthew C; Ecker, Adrian; Avinash, Deepa; Dinges, David F

2008-09-01

To investigate the effects of night work and sleep loss on a simulated luggage screening task (SLST) that mimicked the x-ray system used by airport luggage screeners. We developed more than 5,800 unique simulated x-ray images of luggage organized into 31 stimulus sets of 200 bags each. 25% of each set contained either a gun or a knife with low or high target difficulty. The 200-bag stimuli sets were then run on software that simulates an x-ray screening system (SLST). Signal detection analysis was used to obtain measures of hit rate (HR), false alarm rate (FAR), threat detection accuracy (A'), and response bias (B"(D)). Experimental laboratory study 24 healthy nonprofessional volunteers (13 women, mean age +/- SD = 29.9 +/- 6.5 years). Subjects performed the SLST every 2 h during a 5-day period that included a 35 h period of wakefulness that extended to night work and then another day work period after the night without sleep. Threat detection accuracy A' decreased significantly (P < 0.001) while FAR increased significantly (P < 0.001) during night work, while both A' (P = 0.001) and HR decreased (P = 0.008) during day work following sleep loss. There were prominent time-on-task effects on response bias B"(D) (P= 0.002) and response latency (P = 0.004), but accuracy A' was unaffected. Both HR and FAR increased significantly with increasing study duration (both P < 0.001), while response latency decreased significantly (P <0.001). This study provides the first systematic evidence that night work and sleep loss adversely affect the accuracy of detecting complex real world objects among high levels of background clutter. If the results can be replicated in professional screeners and real work environments, fatigue in luggage screening personnel may pose a threat for air traffic safety unless countermeasures for fatigue are deployed.

The Effect of One Night's Sleep Deprivation on Adolescent Neurobehavioral Performance

PubMed Central

Louca, Mia; Short, Michelle A.

2014-01-01

Study Objectives: To investigate the effects of one night's sleep deprivation on neurobehavioral functioning in adolescents. Design: Participants completed a neurobehavioral test battery measuring sustained attention, reaction speed, cognitive processing speed, sleepiness, and fatigue every 2 h during wakefulness. Baseline performance (defined as those test bouts between 09:00 and 19:00 on days 2 and 3, following two 10-h sleep opportunities) were compared to performance at the same clock time the day following total sleep deprivation. Setting: The sleep laboratory at the Centre for Sleep Research. Participants: Twelve healthy adolescents (6 male), aged 14-18 years (mean = 16.17, standard deviation = 0.83). Measurements and Results: Sustained attention, reaction speed, cognitive processing speed, and subjective sleepiness were all significantly worse following one night without sleep than following 10-h sleep opportunities (all main effects of day, P < 0.05). Sleep deprivation led to increased variability on objective performance measures. There were between-subjects differences in response to sleep loss that were task-specific, suggesting that adolescents may not only vary in terms of the degree to which they are affected by sleep loss but also the domains in which they are affected. Conclusions: These findings suggest that one night of total sleep deprivation has significant deleterious effects upon neurobehavioral performance and subjective sleepiness. These factors impair daytime functioning in adolescents, leaving them at greater risk of poor academic and social functioning and accidents and injuries. Citation: Louca M, Short MA. The effect of one night's sleep deprivation on adolescent neurobehavioral performance. SLEEP 2014;37(11):1799-1807. PMID:25364075

Spontaneous Swallowing during All-Night Sleep in Patients with Parkinson Disease in Comparison with Healthy Control Subjects

PubMed Central

Uludag, Irem Fatma; Tiftikcioglu, Bedile Irem; Ertekin, Cumhur

2016-01-01

Study Objectives: Spontaneous saliva swallows (SS) appear especially during sleep. The rate of SS was rarely investigated in all-night sleep in patients with Parkinson disease (PD). Dysphagia is a frequent symptom in PD, but the rate of SS was never studied with an all-night sleep electroencephalogram (EEG). Methods: A total of 21 patients with PD and 18 age-matched healthy controls were included in the study. Frequencies of SS and coughing were studied in all-night sleep recordings of patients with PD and controls. During all-night sleep, video-EEG 12-channel recording was used including the electromyography (EMG) of the swallowing muscles, nasal airflow, and recording of vertical laryngeal movement using a pair of EEG electrodes over the thyroid cartilage. Results: The total number of SS was increased while the mean duration of sleep was decreased in PD when compared to controls. Sialorrhea and clinical dysphagia, assessed by proper questionnaires, had no effect in any patient group. The new finding was the so-called salvo type of consecutive SS in one set of swallowing. The amount of coughing was significantly increased just after the salvo SS. Conclusions: In PD, the rate of SS was not sufficient to demonstrate the swallowing disorder, such as oropharyngeal dysphagia, but the salvo type of SS was quite frequent. This is a novel finding and may contribute to the understanding of swallowing problems in patients with dysphagic or nondysphagic PD. Citation: Uludag IF, Tiftikcioglu BI, Ertekin C. Spontaneous swallowing during all-night sleep in patients with Parkinson disease in comparison with healthy control subjects. SLEEP 2016;39(4):847–854. PMID:26943467

Acute Sleep Deprivation Enhances Post-Infection Sleep and Promotes Survival during Bacterial Infection in Drosophila

PubMed Central

Kuo, Tzu-Hsing; Williams, Julie A.

2014-01-01

Study Objectives: Sleep is known to increase as an acute response to infection. However, the function of this behavioral response in host defense is not well understood. To address this problem, we evaluated the effect of acute sleep deprivation on post-infection sleep and immune function in Drosophila. Setting: Laboratory. Participants: Drosophila melanogaster. Methods and Results: Flies were subjected to sleep deprivation before (early DEP) or after (late DEP) bacterial infection. Relative to a non-deprived control, flies subjected to early DEP had enhanced sleep after infection as well as increased bacterial clearance and survival outcome. Flies subjected to late DEP experienced enhanced sleep following the deprivation period, and showed a modest improvement in survival outcome. Continuous DEP (early and late DEP) throughout infection also enhanced sleep later during infection and improved survival. However, improved survival in flies subjected to late or continuous DEP did not occur until after flies had experienced sleep. During infection, both early and late DEP enhanced NFκB transcriptional activity as measured by a luciferase reporter (κB-luc) in living flies. Early DEP also increased NFκB activity prior to infection. Flies that were deficient in expression of either the Relish or Dif NFκB transcription factors showed normal responses to early DEP. However, the effect of early DEP on post-infection sleep and survival was abolished in double mutants, which indicates that Relish and Dif have redundant roles in this process. Conclusions: Acute sleep deprivation elevated NFκB-dependent activity, increased post-infection sleep, and improved survival during bacterial infection. Citation: Kuo TH, Williams JA. Acute sleep deprivation enhances post-infection sleep and promotes survival during bacterial infection in Drosophila. SLEEP 2014;37(5):859-869. PMID:24790264

A novel BHLHE41 variant is associated with short sleep and resistance to sleep deprivation in humans.

PubMed

Pellegrino, Renata; Kavakli, Ibrahim Halil; Goel, Namni; Cardinale, Christopher J; Dinges, David F; Kuna, Samuel T; Maislin, Greg; Van Dongen, Hans P A; Tufik, Sergio; Hogenesch, John B; Hakonarson, Hakon; Pack, Allan I

2014-08-01

Earlier work described a mutation in DEC2 also known as BHLHE41 (basic helix-loophelix family member e41) as causal in a family of short sleepers, who needed just 6 h sleep per night. We evaluated whether there were other variants of this gene in two well-phenotyped cohorts. Sequencing of the BHLHE41 gene, electroencephalographic data, and delta power analysis and functional studies using cell-based luciferase. We identified new variants of the BHLHE41 gene in two cohorts who had either acute sleep deprivation (n = 200) or chronic partial sleep deprivation (n = 217). One variant, Y362H, at another location in the same exon occurred in one twin in a dizygotic twin pair and was associated with reduced sleep duration, less recovery sleep following sleep deprivation, and fewer performance lapses during sleep deprivation than the homozygous twin. Both twins had almost identical amounts of non rapid eye movement (NREM) sleep. This variant reduced the ability of BHLHE41 to suppress CLOCK/BMAL1 and NPAS2/BMAL1 transactivation in vitro. Another variant in the same exome had no effect on sleep or response to sleep deprivation and no effect on CLOCK/BMAL1 transactivation. Random mutagenesis identified a number of other variants of BHLHE41 that affect its function. There are a number of mutations of BHLHE41. Mutations reduce total sleep while maintaining NREM sleep and provide resistance to the effects of sleep loss. Mutations that affect sleep also modify the normal inhibition of BHLHE41 of CLOCK/BMAL1 transactivation. Thus, clock mechanisms are likely involved in setting sleep length and the magnitude of sleep homeostasis. Pellegrino R, Kavakli IH, Goel N, Cardinale CJ, Dinges DF, Kuna ST, Maislin G, Van Dongen HP, Tufik S, Hogenesch JB, Hakonarson H, Pack AI. A novel BHLHE41 variant is associated with short sleep and resistance to sleep deprivation in humans. SLEEP 2014;37(8):1327-1336.

Repetitive Traumatic Brain Injury (or Concussion) Increases Severity of Sleep Disturbance among Deployed Military Personnel

PubMed Central

Bryan, Craig J.

2013-01-01

Study Objectives: Considerable research indicates that sleep disturbances and insomnia are more common and severe among individuals following a traumatic brain injury (TBI). It remains unclear, however, how the experience of multiple TBIs affect sleep disturbances and insomnia. The current study investigated the incidence and severity of insomnia and sleep complaints among active-duty military personnel who have sustained multiple TBIs. Design and Setting: Upon intake at a military TBI clinic located in Iraq, 150 male military patients completed standardized self-report measures and clinical interviews. Measurements and Results: Patients were categorized into three groups according to history of TBI: zero TBIs (n = 18), single TBI (n = 54), multiple TBIs (n = 78). Rates of clinical insomnia significantly increased across TBI groups (P < 0.001):- 5.6% for no TBIs, 20.4% for single TBI, and 50.0% for multiple TBIs. Insomnia severity significantly increased across TBI groups even when controlling for depression, posttraumatic stress disorder, and concussion symptom severity (B = 1.134, standard error = 0.577, P = 0.049). Conclusions: Multiple TBIs are associated with increased risk for and severity of sleep disturbance among male military personnel. Citation: Bryan CJ. Repetitive traumatic brain injury (or concussion) increases severity of sleep disturbance among deployed military personnel. SLEEP 2013;36(6):941-946. PMID:23729938

Daily Variations in Objective Nighttime Sleep and Subjective Morning Pain in Older Adults with Insomnia: Evidence of Covariation Over Time

PubMed Central

Dzierzewski, Joseph M.; Williams, Jacob M.; Roditi, Daniela; Marsiske, Michael; McCoy, Karin; McNamara, Joseph; Dautovich, Natalie; Robinson, Michael E.; McCrae, Christina S.

2010-01-01

Objectives To examine the relationship between objectively measured nocturnal sleep and subjective report of morning pain in older adults with insomnia. The goal of the paper was to not only examine the sleep-pain association between-persons (mean-level over 14 days), but also to investigate the within-person, day-to-day association. Design Cross-sectional. Setting North-Central Florida. Participants Fifty community-dwelling older adults (Mage = 69.10 years, SDage = 7.02 years, range = 60 – 90 years) with insomnia participated in the study. Measurements This study employed daily home-based assessment utilizing nightly actigraphic measurement of sleep and daily self-report of pain. Measures were completed over fourteen consecutive days. Results Between persons, average sleep over 14 days was not associated with average levels of rated pain. However, following a night in which an older adult with insomnia experienced above-average total sleep time s/he subsequently reported below-average pain ratings. The model explained approximately 24% of the within-person and 8% of the between-person variance in pain ratings. Conclusions Sleep and pain show day-to-day associations (i.e., covary over time) in older adults with insomnia. Such associations may suggest that common physiological systems underlie both the experience of insomnia and pain. Future research should examine the crossover effects of sleep treatment on pain and of pain treatment on sleep. PMID:20406316

Insufficient Sleep and Suicidality in Adolescents

PubMed Central

Lee, Yu Jin; Cho, Seong-Jin; Cho, In Hee; Kim, Seog Ju

2012-01-01

Study Objectives: To investigate the association between the behaviorally induced insufficient sleep and suicidality among adolescents. Design: A population-based, cross-sectional survey. Setting: General community. Participants: A sample of 8,530 students (grades 7-11) was recruited in the Republic of Korea. The participants were 8,010 students who completed all questionnaires. Intervention: N/A. Measurements: The survey included the Beck Scale for Suicidal Ideation (SSI), the Beck Depression Inventory (BDI), a modified Epworth Sleepiness Scale (ESS), and questionnaires about sleep (weekday/weekend sleep schedule/duration, insomnia and snoring). Results: Adolescents with behaviorally induced insufficient sleep syndrome (BISS) had higher SSI scores than those who slept ≥ 7 hours on weekdays, even after controlling for age, sex, and BDI score (F = 11.71, P < 0.001). After controlling for age and sex, longer weekend oversleep and shorter weekday sleep duration predicted a higher SSI score (β = 0.19, P < 0.001; β = 0.37, P < 0.001). The association between weekend oversleep and SSI score remained significant even after additionally controlling for BDI and ESS scores and presence of insomnia and snoring (β = 0.07, P < 0.01). Conclusion: BISS was found to be associated with increased suicidality. Weekend oversleep was associated with suicidality independently of depression, daytime sleepiness, snoring, and insomnia. The study findings suggest that chronic sleep restriction among adolescents may increase suicidal risk. Citation: Lee YJ; Cho SJ; Cho IH; Kim SJ. Insufficient sleep and suicidality in adolescents. SLEEP 2012;35(4):455-460. PMID:22467982

Duration of sleep inertia after napping during simulated night work and in extended operations.

PubMed

Signal, Tracey Leigh; van den Berg, Margo J; Mulrine, Hannah M; Gander, Philippa H

2012-07-01

Due to the mixed findings of previous studies, it is still difficult to provide guidance on how to best manage sleep inertia after waking from naps in operational settings. One of the few factors that can be manipulated is the duration of the nap opportunity. The aim of the present study was to investigate the magnitude and time course of sleep inertia after waking from short (20-, 40- or 60-min) naps during simulated night work and extended operations. In addition, the effect of sleep stage on awakening and duration of slow wave sleep (SWS) on sleep inertia was assessed. Two within-subject protocols were conducted in a controlled laboratory setting. Twenty-four healthy young men (Protocol 1: n = 12, mean age = 25.1 yrs; Protocol 2: n = 12, mean age = 23.2 yrs) were provided with nap opportunities of 20-, 40-, and 60-min (and a control condition of no nap) ending at 02:00 h after ∼20 h of wakefulness (Protocol 1 [P1]: simulated night work) or ending at 12:00 h after ∼30 h of wakefulness (Protocol 2 [P2]: simulated extended operations). A 6-min test battery, including the Karolinska Sleepiness Scale (KSS) and the 4-min 2-Back Working Memory Task (WMT), was repeated every 15 min the first hour after waking. Nap sleep was recorded polysomnographically, and in all nap opportunities sleep onset latency was short and sleep efficiency high. Mixed-model analyses of variance (ANOVA) for repeated measures were calculated and included the factors time (time post-nap), nap opportunity (duration of nap provided), order (order in which the four protocols were completed), and the interaction of these terms. Results showed no test x nap opportunity effect (i.e., no effect of sleep inertia) on KSS. However, WMT performance was impaired (slower reaction time, fewer correct responses, and increased omissions) on the first test post-nap, primarily after a 40- or 60-min nap. In P2 only, performance improvement was evident 45 min post-awakening for naps of 40 min or more. In ANOVAs where sleep stage on awakening was included, the test x nap opportunity interaction was significant, but differences were between wake and non-REM Stage 1/Stage 2 or wake and SWS. A further series of ANOVAs showed no effect of the duration of SWS on sleep inertia. The results of this study demonstrate that no more than 15 min is required for performance decrements due to sleep inertia to dissipate after nap opportunities of 60 min or less, but subjective sleepiness is not a reliable indicator of this effect. Under conditions where sleep is short, these findings also suggest that SWS, per se, does not contribute to more severe sleep inertia. When wakefulness is extended and napping occurs at midday (i.e., P2), nap opportunities of 40- and 60-min have the advantage over shorter duration sleep periods, as they result in performance benefits ∼45 min after waking.

Short and Long Sleep Duration Associated with Race/Ethnicity, Sociodemographics, and Socioeconomic Position

PubMed Central

Whinnery, Julia; Jackson, Nicholas; Rattanaumpawan, Pinyo; Grandner, Michael A.

2014-01-01

Study Objectives: Short and/or long sleep duration are associated with cardiometabolic disease risk and may be differentially experienced among minorities and the socioeconomically disadvantaged. The present study examined nationally representative data along multiple dimensions of race/ ethnicity and socioeconomic status. Design: Cross-sectional. Setting: Survey. Patients or Participants: 2007-2008 NHANES (N = 4,850). Interventions: None. Measurements and Results: Self-reported sleep duration was classified as very short (< 5 h), short (5-6 h), normative (7-8 h) and long (≥ 9 h). Population-weighted multinomial logistic regression analyses examined race/ ethnicity, country of origin, language, income, education, health insurance, and food security, controlling for all others as well as age, sex, marital-status, and overall self-rated health. Outcome was self-reported sleep duration, relative to normative sleep duration. Blacks/African Americans were more likely than whites to report very short (OR = 2.34, P < 0.001) and short (OR = 1.85, P < 0.001) sleep. Mexican Americans reported less long sleep (OR = 0.36, P = 0.032). Other Hispanics/ Latinos reported more very short sleep (OR = 2.69, P = 0.025). Asians/ Others reported more very short (OR = 3.99, P = 0.002) and short (OR = 2.08, P = 0.002) sleep. Mexico-born adults reported less short sleep (OR = 0.63, P = 0.042). Spanish-only speakers reported less very short sleep (OR = 0.32, P = 0.030). Lower income groups reported more very short sleep versus > $75,000. Compared to college graduates, increased very short sleep was seen among all lower education levels. Those with public insurance reported more very short (OR = 1.67, P = 0.31) and long (OR = 1.83, P = 0.011) sleep versus uninsured. Very low food security was associated with very short (OR = 1.86, P = 0.036) and short (OR = 1.44, P = 0.047) sleep. Conclusions: Minority status and lower socioeconomic position were associated with shorter self-reported sleep durations. Citation: Whinnery J; Jackson N; Rattanaumpawan P; Grandner MA. Short and long sleep duration associated with race/ethnicity, sociodemographics, and socioeconomic position. SLEEP 2014;37(3):601-611. PMID:24587584

Behavioral Profiles Associated with Objective Sleep Duration in Young Children with Insomnia Symptoms.

PubMed

Calhoun, Susan L; Fernandez-Mendoza, Julio; Vgontzas, Alexandros N; Mayes, Susan D; Liao, Duanping; Bixler, Edward O

2017-02-01

Based on previous studies reporting on the association of objective sleep duration and physiologic changes (i.e., increased cortisol) in children, we examined the role of objective sleep duration on differentiating behavioral profiles in children with insomnia symptoms. Seven hundred children (ages 5-12, 47.8% male) from the Penn State Child Cohort underwent a nine-hour polysomnography and parent completed Pediatric Behavior Scale. Insomnia symptoms were defined as parent report of difficulty falling and/or staying asleep, sleep disordered breathing as an AHI of ≥1, and objective short sleep duration as a total sleep time < 7.7 h. Children with insomnia symptoms demonstrated more overall behavioral problems than controls. Significant interactions between insomnia symptoms and objective sleep duration on scores of externalizing behaviors, mood variability and school problems were found. Profile analyses showed that children with insomnia symptoms and normal sleep duration were associated with clinically elevated externalizing behaviors, inattention, mood variability, and school problems, while children with insomnia and short sleep duration were associated with an overall elevated profile in which internalizing behaviors were more prominent. Childhood insomnia symptoms are associated with a wide array of behavioral problems, for which objective sleep duration is useful in differentiating behavioral profiles. Children with insomnia symptoms and normal sleep duration had a behavioral profile consistent with limit-setting and rule-breaking behaviors, while children with insomnia symptoms and short sleep duration had a behavioral profile more consistent with internalizing behaviors resembling that of psychophysiological disorders.

Individually tailored light intervention through closed eyelids to promote circadian alignment and sleep health

PubMed Central

Figueiro, Mariana G.

2016-01-01

Background Light is most effective at changing the timing of the circadian clock when applied close to the core body temperature minimum. The present study investigated, in a home setting, if individually tailored light treatment using flashing blue light delivered through closed eyelids during the early part of the sleep period delayed circadian phase and sleep in a population of healthy older adults and in those suffering from early awakening insomnia. Methods Twenty-eight participants (9 early awakening insomniacs) completed an 8-week, within-subjects study. Twice, participants collected data during two baseline weeks and one intervention week. During the intervention week, participants wore a flashing blue (active) or a flashing red (control) light mask during sleep. Light was expected to delay circadian phase. Saliva samples for dim light melatonin onset (DLMO) were collected at the end of each baseline and intervention week. Wrist actigraphy and Daysimeter, a calibrated light and activity meter, data were collected during the entire study. Results Compared to baseline, flashing blue light, but not flashing red light, significantly (p<0.05) delayed DLMO. The mean ± standard deviation phase shift (minutes) was 0:06 ± 0:30 for the flashing red light and 0:34 ± 0:30 for the flashing blue light. Compared to Day 1, sleep start times were significantly delayed (by approximately 46 minutes) at Day 7 after the flashing blue light. The light intervention did not affect sleep efficiency. Conclusions The present study demonstrated the feasibility of using light through closed eyelids during sleep for promoting circadian alignment and sleep health. PMID:26985450

Characterization of Sleep in Aplysia californica

PubMed Central

Vorster, Albrecht P.A.; Krishnan, Harini C.; Cirelli, Chiara; Lyons, Lisa C.

2014-01-01

Study Objective: To characterize sleep in the marine mollusk, Aplysia californica. Design: Animal behavior and activity were assessed using video recordings to measure activity, resting posture, resting place preference, and behavior after rest deprivation. Latencies for behavioral responses were measured for appetitive and aversive stimuli for animals in the wake and rest states. Setting: Circadian research laboratory for Aplysia. Patients or Participants: A. californica from the Pacific Ocean. Interventions: N/A. Measurements and Results: Aplysia rest almost exclusively during the night in a semi-contracted body position with preferential resting locations in the upper corners of their tank. Resting animals demonstrate longer latencies in head orientation and biting in response to a seaweed stimulus and less frequent escape response steps following an aversive salt stimulus applied to the tail compared to awake animals at the same time point. Aplysia exhibit rebound rest the day following rest deprivation during the night, but not after similar handling stimulation during the day. Conclusions: Resting behavior in Aplysia fulfills all invertebrate characteristics of sleep including: (1) a specific sleep body posture, (2) preferred resting location, (3) reversible behavioral quiescence, (4) elevated arousal thresholds for sensory stimuli during sleep, and (5) compensatory sleep rebound after sleep deprivation. Citation: Vorster AP, Krishnan HC, Cirelli C, Lyons LC. Characterization of sleep in Aplysia californica. SLEEP 2014;37(9):1453-1463. PMID:25142567

Aging Effects on Cardiac and Respiratory Dynamics in Healthy Subjects across Sleep Stages

PubMed Central

Schumann, Aicko Y.; Bartsch, Ronny P.; Penzel, Thomas; Ivanov, Plamen Ch.; Kantelhardt, Jan W.

2010-01-01

Study Objectives: Respiratory and heart rate variability exhibit fractal scaling behavior on certain time scales. We studied the short-term and long-term correlation properties of heartbeat and breathing-interval data from disease-free subjects focusing on the age-dependent fractal organization. We also studied differences across sleep stages and night-time wake and investigated quasi-periodic variations associated with cardiac risk. Design: Full-night polysomnograms were recorded during 2 nights, including electrocardiogram and oronasal airflow. Setting: Data were collected in 7 laboratories in 5 European countries. Participants: 180 subjects without health complaints (85 males, 95 females) aged from 20 to 89 years. Interventions: None. Measurements and Results: Short-term correlations in heartbeat intervals measured by the detrended fluctuation analysis (DFA) exponent α1 show characteristic age dependence with a maximum around 50–60 years disregarding the dependence on sleep and wake states. Long-term correlations measured by α2 differ in NREM sleep when compared with REM sleep and wake, besides weak age dependence. Results for respiratory intervals are similar to those for α2 of heartbeat intervals. Deceleration capacity (DC) decreases with age; it is lower during REM and deep sleep (compared with light sleep and wake). Conclusion: The age dependence of α1 should be considered when using this value for diagnostic purposes in post-infarction patients. Pronounced long-term correlations (larger α2) for heartbeat and respiration during REM sleep and wake indicate an enhanced control of higher brain regions, which is absent during NREM sleep. Reduced DC possibly indicates an increased cardiovascular risk with aging and during REM and deep sleep. Citation: Schumann AY; Bartsch RP; Penzel T; Ivanov PC; Kantelhardt JW. Aging effects on cardiac and respiratory dynamics in healthy subjects across sleep stages. SLEEP 2010;33(7):943-955. PMID:20614854

Association between elder abuse and poor sleep: A cross-sectional study among rural older Malaysians

PubMed Central

Hairi, Noran N.; Choo, Wan Yuen; Hairi, Farizah M.; Sooryanarayana, Rajini; Ahmad, Sharifah N.; Razak, Inayah A.; Peramalah, Devi; Aziz, Suriyati A.; Mohamad, Zaiton L.; Mohamad, Rosmala; Ali, Zainudin M.; Awang Mahmud, Awang B.

2017-01-01

Objectives To examine the association between elder abuse and poor sleep using a Malay validated version of Pittsburgh Sleep Quality Index (PSQI). Design This study was divided into two phases. Phase I tested the construct validity and reliability of the Malay version of PSQI. Phase II was a population-based, cross-sectional study with a multi-stage cluster sampling method. Home-based interviews were conducted by trained personnel using a structured questionnaire, to determine exposure and outcome. Setting Kuala Pilah, a district in Negeri Sembilan which is one of the fourteen states in Malaysia. Participants 1648 community-dwelling older Malaysians. Results The Malay version of PSQI had significant test re-test reliability with intra-class correlation coefficients of 0.62. Confirmatory factor analyses revealed that one factor PSQI scale with three components (subjective sleep quality, sleep latency, and sleep disturbances) was most suitable. Cronbach’s Alpha was 0.60 and composite reliability was 0.63. PSQI scores were highest among neglect (4.11), followed by physical (4.10), psychological (3.96) and financial abuse (3.60). There was a dose-response relationship between clustering of abuse and PSQI scores; 3.41, 3.50 and 3.84 for “no abuse”, “1 type of abuse” and “2 types or more”. Generalized linear models revealed six variables as significant determinants of sleep quality–abuse, co-morbidities, self-rated health, income, social support and gait speed. Among abuse subtypes, only neglect was significantly associated with poor sleep. Conclusion The Malay PSQI was valid and reliable. Abuse was significantly associated with poor sleep. As sleep is essential for health and is a good predictor for mortality among older adults, management of abuse victims should entail sleep assessment. Interventions or treatment modalities which focus on improving sleep quality among abuse victims should be designed. PMID:28686603

Patterns and Predictors of Sleep Quality Before, During, and After Hospitalization in Older Adults

PubMed Central

Dzierzewski, Joseph M.; Mitchell, Michael; Rodriguez, Juan Carlos; Fung, Constance H.; Jouldjian, Stella; Alessi, Cathy A.; Martin, Jennifer L.

2015-01-01

Study Objectives: The impact of hospitalization on sleep in late-life is underexplored. The current study examined patterns of sleep quality before, during, and following hospitalization, investigated predictors of sleep quality patterns, and examined predictors of classification discordance between two suggested clinical cutoffs used to demarcate poor/good sleep. Methods: This study included older adults (n = 163; mean age 79.7 ± 6.9 years, 31% female) undergoing inpatient post-acute rehabilitation. Upon admission to inpatient post-acute rehabilitation, patients completed the Pittsburgh Sleep Quality Index (PSQI) retrospectively regarding their sleep prior to hospitalization. They subsequently completed the PSQI at discharge, and 3 months, 6 months, 9 months, and 1 year post discharge. Patient demographic and clinical characteristics (pain, depression, cognition, comorbidity) were collected upon admission. Results: Using latent class analysis methods, older adults could be classified into (1) Consistently Good Sleepers and (2) Chronically Poor Sleepers based on patterns of self-reported sleep quality pre-illness, during, and up to 1 year following inpatient rehabilitation. This pattern was maintained regardless of the clinical cutoff employed (> 5 or > 8). Logistic regression analyses indicated that higher pain and depressive symptoms were consistently associated with an increased likelihood of being classified as a chronic poor sleeper. While there was substantial classification discordance based on clinical cutoff employed, no significant predictors of this discordance emerged. Conclusions: Clinicians should exercise caution in assessing sleep quality in inpatient settings. Alterations in the cutoffs employed may result in discordant clinical classifications of older adults. Pain and depression warrant detailed considerations when working with older adults on inpatient units when poor sleep is a concern. Citation: Dzierzewski JM, Mitchell M, Rodriguez JC, Fung CH, Jouldjian S, Alessi CA, Martin JL. Patterns and predictors of sleep quality before, during, and after hospitalization in older adults. J Clin Sleep Med 2015;11(1):45–51. PMID:25325580

A brief tool to differentiate factors contributing to insomnia complaints.

PubMed

Townsend, Donald; Kazaglis, Louis; Savik, Kay; Smerud, Adam; Iber, Conrad

2017-03-01

A complaint of insomnia may have many causes. A brief tool examining contributing factors may be useful for nonsleep specialists. This study describes the development of the Insomnia Symptoms Assessment (ISA) for examining insomnia complaints. ISA questions were designed to identify symptoms that may represent 1 of 8 possible factors contributing to insomnia symptoms, including delayed sleep phase syndrome (DSPS), shift work sleep disorder (SWSD), obstructive sleep apnea (OSA), mental health, chronic pain, restless leg syndrome (RLS), poor sleep hygiene, and psychophysiological insomnia (PI). The ISA was completed by 346 new patients. Patients met with a sleep specialist who determined primary and secondary diagnoses. Mean age was 45 (18-85) years and 51% were male. Exploratory factor analysis (n = 217) and confirmatory factor analysis (n = 129) supported 5 factors with good internal consistency (Cronbach's alpha), including RLS (.72), OSA (.60), SWSD (.67), DSPS (.64), and PI (.80). Thirty percent had 1 sleep diagnosis with a mean of 2.2 diagnoses per patient. No diagnosis was entered for 1.2% of patients. The receiver operating characteristics were examined and the area under the curves calculated as an indication of convergent validity for the primary diagnosis (N = 346) were .97 for SWSD, .78 for OSA, .67 for DSPS, .54 for PI, and .80 for RLS. The ISA demonstrated good internal consistency and corresponds well to expert diagnoses. Next steps include setting sensitivity/specificity cutoffs to suggest initial treatment recommendations for use in other settings. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A Pilot Study to Assess a Teaching Intervention to Improve Sleep-Wake Disturbances in Parents of Children Diagnosed With Epilepsy.

PubMed

Ledet, Davonna; Aplin-Kalisz, Christina; Filter, Marilyn; Dycus, Paula

2016-02-01

The aim of this study was to assess the impact of screening and teaching interventions for sleep-wake disturbances in parents of childhood patients with epilepsy. This was a prospective, descriptive study using convenience sampling. After informed consent was obtained from eligible parents who agreed to participate, study questionnaires were administered. All parents were provided with an individualized teaching intervention. Study tools were readministered 8-12 weeks later to evaluate if the individualized teaching intervention altered or improved sleep-wake disturbances. The t value for the paired t test of the Epworth Sleepiness Scale prescore and postscore was 0.000 with a two-tailed probability value of 1.000, and the t value for the paired t test of the Pittsburgh Sleep Quality Index prescore and postscore was 0.713 with a two-tailed probability value of .492, indicating no significant difference between pre and post Epworth Sleepiness Scale or Pittsburgh Sleep Quality Index scores. A sleep hygiene teaching intervention for parents of children with epilepsy was not effective in this setting of an inner-city epilepsy monitoring unit in changing postintervention scores on measures of both nighttime sleep quality and daytime sleepiness. These results must be interpreted with caution secondary to the small number included in the initial phase of this study. A larger number of participants will be needed to verify these findings. If the results remain consistent with a larger number, studies evaluating variables of cause may be helpful to determine more effective interventions.

Does recall after sleep-dependent memory consolidation reinstate sensitivity to retroactive interference?

PubMed

Deliens, Gaétane; Schmitz, Rémy; Caudron, Isaline; Mary, Alison; Leproult, Rachel; Peigneux, Philippe

2013-01-01

Previous studies have shown that newly encoded memories are more resistant to retroactive interference when participants are allowed to sleep after learning the original material, suggesting a sleep-related strengthening of memories. In the present study, we investigated delayed, long-term effects of sleep vs. sleep deprivation (SD) on the first post-training night on memory consolidation and resistance to interference. On day 1, participants learned a list of unrelated word pairs (AB), either in the morning or in the evening, then spent the post-training night in a sleep or sleep deprivation condition, in a within-subject paradigm. On day 4, at the same time of day, they learned a novel list of word pairs (AC) in which 50% of the word pairs stemmed with the same word than in the AB list, resulting in retroactive interference. Participants had then to recall items from the AB list upon presentation of the "A" stem. Recall was marginally improved in the evening, as compared to the morning learning group. Most importantly, retroactive interference effects were found in the sleep evening group only, contrary to the hypothesis that sleep exerts a protective role against intrusion by novel but similar learning. We tentatively suggest that these results can be explained in the framework of the memory reconsolidation theory, stating that exposure to similar information sets back consolidated items in a labile form again sensitive to retroactive interference. In this context, sleep might not protect against interference but would promote an update of existing episodic memories while preventing saturation of the memory network due to the accumulation of dual traces.

The Impact of Partial Sleep Deprivation on Moral Reasoning in Military Officers

PubMed Central

Olsen, Olav Kjellevold; Pallesen, Ståle; Eid, Jarle

2010-01-01

Study Objectives: The present study explores the impact of long-term partial sleep deprivation on the activation of moral justice schemas, which are suggested to play a prominent role in moral reasoning and the formation of moral judgments and behavior. Design: Participants judged 5 dilemmas in rested and partially sleep deprived condition, in a counterbalanced design. Setting: In classroom and field exercises at the Norwegian Naval Academy and the Norwegian Army Academy. Participants: Seventy-one Norwegian naval and army officer cadets. Measurements and Results: The results showed that the officers' ability to conduct mature and principally oriented moral reasoning was severely impaired during partial sleep deprivation compared to the rested state. At the same time, the officers became substantially more rules-oriented in the sleep deprived condition, while self-oriented moral reasoning did not change. Interaction effects showed that those officers who displayed high levels of mature moral reasoning (n = 24) in the rested condition, lost much of this capacity during sleep deprivation in favor of a strong increase in rules-oriented moral reasoning as well as self-orientation. Conversely, officers at low levels of mature moral reasoning in rested condition (n = 23) were unaffected by sleep deprivation. Conclusions: The present data show that long-term partial sleep deprivation has an impact on the activation of moral justice schemas, and consequently on the ability to make moral justice judgments. Citation: Olsen OK; Pallesen S; Eid J. The impact of partial sleep deprivation on moral reasoning in military officers. SLEEP 2010;33(8):1086-1090. PMID:20815191

Sleep EEG Provides Evidence that Cortical Changes Persist into Late Adolescence

PubMed Central

Tarokh, Leila; Van Reen, Eliza; LeBourgeois, Monique; Seifer, Ronald; Carskadon, Mary A.

2011-01-01

Study Objectives: To examine developmental changes in the human sleep electroencephalogram (EEG) during late adolescence. Setting: A 4-bed sleep laboratory. Participants: Fourteen adolescents (5 boys) were studied at ages 15 or 16 (initial) and again at ages 17 to 19 (follow-up). Interventions: N/A Measurements and Results: All-night polysomnography was recorded at each assessment and scored according to the criteria of Rechtschaffen and Kales. A 27% decline in duration of slow wave sleep, and a 22% increase of stage 2 sleep was observed from the initial to the follow-up session. All-night spectral analysis of 2 central and 2 occipital leads revealed a significant decline of NREM and REM sleep EEG power with increasing age across frequencies in both states. Time-frequency analysis revealed that the decline in power was consistent across the night for all bands except the delta band. The decreases in power were most pronounced over the left central (C3/A2) and right occipital (O2/A1) derivations. Conclusions: Using longitudinal data, we show that the developmental changes to the sleeping EEG that begin in early adolescence continue into late adolescence. As with early adolescents, we observed hemispheric asymmetry in the decline of sleep EEG power. This decline was state and frequency nonspecific, suggesting that it may be due to the pruning of synapses known to occur during adolescence. Citation: Tarokh L; Van Reen E; LeBourgeois M; Seifer R; Carskadon MA. Sleep EEG provides evidence that cortical changes persist into late adolescence. SLEEP 2011;34(10):1385–1393. PMID:21966070

Very early screening for sleep-disordered breathing in acute coronary syndrome in patients without acute heart failure.

PubMed

Van den Broecke, Sandra; Jobard, Olivier; Montalescot, Gilles; Bruyneel, Marie; Ninane, Vincent; Arnulf, Isabelle; Similowski, Thomas; Attali, Valérie

2014-12-01

Obstructive sleep apnea (OSA) is frequently associated with acute coronary syndrome (ACS). Screening of sleep-disordered breathing (SDB) has not been previously evaluated in ACS within 72 h in intensive care settings and its management could potentially enhance patients' prognosis. This pilot study assessed the feasibility of SDB screening at the early phase of ACS. All consecutive patients admitted to the coronary care unit (CCU) for ACS without acute heart failure underwent one overnight-attended polysomnography (PSG) within 72 h after admission. A telemonitoring (TM) system was set up to remotely monitor the signals and repair faulty sensors. The 27 recordings were analyzed as respiratory polygraphy (RP) and as PSG, and the results were compared. The TM system allowed successful intervention in 48% of recordings, resulting in excellent quality PSG for 89% of cases. The prevalence of SDB [apnea-hypopnea index (AHI) ≥ 15/h] was 82% and mainly consisted of central SDB and periodic breathing, except three patients with OSA. Compared with PSG, RP underestimated AHI, probably due to the poor sleep efficiency, reduction of slow-wave sleep, and alteration of rapid eye movement sleep. An early SDB screening by remote-attended PSG is feasible in ACS patients shortly after admission to CCU. The TM enhanced the quality of PSG. A high prevalence of central SDB was noticed, for which the etiology remains unknown. Further large-scale studies are needed to determine whether central SDB is an incidental finding in early ACS and whether the presence and severity of SDB have a prognostic impact. Copyright © 2014 Elsevier B.V. All rights reserved.

Scalable Passive Sleep Monitoring Using Mobile Phones: Opportunities and Obstacles.

PubMed

Saeb, Sohrab; Cybulski, Thaddeus R; Schueller, Stephen M; Kording, Konrad P; Mohr, David C

2017-04-18

Sleep is a critical aspect of people's well-being and as such assessing sleep is an important indicator of a person's health. Traditional methods of sleep assessment are either time- and resource-intensive or suffer from self-reporting biases. Recently, researchers have started to use mobile phones to passively assess sleep in individuals' daily lives. However, this work remains in its early stages, having only examined relatively small and homogeneous populations in carefully controlled contexts. Thus, it remains an open question as to how well mobile device-based sleep monitoring generalizes to larger populations in typical use cases. The aim of this study was to assess the ability of machine learning algorithms to detect the sleep start and end times for the main sleep period in a 24-h cycle using mobile devices in a diverse sample. We collected mobile phone sensor data as well as daily self-reported sleep start and end times from 208 individuals (171 females; 37 males), diverse in age (18-66 years; mean 39.3), education, and employment status, across the United States over 6 weeks. Sensor data consisted of geographic location, motion, light, sound, and in-phone activities. No specific instructions were given to the participants regarding phone placement. We used random forest classifiers to develop both personalized and global predictors of sleep state from the phone sensor data. Using all available sensor features, the average accuracy of classifying whether a 10-min segment was reported as sleep was 88.8%. This is somewhat better than using the time of day alone, which gives an average accuracy of 86.9%. The accuracy of the model considerably varied across the participants, ranging from 65.1% to 97.3%. We found that low accuracy in some participants was due to two main factors: missing sensor data and misreports. After correcting for these, the average accuracy increased to 91.8%, corresponding to an average median absolute deviation (MAD) of 38 min for sleep start time detection and 36 min for sleep end time. These numbers are close to the range reported by previous research in more controlled situations. We find that mobile phones provide adequate sleep monitoring in typical use cases, and that our methods generalize well to a broader population than has previously been studied. However, we also observe several types of data artifacts when collecting data in uncontrolled settings. Some of these can be resolved through corrections, but others likely impose a ceiling on the accuracy of sleep prediction for certain subjects. Future research will need to focus more on the understanding of people's behavior in their natural settings in order to develop sleep monitoring tools that work reliably in all cases for all people. ©Sohrab Saeb, Thaddeus R Cybulski, Konrad P Kording, David C Mohr. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 18.04.2017.

[Non-face-to-face sleep improvement program in a workplace: bibliotherapy with and without behavioral self-control procedure].

PubMed

Adachi, Yoshiko; Kunitsuka, Kouko; Taniyama, Katsuko; Hayashi, Chikako; Tanaka, Minori; Sato, Chifumi

2010-01-01

Sleep hygiene education has been important health issue in the health promotion and the prevention of lifestyle-related diseases. A feasible and effective method is necessary for population approach. To evaluate the effects of a non-face-to-face brief behavioral program for a sleep improvement in workplaces. Research design was a cluster control trial. Three hundred and thirty participants were allocated to the bibliotherapy group (BTG; n=130) or self-control group (SCG; n=200). Two groups were recruited from separated local sections of a Japanese company each other. There was no eligibility criteria and the intervention was open to every worker in the workplaces. All participants received a self-help booklet and information on recent topics of insomnia-related health problems. SCG participants set several behaviors for habit improvement and monitored those behaviors for 4 wk additionally. The replies to the questionnaire showed that almost all of them had any sleep disturbances. A total of 158 participants in SCG (79%) and a total of 106 participants in BTG (82%) responded to the post questionnaire. Sleep parameters of pre and post questionnaires were compared between SCG and BTG. Overall, sleep onset latency was reduced and sleep efficiency was improved. The significant changes were found in only SCG. Re-analysis of pre and post 3-days' sleep diaries showed that the subjects in both group improved significantly in the main variables (total sleep time, number of awakenings, time spent awake, sleep efficiency). Sleep onset latency, wake after sleep onset, and daytime sleepiness improved significantly in only SCG. These results suggest that an additional target setting and self-monitoring could promote the effectiveness for sleep improvement of a bibliotherapy.

Sleep and morningness-eveningness in the 'middle' years of life (20-59 y)

NASA Technical Reports Server (NTRS)

Carrier, J.; Monk, T. H.; Buysse, D. J.; Kupfer, D. J.

1997-01-01

The following four issues were assessed in a group of 110 adults between the age of 20 and 59y: (1) the effect of age (regarded as a continuous variable) on polysomnographic sleep characteristics, habitual sleep-diary patterns, and subjective sleep quality; (2) the effects of age on morningness-eveningness; (3) the effects of morningness-eveningness on sleep, after controlling for the effects of age; and (4) the role of morningness-eveningness as a mediator of the age and sleep relationship. Increasing age was related to earlier habitual waketime, earlier bedtime, less time in bed and better mood and alertness at waketime. In the laboratory, increasing age was associated with less time asleep, increased number of awakenings, decreased sleep efficiency, lower percentages of slow-wave sleep (SWS) and rapid eye movement (REM) sleep, higher percentages of Stage 1 and 2, shorter REM latency and reduced REM activity and density. Increasing age was also associated with higher morningness scores. After controlling for the effects of age, morningness was associated with earlier waketime, earlier bedtime, less time in bed, better alertness at waketime, less time spent asleep, more wake in the last 2 h of sleep, decreased REM activity, less stage REM (min and percentage), more Stage 1 (min and percentage) and fewer minutes of Stage 2. For one set of variables (night time in bed, waketime, total sleep time, wake in the last 2 h of sleep and minutes of REM and REM activity), morningness-eveningness accounted for about half of the relationship between age and sleep. For another set of variables (bedtime, alertness at waketime, percentages of REM and Stage 1), morningness-eveningness accounted for the entire relationship between age and sleep. In conclusion, age and morningness were both important predictors of the habitual sleep patterns and polysomnographic sleep characteristics of people in the middle years of life (20-59 y).

Distributed Sleep Scheduling in Wireless Sensor Networks via Fractional Domatic Partitioning

NASA Astrophysics Data System (ADS)

Schumacher, André; Haanpää, Harri

We consider setting up sleep scheduling in sensor networks. We formulate the problem as an instance of the fractional domatic partition problem and obtain a distributed approximation algorithm by applying linear programming approximation techniques. Our algorithm is an application of the Garg-Könemann (GK) scheme that requires solving an instance of the minimum weight dominating set (MWDS) problem as a subroutine. Our two main contributions are a distributed implementation of the GK scheme for the sleep-scheduling problem and a novel asynchronous distributed algorithm for approximating MWDS based on a primal-dual analysis of Chvátal's set-cover algorithm. We evaluate our algorithm with ns2 simulations.

In-school Snacking, Breakfast Consumption, and Sleeping Patterns of Normal and Overweight Iranian High School Girls: A Study in Urban and Rural Areas in Guilan, Iran

ERIC Educational Resources Information Center

Maddah, Mohsen; Rashidi, Arash; Mohammadpour, Behnoush; Vafa, Reza; Karandish, Majid

2009-01-01

Objective: To investigate the relationship of snacking during school hours, sleep time, and breakfast consumption by weight status of Iranian high school girls in urban and rural areas in Guilan Province, Iran. Design: Data were collected by self-administered questionnaire and measure of body weight and height. Setting: High schools in urban and…

Periodic Limb Movements During Sleep: Population Prevalence, Clinical Correlates, and Racial Differences

PubMed Central

Scofield, Holly; Roth, Thomas; Drake, Christopher

2008-01-01

Study Objective: There is growing interest in the study of periodic limb movements during sleep and their potential clinical correlates. The aim of the present analysis is to address the lack of population-based studies using polysomnographic (PSG) measures to determine the prevalence of period limb movements during sleep in specific racial groups as well as the general population. Settings and participants: A community-based sample of 592 participants drawn from the general population of tricounty Detroit (mean age = 41.9 ± 12.6 years; 52.9% F; 31.5% African American). All individuals were assessed using objective and subjective measures in the sleep laboratory. Measurements: Participants were evaluated during a 24-h laboratory assessment, including a polysomnogram and multiple sleep latency test. Periodic leg movements were scored using standard criteria. Reports of sleep disturbance and daytime sleepiness were also assessed using standardized measures including the Global Sleep Assessment Questionnaire (GSAQ) and the Epworth Sleepiness Scale (ESS). Results: The overall prevalence of periodic limb movements during sleep (PLMSI >15) was 7.6%. African Americans had a lower prevalence of PLMSI >15 than Caucasians (4.3% vs. 9.3%; Χ2 = 4.5, P < 0.05). Regardless of race, symptoms of insomnia were significantly higher in individuals with PLMSI >15 than in those with PLMSI ≤15 (45% vs. 25%; Χ2 = 6.84, P < 0.01). Conclusion: This is the first study to determine the prevalence of PLMS in a population-based sample using standardized objective criteria. A key finding of the present study is that racial differences in this PSG parameter do exist, with African Americans being less likely to have elevated PLMS. Citation: Scofield H; Roth T; Drake C. Periodic limb movements during sleep: population prevalence, clinical correlates, and racial differences. SLEEP 2008;31(9):1221-1227. PMID:18788647

Daily Acclimation Handling Does Not Affect Hippocampal Long-Term Potentiation or Cause Chronic Sleep Deprivation in Mice

PubMed Central

Vecsey, Christopher G.; Wimmer, Mathieu E. J.; Havekes, Robbert; Park, Alan J.; Perron, Isaac J.; Meerlo, Peter; Abel, Ted

2013-01-01

Study Objectives: Gentle handling is commonly used to perform brief sleep deprivation in rodents. It was recently reported that daily acclimation handling, which is often used before behavioral assays, causes alterations in sleep, stress, and levels of N-methyl-D-aspartate receptor subunits prior to the actual period of sleep deprivation. It was therefore suggested that acclimation handling could mediate some of the observed effects of subsequent sleep deprivation. Here, we examine whether acclimation handling, performed as in our sleep deprivation studies, alters sleep/wake behavior, stress, or forms of hippocampal synaptic plasticity that are impaired by sleep deprivation. Design: Adult C57BL/6J mice were either handled daily for 6 days or were left undisturbed in their home cages. On the day after the 6th day of handling, long-term potentiation (LTP) was induced in hippocampal slices with spaced four-train stimulation, which we previously demonstrated to be impaired by brief sleep deprivation. Basal synaptic properties were also assessed. In three other sets of animals, activity monitoring, polysomnography, and stress hormone measurements were performed during the 6 days of handling. Results: Daily gentle handling alone does not alter LTP, rest/activity patterns, or sleep/wake architecture. Handling initially induces a minimal stress response, but by the 6th day, stress hormone levels are unaltered by handling. Conclusion: It is possible to handle mice daily to accustom them to the researcher without causing alterations in sleep, stress, or synaptic plasticity in the hippocampus. Therefore, effects of acclimation handling cannot explain the impairments in signaling mechanisms, synaptic plasticity, and memory that result from brief sleep deprivation. Citation: Vecsey CG; Wimmer MEJ; Havekes R; Park AJ; Perron IJ; Meerlo P; Abel T. Daily acclimation handling does not affect hippocampal long-term potentiation or cause chronic sleep deprivation in mice. SLEEP 2013;36(4):601-607. PMID:23565007

Pregabalin Versus Pramipexole: Effects on Sleep Disturbance in Restless Legs Syndrome

PubMed Central

Garcia-Borreguero, Diego; Patrick, Jeffrey; DuBrava, Sarah; Becker, Philip M.; Lankford, Alan; Chen, Crystal; Miceli, Jeffrey; Knapp, Lloyd; Allen, Richard P.

2014-01-01

Study Objectives: To compare pregabalin versus placebo and pramipexole for reducing restless legs syndrome (RLS)-related sleep disturbance. Design: Randomized, double-blinded, crossover trial. Setting: Twenty-three US sleep centers. Participants: Eighty-five individuals with moderate to severe idiopathic RLS and associated sleep disturbance. Interventions: Participants were randomized across 6 treatment sequences comprising three 4-week periods on pregabalin 300 mg/day (n = 75), pramipexole 0.5 mg/day (n = 76), or placebo (n = 73). Measurements and Results: Polysomnography was conducted over 2 nights at the end of each period. Primary (wake after sleep onset [WASO], pregabalin vs placebo) and key secondary endpoints were analyzed for statistical significance, with descriptive statistics for other endpoints. Pregabalin improved sleep maintenance, demonstrated by reductions in WASO (-27.1 min vs placebo [P < 0.0001]; -26.9 vs pramipexole) and number of awakenings after sleep onset (-2.7 vs placebo; -7.9 vs pramipexole [P < 0.0001]) by polysomnography, and an increase in subjective total sleep time (30.8 min vs placebo [P < 0.0001]; 26.8 vs pramipexole). Pregabalin also increased slow wave sleep duration (20.9 min vs placebo; 32.1 vs pramipexole [P < 0.0001]). Reduction in periodic limb movement arousal index (PLMAI) with pregabalin was similar to pramipexole and greater than placebo (-3.7 PLMA/h [P < 0.0001]), although reduction in total PLM in sleep was less than for pramipexole. Conclusions: This study demonstrated improvements in objective and subjective measures of sleep maintenance and sleep architecture with pregabalin compared with placebo and pramipexole. Effects of pregabalin on periodic limb movement arousal index were comparable to pramipexole. Trial Registration: ClinicalTrials.gov identifier, NCT00991276; http://clinicaltrials.gov/show/NCT00991276 Citation: Garcia-Borreguero D; Patrick J; DuBrava S; Becker PM; Lankford A; Chen C; Miceli J; Knapp L; Allen RP. Pregabalin versus pramipexole: effects on sleep disturbance in restless legs syndrome. SLEEP 2014;37(4):635-643. PMID:24899755

Cervical column posture and airway dimensions in clinical bruxist adults: a preliminary study.

PubMed

Restrepo, C C; Álvarez, C P; Jaimes, J; Gómez, A F

2013-11-01

The aim of this study was to compare the cervical column posture and the upper airway dimensions between sleep bruxist and non-bruxist young adults. Twenty-three sleep-grinders and 22 asymptomatic subjects, selected according to the American Academy of Sleep Medicine (AASM) criteria (report by a sleep partner and the presence of dental wear, according to Wetselaar et al.), were evaluated. The mean age was 23·8 years (range 18-30). All the subjects had complete permanent dentition and skeletal and occlusal class I. A digital cephalometric radiograph with natural head posture was performed for each subject. The craniocervical posture was traced and evaluated according to Solow and Tallgren, and the airway dimensions of the oropharynx and nasopharynx were evaluated in agreement with Sayinsu. The data were analysed with independent-samples t-tests and Mann-Whitney U-test. Significance was set at P < 0·05. Sleep bruxist young adults presented more forwarded cervical column posture and narrower measures of the oropharynx, when compared with controls (P < 0·05). As in children, anterior cervical column posture was found to be associated with sleep bruxism. © 2013 John Wiley & Sons Ltd.

Enhancing Slow Wave Sleep with Sodium Oxybate Reduces the Behavioral and Physiological Impact of Sleep Loss

PubMed Central

Walsh, James K.; Hall-Porter, Janine M.; Griffin, Kara S.; Dodson, Ehren R.; Forst, Elizabeth H.; Curry, Denise T.; Eisenstein, Rhody D.; Schweitzer, Paula K.

2010-01-01

Study Objectives: To investigate whether enhancement of slow wave sleep (SWS) with sodium oxybate reduces the impact of sleep deprivation. Design: Double-blind, parallel group, placebo-controlled design Setting: Sleep research laboratory Participants: Fifty-eight healthy adults (28 placebo, 30 sodium oxybate), ages 18-50 years. Interventions: A 5-day protocol included 2 screening/baseline nights and days, 2 sleep deprivation nights, each followed by a 3-h daytime (08:00-11:00) sleep opportunity and a recovery night. Sodium oxybate or placebo was administered prior to each daytime sleep period. Multiple sleep latency test (MSLT), psychomotor vigilance test (PVT), Karolinska Sleepiness Scale (KSS), and Profile of Mood States were administered during waking hours. Measurements and Results: During daytime sleep, the sodium oxybate group had more SWS, more EEG spectral power in the 1-9 Hz range, and less REM. Mean MSLT latency was longer for the sodium oxybate group on the night following the first daytime sleep period and on the day following the second day sleep period. Median PVT reaction time was faster in the sodium oxybate group following the second day sleep period. The change from baseline in SWS was positively correlated with the change in MSLT and KSS. During recovery sleep the sodium oxybate group had less TST, SWS, REM, and slow wave activity (SWA) than the placebo group. Conclusions: Pharmacological enhancement of SWS with sodium oxybate resulted in a reduced response to sleep loss on measures of alertness and attention. In addition, SWS enhancement during sleep restriction appears to result in a reduced homeostatic response to sleep loss. Citation: Walsh JK; Hall-Porter JM; Griffin KS; Dodson ER; Forst EH; Curry DT; Eisenstein RD; Schweitzer PK. Enhancing slow wave sleep with sodium oxybate reduces the behavioral and physiological impact of sleep loss. SLEEP 2010;33(9):1217-1225. PMID:20857869

Home sleep studies in the assessment of sleep apnea/hypopnea syndrome.

PubMed

Golpe, Rafael; Jiménez, Antonio; Carpizo, Rosario

2002-10-01

To determine the clinical utility of a limited sleep-recording device used unsupervised in the patient's home, compared with in-laboratory, fully supervised polysomnography for the diagnosis of sleep apnea/hypopnea syndrome (SAHS), and to assess its impact on costs. Prospective case study. The sleep-disorders unit of a tertiary referral university hospital. Fifty-five patients suspected of having SAHS and living within 30 km of our laboratory. Patients were studied first in their homes with the limited sleep-recording device. Polysomnography was performed within 30 days of the first study. Both studies were read by independent investigators blinded to the results of the other study. Diagnoses and therapeutic decisions regarding the use of continuous positive airway pressure obtained from the home and laboratory studies were compared. Agreement between the home and laboratory study recordings was also assessed using receiver operating characteristic (ROC) curves and Bland-Altman analysis. One half of the home studies were randomly assigned to be performed with a sleep technician's set up of the equipment in the patient's home (group 1), and the other half with the patient's own setup of the sleep-recording device (group 2), after an instruction period in the hospital. An economic analysis was performed, considering the cost of repeating studies in cases with faulty or inconclusive home studies (these patients should undergo polysomnography as a second step). Seven percent of the home studies in group 1, and 33% in group 2 produced no interpretable data because of artifacts (p < 0.05). Sixteen percent of the home study findings were inconclusive. The diagnosis obtained from the limited sleep-recording device and polysomnography agreed in 75% of the interpretable home studies (89%, if inconclusive home studies were excluded). The area under the ROC curve for the home study-derived parameters was between 0.84 and 0.89, compared with polysomnography. There was no bias between home and polysomnography studies in the Bland-Altman plot. The cost per study of home study recordings was less expensive than that of polysomnography (143.86 euros), either with (93.08 euros) or without (129.97 euros) intervention of the technician in the patient's home. Home sleep studies are a viable form of diagnosing SAHS, and are less expensive than polysomnography. Intervention of a sleep technician in the patient's home was the least expensive strategy, because of the high percentages of faulty studies with the patient's own setup of the equipment, when using the limited sleep-recording device.

Trait- and pre-sleep-state-dependent arousal in insomnia disorders: what role may sleep reactivity and sleep-related metacognitions play? A pilot study.

PubMed

Palagini, Laura; Mauri, Mauro; Dell'Osso, Liliana; Riemann, Dieter; Drake, Christopher L

2016-09-01

Research into the cause of chronic insomnia has identified hyperarousal as a key factor, which is likely to have both trait and state components. Sleep-related cognition, metacognition, and sleep reactivity also play an important role in insomnia. Our aim was to investigate how these insomnia-related constructs are associated with trait predisposition and pre-sleep arousal in subjects with an insomnia disorder. Fifty-three individuals with insomnia disorder (according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (F = 33; 52 + 10)) and 30 healthy controls (F = 18; 51.8 + 12 years) were evaluated with a set of questionnaires, including the Ford Insomnia Response to Stress Test (FIRST), Metacognition Questionnaire - Insomnia (MCQI), Arousal Predisposition Scale (APS), and Pre-sleep Arousal Scale (PSAS). Statistical analyses included multiple regression to elucidate the independent determinants of APS and PSAS. Participants with insomnia presented higher FIRST, MCQI, APS, PSAS scores (p-values <0.001) than healthy controls. In insomnia, APS and cognitive PSAS were best determined by MCQI (respectively, B = 0.09, p = 0.001, B = 0.08, p = 0.02), somatic PSAS by cognitive arousal (PSAS B = 0.35, p = 0.004) CONCLUSIONS: This study suggests that in insomnia disorders, trait predisposition toward hyperarousal and pre-sleep-cognitive-state-dependent arousal may be closely related to sleep-related metacognitive processes. Sleep-related metacognitive processes may be associated with trait hyperarousal within the framework of a mutual relationship, and could, in turn, modulate cognitive pre-sleep-state arousal. A broad range of cognitive and metacognitive processes should be considered when dealing with subjects with insomnia. Copyright © 2016 Elsevier B.V. All rights reserved.

Treatment of Sleep Disorders after Traumatic Brain Injury

PubMed Central

Castriotta, Richard J.; Atanasov, Strahil; Wilde, Mark C.; Masel, Brent E.; Lai, Jenny M.; Kuna, Samuel T.

2009-01-01

Study Objectives: Determine whether treatment of sleep disorders identified in brain injured adults would result in resolution of those sleep disorders and improvement of symptoms and daytime function. Methods: Prospective evaluation of unselected traumatic brain injury patients with nocturnal polysomnography (NPSG), multiple sleep latency test (MSLT), Epworth Sleepiness Scale (ESS), and neuropsychological testing including Psychomotor Vigilance Test (PVT), Profile of Mood States (POMS), and Functional Outcome of Sleep Questionnaire (FOSQ) before and after treatment with continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA), modafinil (200 mg) for narcolepsy and posttraumatic hypersomnia (PTH), or pramipexole (0.375 mg) for periodic limb movements in sleep (PLMS). Setting: Three academic medical centers. Participants: Fifty-seven (57) adults ≥ 3 months post traumatic brain injury (TBI). Measurements And Results: Abnormal sleep studies were found in 22 subjects (39%), of whom 13 (23%) had OSA, 2 (3%) had PTH, 3 (5%) had narcolepsy, 4 (7%) had PLMS, and 12 had objective excessive daytime sleepiness with MSLT score < 10 minutes. Apneas, hypopneas, and snoring were eliminated by CPAP in OSA subjects, but there was no significant change in MSLT scores. Periodic limb movements were eliminated with pramipexole. One of 3 narcolepsy subjects and 1 of 2 PTH subjects had resolution of hypersomnia with modafinil. There was no significant change in FOSQ, POMS, or PVT results after treatment. Conclusions: Treatment of sleep disorders after TBI may result in polysomnographic resolution without change in sleepiness or neuropsychological function. Citation: Castriotta RJ; Atanasov S; Wilde MC; Masel BE; Lai JM; Kuna ST. Treatment of sleep disorders after traumatic brain injury. J Clin Sleep Med 2009;5(2):137-144. PMID:19968047

Manipulating the circadian and sleep cycles to protect against metabolic disease.

PubMed

Nohara, Kazunari; Yoo, Seung-Hee; Chen, Zheng Jake

2015-01-01

Modernization of human society parallels an epidemic of metabolic disorders including obesity. Apart from excess caloric intake, a 24/7 lifestyle poses another important challenge to our metabolic health. Recent research under both laboratory and epidemiological settings has indicated that abnormal temporal organization of sleep and wakeful activities including food intake is a significant risk factor for metabolic disease. The circadian clock system is our intrinsic biological timer that regulates internal rhythms such as the sleep/wake cycle and also responses to external stimuli including light and food. Initially thought to be mainly involved in the timing of sleep, the clock, and/or clock genes may also play a role in sleep architecture and homeostasis. Importantly, an extensive body of evidence has firmly established a master regulatory role of the clock in energy balance. Together, a close relationship between well-timed circadian/sleep cycles and metabolic health is emerging. Exploiting this functional connection, an important holistic strategy toward curbing the epidemic of metabolic disorders (e.g., obesity) involves corrective measures on the circadian clock and sleep. In addition to behavioral and environmental interventions including meal timing and light control, pharmacological agents targeting sleep and circadian clocks promise convenient and effective applications. Recent studies, for example, have reported small molecules targeting specific clock components and displaying robust beneficial effects on sleep and metabolism. Furthermore, a group of clock-amplitude-enhancing small molecules (CEMs) identified via high-throughput chemical screens are of particular interest for future in vivo studies of their metabolic and sleep efficacies. Elucidating the functional relationship between clock, sleep, and metabolism will also have far-reaching implications for various chronic human diseases and aging.

Diurnal Rhythms in Blood Cell Populations and the Effect of Acute Sleep Deprivation in Healthy Young Men

PubMed Central

Ackermann, Katrin; Revell, Victoria L.; Lao, Oscar; Rombouts, Elwin J.; Skene, Debra J.; Kayser, Manfred

2012-01-01

Study Objectives: The sleep/wake cycle is accompanied by changes in circulating numbers of immune cells. The goal of this study was to provide an in-depth characterization of diurnal rhythms in different blood cell populations and to investigate the effect of acute sleep deprivation on the immune system, as an indicator of the body's acute stress response. Design: Observational within-subject design. Setting: Home environment and Clinical Research Centre. Participants: 15 healthy male participants aged 23.7 ± 5.4 (standard deviation) yr. Interventions: Total sleep deprivation. Measurements and Results: Diurnal rhythms of several blood cell populations were assessed under a normal sleep/wake cycle followed by 29 hr of extended wakefulness. The effect of condition (sleep versus sleep deprivation) on peak time and amplitude was investigated. Interindividual variation of, and the level of correlation between, the different cell populations was assessed. Comprehensive nonlinear curve fitting showed significant diurnal rhythms for all blood cell types investigated, with CD4 (naïve) cells exhibiting the most robust rhythms independent of condition. For those participants exhibiting significant diurnal rhythms in blood cell populations, only the amplitude of the granulocyte rhythm was significantly reduced by sleep deprivation. Granulocytes were the most diverse population, being most strongly affected by condition, and showed the lowest correlations with any other given cell type while exhibiting the largest interindividual variation in abundance. Conclusions: Granulocyte levels and diurnal rhythmicity are directly affected by acute sleep deprivation; these changes mirror the body's immediate immune response upon exposure to stress. Citation: Ackermann K; Revell VL; Lao O; Rombouts EJ; Skene DJ; Kayser M. Diurnal rhythms in blood cell populations and the effect of acute sleep deprivation in healthy young men. SLEEP 2012;35(7):933-940. PMID:22754039

Treatment of sleep-disordered breathing with positive airway pressure devices: technology update.

PubMed

Johnson, Karin Gardner; Johnson, Douglas Clark

2015-01-01

Many types of positive airway pressure (PAP) devices are used to treat sleep-disordered breathing including obstructive sleep apnea, central sleep apnea, and sleep-related hypoventilation. These include continuous PAP, autoadjusting CPAP, bilevel PAP, adaptive servoventilation, and volume-assured pressure support. Noninvasive PAP has significant leak by design, which these devices adjust for in different manners. Algorithms to provide pressure, detect events, and respond to events vary greatly between the types of devices, and vary among the same category between companies and different models by the same company. Many devices include features designed to improve effectiveness and patient comfort. Data collection systems can track compliance, pressure, leak, and efficacy. Understanding how each device works allows the clinician to better select the best device and settings for a given patient. This paper reviews PAP devices, including their algorithms, settings, and features.

Consumer sleep monitors: is there a baby in the bathwater?

PubMed Central

Russo, Kathryn; Goparaju, Balaji; Bianchi, Matt T

2015-01-01

The rapid expansion of consumer sleep devices is outpacing the validation data necessary to assess the potential use of these devices in clinical and research settings. Common sleep monitoring devices utilize a variety of sensors to track movement as well as cardiac and respiratory physiology. The variety of sensors and user-specific factors offer the potential, at least theoretically, for clinically relevant information. We describe the current challenges for interpretation of consumer sleep monitoring data, since the devices are mainly used in non-medical contexts (consumer use) although medically-definable sleep disorders may commonly occur in this setting. A framework for addressing questions of how certain devices might be useful is offered. We suggest that multistage validation efforts are crucially needed, from the level of sensor data and algorithm output, to extrapolations beyond healthy adults and into other populations and real-world environments. PMID:26604847

Sleep respiratory parameters in children with idiopathic epilepsy: A cross-sectional study.

PubMed

Gogou, Maria; Haidopoulou, Katerina; Eboriadou, Maria; Pavlidou, Efterpi; Hatzistylianou, Maria; Pavlou, Evaggelos

2016-10-01

The aim of this study is to explore and compare through polysomnography respiratory sleep parameters between children with idiopathic epilepsy and healthy children. Our cross-sectional study included 40 children with idiopathic epilepsy and 27 healthy children, who underwent overnight polysomnography. Data about sleep respiratory parameters were obtained and statistically analyzed. The level of statistical significance was set at 0.05. The prevalence of Obstructive Sleep Apnea Syndrome was significantly higher in the epilepsy group (35% vs 7.4%, p<0.01). Moreover, the odds ratio of an obstructive apnea index ≥1 in the epilepsy group was 10.6 (95% Confidence Intervals: 3.08-37.08) in comparison to the control group. The mean value of the obstructive apnea-hypopnea index was significantly higher in children with epilepsy compared to healthy children (2.46±1.22 vs 1.21±0.83, p=0.027). The mean values of central apnea index and desaturation index were comparable between these two groups. Longest apnea duration was significantly higher in the group of poor seizure control. All other sleep respiratory variables did not differ significantly between children with poor and good seizure control and between children with generalized and focal epilepsy. Children with epilepsy seem to present more prominent sleep breathing instability in comparison to healthy children, which mainly includes a predisposition to obstructive respiratory events. More studies are needed to investigate the relationship between sleep apneas and seizure control. Copyright © 2016 Elsevier B.V. All rights reserved.

Effects of afternoon "siesta" naps on sleep, alertness, performance, and circadian rhythms in the elderly

NASA Technical Reports Server (NTRS)

Monk, T. H.; Buysse, D. J.; Carrier, J.; Billy, B. D.; Rose, L. R.

2001-01-01

STUDY OBJECTIVES: To determine the effects of a 90-minute afternoon nap regimen on nocturnal sleep, circadian rhythms, and evening alertness and performance levels in the healthy elderly. DESIGN AND SETTING: Nine healthy elderly subjects (4m, 5f, age range 74y-87y) each experienced both nap and no-nap conditions in two studies each lasting 17 days (14 at home, 3 in the laboratory). In the nap condition a 90-minute nap was enforced between 13:30 and 15:00 every day, in the no-nap condition daytime napping was prohibited, and activity encouraged in the 13:30-15:00 interval. The order of the two conditions was counterbalanced. PARTICIPANTS: N/A INTERVENTIONS: N/A MEASUREMENTS: Diary measures, pencil and paper alertness tests, and wrist actigraphy were used at home. In the 72 hour laboratory studies, these measures were augmented by polysomnographic sleep recording, continuous rectal temperature measurement, a daily evening single trial of a Multiple Sleep Latency Test (MSLT), and computerized tests of mood, activation and performance efficiency. RESULTS: By the second week in the "at home" study, an average of 58 minutes of sleep was reported per siesta nap; in the laboratory, polysomnography confirmed an average of 57 minutes of sleep per nap. When nap and no-nap conditions were compared, mixed effects on nocturnal sleep were observed. Diary measures indicated no significant difference in nocturnal sleep duration, but a significant increase (of 38 mins.) in 24-hour Total Sleep Time (TST) when nocturnal sleeps and naps were added together (p<0.025). The laboratory study revealed a decrease of 2.4% in nocturnal sleep efficiency in the nap condition (p<0.025), a reduction of nocturnal Total Sleep Time (TST) by 48 mins. in the nap condition (p<0.001) which resulted primarily from significantly earlier waketimes (p<0.005), but no reliable effects on Wake After Sleep Onset (WASO), delta sleep measures, or percent stages 1 & 2. Unlike the diary study, the laboratory study yielded no overall increase in 24-hour TST consequent upon the siesta nap regimen. The only measure of evening alertness or performance to show an improvement was sleep latency in a single-trial evening MSLT (nap: 15.6 mins., no nap: 11.5 mins., p<0.005). No significant change in circadian rhythm parameters was observed. CONCLUSIONS: Healthy seniors were able to adopt a napping regimen involving a 90-minute siesta nap each day between 13:30 and 15:00, achieving about one hour of actual sleep per nap. There were some negative consequences for nocturnal sleep in terms of reduced sleep efficiency and earlier waketimes, but also some positive consequences for objective evening performance and (in the diary study) 24-hour sleep totals. Subjective alertness measures and performance measures showed no reliable effects and circadian phase parameters appeared unchanged.

Telephone Problem-Solving Treatment Improves Sleep Quality in Service Members With Combat-Related Mild Traumatic Brain Injury: Results From a Randomized Clinical Trial.

PubMed

Vuletic, S; Bell, K R; Jain, S; Bush, N; Temkin, N; Fann, J R; Stanfill, K E; Dikmen, S; Brockway, J A; He, F; Ernstrom, K; Raman, R; Grant, G; Stein, M B; Gahm, G A

2016-01-01

Evaluate sleep quality, its correlates, and the effect of telephone-based problem-solving treatment (PST) in active duty postdeployment service members with mild traumatic brain injury (mTBI) SETTING:: Randomized clinical trial. Active duty service members with combat-related mTBI. Education-only (EO) and PST groups (N = 178 each) received printed study materials and 12 educational brochures. The PST group additionally received up to 12 PST telephone calls addressing participant-selected issues. Outcomes were evaluated postintervention (6 months) and at 12 months. Pittsburgh Sleep Quality Index. Sleep quality was manifestly poor in both groups at baseline (Pittsburgh Sleep Quality Index = 12.5 ± 4). Overall sleep quality was significantly different between the PST and EO groups at 6 months (P = .003) but not at 12 months. Longitudinally, PST significantly improved sleep quality at 6 months (P = .001) but not over the follow-up. Low sleep quality was associated with concussion symptoms, pain, depression, and posttraumatic stress disorder at all time points (P < .0001). Sleep disorders, common in postdeployment service members with mTBI, are strongly associated with the presence of pain, posttraumatic stress disorder, and depression. Telephone-based PST may be an effective therapeutic approach for reducing sleep disorders in this population. Research should focus on maintenance of treatment gains.

Does the Circadian Modulation of Dream Recall Modify with Age?

PubMed Central

Chellappa, Sarah Laxhmi; Münch, Mirjam; Blatter, Katharina; Knoblauch, Vera; Cajochen, Christian

2009-01-01

Study objectives: The ultradian NREM-REM sleep cycle and the circadian modulation of REM sleep sum to generate dreaming. Here we investigated age-related changes in dream recall, number of dreams, and emotional domain characteristics of dreaming during both NREM and REM sleep. Design: Analysis of dream recall and sleep EEG (NREM/REM sleep) during a 40-h multiple nap protocol (150 min of wakefulness and 75 min of sleep) under constant routine conditions. Setting: Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Basel, Switzerland. Participants: Seventeen young (20-31 years) and 15 older (57-74 years) healthy volunteers Interventions: N/A. Measurements and Results: Dream recall and number of dreams varied significantly across the circadian cycle and between age groups, with older subjects exhibiting fewer dreams (P < 0.05), particularly after naps scheduled during the biological day, closely associated with the circadian rhythm of REM sleep. No significant age differences were observed for the emotional domain of dream content. Conclusions: Since aging was associated with attenuated amplitude in the circadian modulation of REM sleep, our data suggest that the age-related decrease in dream recall can result from an attenuated circadian modulation of REM sleep. Citation: Chellappa SL; Möunch M; Blatter K; Knoblauch V; Cajochen C. Does the circadian modulation of dream recall modify with age? SLEEP 2009;32(9):1201-1209. PMID:19750925

Sleep and Cognitive Decline: A Strong Bidirectional Relationship. It Is Time for Specific Recommendations on Routine Assessment and the Management of Sleep Disorders in Patients with Mild Cognitive Impairment and Dementia.

PubMed

Guarnieri, Biancamaria; Sorbi, Sandro

2015-01-01

Sleep disturbances and disruption of the neural regulation of the sleep-wake rhythm appear to be involved in the cellular and molecular mechanisms of cognitive decline. Although sleep problems are highly prevalent in mild cognitive impairment (MCI) and many types of dementia, they have not been systematically investigated in the clinical setting and are often only investigated by sleep specialists upon individual request. This review discusses sleep disorders in the context of cognitive decline and provides an overview of the clinical diagnosis and management of these disorders in patients with dementia and MCI. Key Messages: Sleep disorders are largely underestimated and do not receive sufficient attention in the global management of dementia patients. Sleep disturbances have a significant impact on cognitive and physical functions in individuals with cognitive decline and may be associated with important psychological distress and depression. They are positively associated with the severity of behavioral problems and cognitive impairment. The recent recommendations by the Sleep Study Group of the Italian Dementia Research Association can be used as a guideline for the clinical assessment and management of sleep disorders in MCI and dementia patients. Sleep disorders should be carefully investigated using an in-depth sleep history, physical examination, questionnaires and clinical scales and should be validated with the support of a direct caregiver. The recommendations for older adults can be used as a framework to guide the diagnosis and treatment of sleep disorders in individuals with dementia and MCI. The management strategy should be based on the choice of different treatments for each sleep problem present in the same patient, while avoiding adverse interactions between treatments. © 2015 S. Karger AG, Basel.

Arousal from Sleep Does Not Lead to Reduced Dilator Muscle Activity or Elevated Upper Airway Resistance on Return to Sleep in Healthy Individuals

PubMed Central

Jordan, Amy S.; Cori, Jennifer M.; Dawson, Andrew; Nicholas, Christian L.; O'Donoghue, Fergal J.; Catcheside, Peter G.; Eckert, Danny J.; McEvoy, R. Doug; Trinder, John

2015-01-01

Study Objectives: To compare changes in end-tidal CO2, genioglossus muscle activity and upper airway resistance following tone-induced arousal and the return to sleep in healthy individuals with small and large ventilatory responses to arousal. Design: Observational study. Setting: Two sleep physiology laboratories. Patients or Participants: 35 men and 25 women with no medical or sleep disorders. Interventions: Auditory tones to induce 3-s to 15-s cortical arousals from sleep. Measurements and Results: During arousal from sleep, subjects with large ventilatory responses to arousal had higher ventilation (by analytical design) and tidal volume, and more marked reductions in the partial pressure of end-tidal CO2 compared to subjects with small ventilatory responses to arousal. However, following the return to sleep, ventilation, genioglossus muscle activity, and upper airway resistance did not differ between high and low ventilatory response groups (Breath 1 on return to sleep: ventilation 6.7 ± 0.4 and 5.5 ± 0.3 L/min, peak genioglossus activity 3.4% ± 1.0% and 4.8% ± 1.0% maximum, upper airway resistance 4.7 ± 0.7 and 5.5 ± 1.0 cm H2O/L/s, respectively). Furthermore, dilator muscle activity did not fall below the pre-arousal sleeping level and upper airway resistance did not rise above the pre-arousal sleeping level in either group for 10 breaths following the return to sleep. Conclusions: Regardless of the magnitude of the ventilatory response to arousal from sleep and subsequent reduction in PETCO2, healthy individuals did not develop reduced dilator muscle activity nor increased upper airway resistance, indicative of partial airway collapse, on the return to sleep. These findings challenge the commonly stated notion that arousals predispose to upper airway obstruction. Citation: Jordan AS, Cori JM, Dawson A, Nicholas CL, O'Donoghue FJ, Catcheside PG, Eckert DJ, McEvoy RD, Trinder J. Arousal from sleep does not lead to reduced dilator muscle activity or elevated upper airway resistance on return to sleep in healthy individuals. SLEEP 2015;38(1):53–59. PMID:25325511

Transcriptional Signatures of Sleep Duration Discordance in Monozygotic Twins.

PubMed

Watson, N F; Buchwald, D; Delrow, J J; Altemeier, W A; Vitiello, M V; Pack, A I; Bamshad, M; Noonan, C; Gharib, S A

2017-01-01

Habitual short sleep duration is associated with adverse metabolic, cardiovascular, and inflammatory effects. Co-twin study methodologies account for familial (eg, genetics and shared environmental) confounding, allowing assessment of subtle environmental effects, such as the effect of habitual short sleep duration on gene expression. Therefore, we investigated gene expression in monozygotic twins discordant for actigraphically phenotyped habitual sleep duration. Eleven healthy monozygotic twin pairs (82% female; mean age 42.7 years; SD = 18.1), selected based on subjective sleep duration discordance, were objectively phenotyped for habitual sleep duration with 2 weeks of wrist actigraphy. Peripheral blood leukocyte (PBL) RNA from fasting blood samples was obtained on the final day of actigraphic measurement and hybridized to Illumina humanHT-12 microarrays. Differential gene expression was determined between paired samples and mapped to functional categories using Gene Ontology. Finally, a more comprehensive gene set enrichment analysis was performed based on the entire PBL transcriptome. The mean 24-hour sleep duration of the total sample was 439.2 minutes (SD = 46.8 minutes; range 325.4-521.6 minutes). Mean within-pair sleep duration difference per 24 hours was 64.4 minutes (SD = 21.2; range 45.9-114.6 minutes). The twin cohort displayed distinctive pathway enrichment based on sleep duration differences. Habitual short sleep was associated with up-regulation of genes involved in transcription, ribosome, translation, and oxidative phosphorylation. Unexpectedly, genes down-regulated in short sleep twins were highly enriched in immuno-inflammatory pathways such as interleukin signaling and leukocyte activation, as well as developmental programs, coagulation cascade, and cell adhesion. Objectively assessed habitual sleep duration in monozygotic twin pairs appears to be associated with distinct patterns of differential gene expression and pathway enrichment. By accounting for familial confounding and measuring real life sleep duration, our study shows the transcriptomic effects of habitual short sleep on dysregulated immune response and provides a potential link between sleep deprivation and adverse metabolic, cardiovascular, and inflammatory outcomes. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

Scalp and Source Power Topography in Sleepwalking and Sleep Terrors: A High-Density EEG Study.

PubMed

Castelnovo, Anna; Riedner, Brady A; Smith, Richard F; Tononi, Giulio; Boly, Melanie; Benca, Ruth M

2016-10-01

To examine scalp and source power topography in sleep arousals disorders (SADs) using high-density EEG (hdEEG). Fifteen adult subjects with sleep arousal disorders (SADs) and 15 age- and gender-matched good sleeping healthy controls were recorded in a sleep laboratory setting using a 256 channel EEG system. Scalp EEG analysis of all night NREM sleep revealed a localized decrease in slow wave activity (SWA) power (1-4 Hz) over centro-parietal regions relative to the rest of the brain in SADs compared to good sleeping healthy controls. Source modelling analysis of 5-minute segments taken from N3 during the first half of the night revealed that the local decrease in SWA power was prominent at the level of the cingulate, motor, and sensori-motor associative cortices. Similar patterns were also evident during REM sleep and wake. These differences in local sleep were present in the absence of any detectable clinical or electrophysiological sign of arousal. Overall, results suggest the presence of local sleep differences in the brain of SADs patients during nights without clinical episodes. The persistence of similar topographical changes in local EEG power during REM sleep and wakefulness points to trait-like functional changes that cross the boundaries of NREM sleep. The regions identified by source imaging are consistent with the current neurophysiological understanding of SADs as a disorder caused by local arousals in motor and cingulate cortices. Persistent localized changes in neuronal excitability may predispose affected subjects to clinical episodes. © 2016 Associated Professional Sleep Societies, LLC.

Genetic Dissociation of Daily Sleep and Sleep Following Thermogenetic Sleep Deprivation in Drosophila

PubMed Central

Dubowy, Christine; Moravcevic, Katarina; Yue, Zhifeng; Wan, Joy Y.; Van Dongen, Hans P.A.; Sehgal, Amita

2016-01-01

Study Objectives: Sleep rebound—the increase in sleep that follows sleep deprivation—is a hallmark of homeostatic sleep regulation that is conserved across the animal kingdom. However, both the mechanisms that underlie sleep rebound and its relationship to habitual daily sleep remain unclear. To address this, we developed an efficient thermogenetic method of inducing sleep deprivation in Drosophila that produces a substantial rebound, and applied the newly developed method to assess sleep rebound in a screen of 1,741 mutated lines. We used data generated by this screen to identify lines with reduced sleep rebound following thermogenetic sleep deprivation, and to probe the relationship between habitual sleep amount and sleep following thermogenetic sleep deprivation in Drosophila. Methods: To develop a thermogenetic method of sleep deprivation suitable for screening, we thermogenetically stimulated different populations of wake-promoting neurons labeled by Gal4 drivers. Sleep rebound following thermogenetically-induced wakefulness varies across the different sets of wake-promoting neurons that were stimulated, from very little to quite substantial. Thermogenetic activation of neurons marked by the c584-Gal4 driver produces both strong sleep loss and a substantial rebound that is more consistent within genotypes than rebound following mechanical or caffeine-induced sleep deprivation. We therefore used this driver to induce sleep deprivation in a screen of 1,741 mutagenized lines generated by the Drosophila Gene Disruption Project. Flies were subjected to 9 h of sleep deprivation during the dark period and released from sleep deprivation 3 h before lights-on. Recovery was measured over the 15 h following sleep deprivation. Following identification of lines with reduced sleep rebound, we characterized baseline sleep and sleep depth before and after sleep deprivation for these hits. Results: We identified two lines that consistently exhibit a blunted increase in the duration and depth of sleep after thermogenetic sleep deprivation. Neither of the two genotypes has reduced total baseline sleep. Statistical analysis across all screened lines shows that genotype is a strong predictor of recovery sleep, independent from effects of genotype on baseline sleep. Conclusions: Our data show that rebound sleep following thermogenetic sleep deprivation can be genetically separated from sleep at baseline. This suggests that genetically controlled mechanisms of sleep regulation not manifest under undisturbed conditions contribute to sleep rebound following thermogenetic sleep deprivation. Citation: Dubowy C, Moravcevic K, Yue Z, Wan JY, Van Dongen HP, Sehgal A. Genetic dissociation of daily sleep and sleep following thermogenetic sleep deprivation in Drosophila. SLEEP 2016;39(5):1083–1095. PMID:26951392

Pulsing blue light through closed eyelids: effects on acute melatonin suppression and phase shifting of dim light melatonin onset.

PubMed

Figueiro, Mariana G; Plitnick, Barbara; Rea, Mark S

2014-01-01

Circadian rhythm disturbances parallel the increased prevalence of sleep disorders in older adults. Light therapies that specifically target regulation of the circadian system in principle could be used to treat sleep disorders in this population. Current recommendations for light treatment require the patients to sit in front of a bright light box for at least 1 hour daily, perhaps limiting their willingness to comply. Light applied through closed eyelids during sleep might not only be efficacious for changing circadian phase but also lead to better compliance because patients would receive light treatment while sleeping. Reported here are the results of two studies investigating the impact of a train of 480 nm (blue) light pulses presented to the retina through closed eyelids on melatonin suppression (laboratory study) and on delaying circadian phase (field study). Both studies employed a sleep mask that provided narrowband blue light pulses of 2-second duration every 30 seconds from arrays of light-emitting diodes. The results of the laboratory study demonstrated that the blue light pulses significantly suppressed melatonin by an amount similar to that previously shown in the same protocol at half the frequency (ie, one 2-second pulse every minute for 1 hour). The results of the field study demonstrated that blue light pulses given early in the sleep episode significantly delayed circadian phase in older adults; these results are the first to demonstrate the efficacy and practicality of light treatment by a sleep mask aimed at adjusting circadian phase in a home setting.

Ventilatory Responses to Hypercapnia during Wakefulness and Sleep in Obese Adolescents With and Without Obstructive Sleep Apnea Syndrome

PubMed Central

Yuan, Haibo; Pinto, Swaroop J.; Huang, Jingtao; McDonough, Joseph M.; Ward, Michelle B.; Lee, Yin N.; Bradford, Ruth M.; Gallagher, Paul R.; Shults, Justine; Konstantinopoulou, Sophia; Samuel, John M.; Katz, Eliot S.; Hua, Shucheng; Tapia, Ignacio E.; Marcus, Carole L.

2012-01-01

Study Objectives: Abnormal ventilatory drive may contribute to the pathophysiology of the childhood obstructive sleep apnea syndrome (OSAS). Concomitant with the obesity epidemic, more adolescents are developing OSAS. However, few studies have specifically evaluated the obese adolescent group. The authors hypothesized that obese adolescents with OSAS would have a blunted hypercapnic ventilatory response (HCVR) while awake and blunted ventilatory responses to carbon dioxide (CO2) during sleep compared with obese and lean adolescents without OSAS. Design: CVR was measured during wakefulness. During nonrapid eye movement (NREM) and rapid eye movement (REM) sleep, respiratory parameters and genioglossal electromyogram were measured during CO2 administration in comparison with room air in obese adolescents with OSAS, obese control study participants, and lean control study participants. Setting: Sleep laboratory. Participants: Twenty-eight obese patients with OSAS, 21 obese control study participants, and 37 lean control study participants. Results: The obese OSAS and obese control groups had a higher HCVR compared with the lean control group during wakefulness. During both sleep states, all 3 groups had a response to CO2; however, the obese OSAS group had lower percentage changes in minute ventilation, inspiratory flow, inspiratory time, and tidal volume compared with the 2 control groups. There were no significance differences in genioglossal activity between groups. Conclusions: HCVR during wakefulness is increased in obese adolescents. Obese adolescents with OSAS have blunted ventilatory responses to CO2 during sleep and do not have a compensatory prolongation of inspiratory time, despite having normal CO2 responsivity during wakefulness. Central drive may play a greater role than upper airway neuromotor tone in adapting to hypercapnia. Citation: Yuan H; Pinto SJ; Huang J; McDonough JM; Ward MB; Lee YN; Bradford RM; Gallagher PR; Shults J; Konstantinopoulou S; Samuel JM; Katz ES; Hua S; Tapia IE; Marcus CL. Ventilatory responses to hypercapnia during wakefulness and sleep in obese adolescents with and without obstructive sleep apnea syndrome. SLEEP 2012;35(9):1257–1267. PMID:22942504

The yin and yang of sleep and attention

PubMed Central

Kirszenblat, Leonie; van Swinderen, Bruno

2015-01-01

Sleep is not a single state, but a complex set of brain processes that supports a number of physiological needs. Sleep deprivation is known to affect attention in many animals, suggesting that a key function of sleep is to regulate attention. Conversely, tasks that require more attention drive sleep need and sleep intensity. Attention involves the ability to filter incoming stimuli based on their relative salience, and this is likely to require coordinated synaptic activity across the brain. This capacity may have only become possible with the evolution of related neural mechanisms that support two key sleep functions: stimulus suppression and synaptic plasticity. We argue here that sleep and attention may have co-evolved as brain states that regulate each other. PMID:26602764

Core Body and Skin Temperature in Type 1 Narcolepsy in Daily Life; Effects of Sodium Oxybate and Prediction of Sleep Attacks.

PubMed

van der Heide, Astrid; Werth, Esther; Donjacour, Claire E H M; Reijntjes, Robert H A M; Lammers, Gert Jan; Van Someren, Eus J W; Baumann, Christian R; Fronczek, Rolf

2016-11-01

Previous laboratory studies in narcolepsy patients showed altered core body and skin temperatures, which are hypothesised to be related to a disturbed sleep wake regulation. In this ambulatory study we assessed temperature profiles in normal daily life, and whether sleep attacks are heralded by changes in skin temperature. Furthermore, the effects of three months of treatment with sodium oxybate (SXB) were investigated. Twenty-five narcolepsy patients and 15 healthy controls were included. Core body, proximal and distal skin temperatures, and sleep-wake state were measured simultaneously for 24 hours in ambulatory patients. This procedure was repeated in 16 narcolepsy patients after at least 3 months of stable treatment with SXB. Increases in distal skin temperature and distal-to-proximal temperature gradient (DPG) strongly predicted daytime sleep attacks (P < 0.001). As compared to controls, patients had a higher proximal and distal skin temperature in the morning, and a lower distal skin temperature during the night (all P < 0.05). Furthermore, they had a higher core body temperature during the first part of the night (P < 0.05), which SXB decreased (F = 4.99, df = 1, P = 0.03) to a level similar to controls. SXB did not affect skin temperature. This ambulatory study demonstrates that daytime sleep attacks were preceded by clear changes in distal skin temperature and DPG. Furthermore, changes in core body and skin temperature in narcolepsy, previously only studied in laboratory settings, were partially confirmed. Treatment with SXB resulted in a normalisation of the core body temperature profile. Future studies should explore whether predictive temperature changes can be used to signal or even prevent sleep attacks. © 2016 Associated Professional Sleep Societies, LLC.

Is Homeostatic Sleep Regulation Under Low Sleep Pressure Modified by Age?

PubMed Central

Munch, Mirjam; Knoblauch, Vera; Blatter, Katharina; Wirz-Justice, Anna; Cajochen, Christian

2007-01-01

Study Objectives: We have previously shown that healthy older volunteers react with an attenuated frontal predominance of sleep electroencephalogram (EEG) delta activity in response to high sleep pressure. Here, we investigated age-related changes in homeostatic sleep regulation under low sleep pressure conditions, with respect to regional EEG differences and their dynamics. Design: Analysis of the sleep EEG during an 8-hour baseline night, during a 40-hour multiple nap protocol (150 minutes of wakefulness and 75 minutes of sleep) and during the following 8-hour recovery night under constant posture conditions. Setting: Centre for Chronobiology, Psychiatric University Clinics, Basel, Switzerland Participants: Sixteen young (20–31 years) and 15 older (57–74 years) healthy volunteers Interventions: N/A. Measurements and Results: All-night EEG spectra revealed an increase in spindle activity (13–15.25 Hz) for both age groups, but only in the young did we find a significant decrease of delta activity (0.5–1.25 Hz) in response to low sleep pressure conditions, predominantly in occipital brain regions. However, delta activity during the first non-rapid eye movement (NREM) sleep episode was equally reduced in both age groups. This response lasted significantly longer in the young (across the first 2 NREM sleep episodes) than in the older participants (only the first NREM sleep episode). Conclusion: The initial EEG delta response to low sleep pressure was similar in healthy older and young participants. Therefore, age-related sleep deteriorations cannot solely be attributed to alterations in the homeostatic sleep-regulatory system. It is, rather, the interplay of circadian and homeostatic factors of sleep regulation, which is changed with aging. Citation: Munch M; Knoblauch V; Blatter K et al. Is homeostatic sleep regulation under low sleep pressure modified by age? SLEEP 2007;30(6):781-792. PMID:17580600

Poor sleep quality predicts deficient emotion information processing over time in early adolescence.

PubMed

Soffer-Dudek, Nirit; Sadeh, Avi; Dahl, Ronald E; Rosenblat-Stein, Shiran

2011-11-01

There is deepening understanding of the effects of sleep on emotional information processing. Emotion information processing is a key aspect of social competence, which undergoes important maturational and developmental changes in adolescence; however, most research in this area has focused on adults. Our aim was to test the links between sleep and emotion information processing during early adolescence. Sleep and facial information processing were assessed objectively during 3 assessment waves, separated by 1-year lags. Data were obtained in natural environments-sleep was assessed in home settings, and facial information processing was assessed at school. 94 healthy children (53 girls, 41 boys), aged 10 years at Time 1. N/A. Facial information processing was tested under neutral (gender identification) and emotional (emotional expression identification) conditions. Sleep was assessed in home settings using actigraphy for 7 nights at each assessment wave. Waking > 5 min was considered a night awakening. Using multilevel modeling, elevated night awakenings and decreased sleep efficiency significantly predicted poor performance only in the emotional information processing condition (e.g., b = -1.79, SD = 0.52, confidence interval: lower boundary = -2.82, upper boundary = -0.076, t(416.94) = -3.42, P = 0.001). Poor sleep quality is associated with compromised emotional information processing during early adolescence, a sensitive period in socio-emotional development.

Update on energy homeostasis and insufficient sleep.

PubMed

Penev, Plamen D

2012-06-01

Driven by the demands and opportunities of modern life, many people habitually sleep less than 6 h a night. In the sleep clinic, chronic sleep restriction is recognized by the diagnosis of insufficient sleep syndrome (ICSD-9, 307.49-4), which is receiving increased scrutiny as a potential risk to metabolic health. Its relevance for the practicing endocrinologist is highlighted by a stream of epidemiological data that show an association of insufficient sleep with increased incidence of obesity and related morbidities. A central theme of this update is the notion that sleep loss incurs additional metabolic cost, which triggers a set of neuroendocrine, metabolic, and behavioral adaptations aimed at increasing food intake and conserving energy. Although this coordinated response may have evolved to offset the metabolic demands of extended wakefulness in natural habitats with limited food availability, it can be maladaptive in the context of a modern environment that allows many to overeat while maintaining a sedentary lifestyle without sufficient sleep. Importantly, such sleep loss-related metabolic adaptation may undermine the success of behavioral interventions based on reduced caloric intake and increased physical activity to lower metabolic risk in obesity-prone individuals. This emerging perspective is based on data from recently published human interventional studies and requires further experimental support. Nevertheless, it now seems prudent to recommend that overweight and obese individuals attempting to reduce their caloric intake and maintain increased physical activity should obtain adequate sleep and, if needed, seek effective treatment for any coexisting sleep disorders.

Wrist actigraphic measures of sleep in space

NASA Technical Reports Server (NTRS)

Monk, T. H.; Buysse, D. J.; Rose, L. R.

1999-01-01

STUDY OBJECTIVES: To determine whether wrist actigraphy is useful as a tool for space-based sleep research. Specifically, to determine whether bedtimes and waketimes can be identified from the actigraphic record, and whether actigraphic measures of sleep in space are related to polysomnographic (PSG) ones. DESIGN AND SETTING: Actigraphy, sleep diary, and Polysomnographic (PSG) measures of sleep were obtained from four subjects in two 72h measurement blocks occurring 2d and 12d into a 17d Space Shuttle mission in orbiting the earth in microgravity. PATIENTS: Four healthy male astronauts aged 38y - 47y. INTERVENTIONS: NA. MEASUREMENTS AND RESULTS: Sleep onset and offset at "night" could be quite clearly identified from the actigraphic record and were better estimated by actigraph than by diary. There was a high correlation between actigraphic and PSG estimates of sleep duration (r = 0.96) and sleep efficiency (r = 0.88), and a similarity in the mean estimates obtained. On a minute-by-minute basis, there was a good correlation between sleep stage and actigraphic movement counts, with a higher level of counts per minute recorded in epochs with lighter PSG sleep stages. There was also a high correlation (r = 0.90) between minutes of stage 0 (wake) occurring between bedtime and wake time, and number of non-zero actigraph epochs during the same interval. CONCLUSIONS: Actigraphy worked well in space both as a way of detecting bedtimes and waketimes, and as an indicant of sleep restlessness.

[Preparation and effect of a behavioral science-based education program for sleep improvement among medical students].

PubMed

Ueda, Masumi; Adachi, Yoshiko; Hayama, Junko; Yamagami, Toshiko

2008-01-01

The present study aimed to investigate a simple education program that is effective for sleep improvement among medical students who will be medical doctors in the future. The education program applied in the present study was developed for sleep improvement based on behavioral science and changes in knowledge and sleeping habits were observed. Subjects were 6th-year medical students of 2002 and 2003. Students of 2002 attended a program including a 90-minute lecture and a 2-week practice learning session, and students of 2003 attended only the lecture. In the lecture, behavior therapy for chronic insomnia was explained using a booklet. In the practice learning session, students set a target behavior for improvement and conducted self-monitoring of their sleep and the targeted behavior. Changes in knowledge about sleep, attitude toward the therapy, sleep, and sleep-related habits were observed and compared between the 2 groups of subjects immediately and 2-weeks after the lecture. It was found that after both programs subjects had more knowledge about sleep than before. In the program including practice learning session, subjects' attitude for managing patients changed from before the lecture to after the lecture, and after the practice learning session. It was found that more than half of the students thought that they could provide sleep guidance based on the behavior therapy. Regarding the subjects' sleep, significant improvements were observed for "having nightmares upon falling asleep," "sleepiness during daytime," "sense of getting a sound sleep," and "mood upon waking up." Regarding sleep-related habits, significant improvements were observed for "taking a nap," "dozing off," and "eating breakfast." On the other hand, only the lecture subjects improved irregularity of bedtime and sleeping time. Although an increase in knowledge and improvement of sleep were observed among students who attended only the lecture, a further increase in knowledge and improvement of sleeping habits were observed among students who also attended the practice learning session. The results described herein suggest developing and providing a simple and convenient education program for sleep improvement was effective for increasing students' knowledge about sleep, developing improved coping methods regarding sleep, and improving sleep. It is also suggested that behavioral scientific instructive methods, including practice learning, are effective for medical education.

The impact of long work hours and shift work on cognitive errors in nurses.

PubMed

Rhéaume, Ann; Mullen, Jane

2018-01-01

Pilot study to examine the impact of long work hours and shift work on cognitive errors in nurses. Twelve-hour shifts are more commonly used in hospital settings and there is growing concern over the impact that extended and irregular work hours have on nurses' well-being and performance. Twenty-eight nurses working different shifts (8-hr days and 12-hr rotation) participated in this study. Nurses were assessed at the beginning of four consecutive shifts using actigraphy, a sleep diary and an after work questionnaire. Nurses working 12-hr rotations had less total sleep time and less sleep efficiency than 8-hr day nurses. Twelve-hour rotation nurses also napped more than their counterparts. There were no differences between the two groups with respect to cognitive errors. Twelve-hour rotations have a negative effect on nurses' sleep patterns. There is no evidence indicating 12-hr rotations increased errors. Nurse managers can implement specific strategies, such as greater shift work flexibility and designated quiet time, to reduce the effects of disturbed sleep patterns in nurses. © 2017 John Wiley & Sons Ltd.

The Association between Use of Mobile Phones after Lights Out and Sleep Disturbances among Japanese Adolescents: A Nationwide Cross-Sectional Survey

PubMed Central

Munezawa, Takeshi; Kaneita, Yoshitaka; Osaki, Yoneatsu; Kanda, Hideyuki; Minowa, Masumi; Suzuki, Kenji; Higuchi, Susumu; Mori, Junichiro; Yamamoto, Ryuichiro; Ohida, Takashi

2011-01-01

Study Objective: The objective of this study was to examine the association between the use of mobile phones after lights out and sleep disturbances among Japanese adolescents. Design and Setting: This study was designed as a cross-sectional survey. The targets were students attending junior and senior high schools throughout Japan. Sample schools were selected by cluster sampling. Self-reported anonymous questionnaires were sent to schools for all students to fill out. Participants: A total of 95,680 adolescents responded. The overall response rate was 62.9%, and 94,777 questionnaires were subjected to analysis. Intervention: N/A Measurements and Results: Daily mobile phone use, even if only for a brief moment every day, was reported by 84.4%. Moreover, as for use of mobile phones after lights out, 8.3% reported using their mobile phone for calling every day and 17.6% reported using it for sending text messages every day. Multiple logistic regression analysis showed that mobile phone use for calling and for sending text messages after lights out was associated with sleep disturbances (short sleep duration, subjective poor sleep quality, excessive daytime sleepiness, and insomnia symptoms) independent of covariates and independent of each other. Conclusion: This study showed that the use of mobile phones for calling and for sending text messages after lights out is associated with sleep disturbances among Japanese adolescents. However, there were some limitations, such as small effect sizes, in this study. More studies that examine the details of this association are necessary to establish strategies for sleep hygiene in the future. Citation: Munezawa T; Kaneita Y; Osaki Y; Kanda H; Minowa M; Suzuki K; Higuchi S; Mori J; Yamamoto R; Ohida T. The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. SLEEP 2011;34(8):1013-1020. PMID:21804663

An accurate sleep stages classification system using a new class of optimally time-frequency localized three-band wavelet filter bank.

PubMed

Sharma, Manish; Goyal, Deepanshu; Achuth, P V; Acharya, U Rajendra

2018-07-01

Sleep related disorder causes diminished quality of lives in human beings. Sleep scoring or sleep staging is the process of classifying various sleep stages which helps to detect the quality of sleep. The identification of sleep-stages using electroencephalogram (EEG) signals is an arduous task. Just by looking at an EEG signal, one cannot determine the sleep stages precisely. Sleep specialists may make errors in identifying sleep stages by visual inspection. To mitigate the erroneous identification and to reduce the burden on doctors, a computer-aided EEG based system can be deployed in the hospitals, which can help identify the sleep stages, correctly. Several automated systems based on the analysis of polysomnographic (PSG) signals have been proposed. A few sleep stage scoring systems using EEG signals have also been proposed. But, still there is a need for a robust and accurate portable system developed using huge dataset. In this study, we have developed a new single-channel EEG based sleep-stages identification system using a novel set of wavelet-based features extracted from a large EEG dataset. We employed a novel three-band time-frequency localized (TBTFL) wavelet filter bank (FB). The EEG signals are decomposed using three-level wavelet decomposition, yielding seven sub-bands (SBs). This is followed by the computation of discriminating features namely, log-energy (LE), signal-fractal-dimensions (SFD), and signal-sample-entropy (SSE) from all seven SBs. The extracted features are ranked and fed to the support vector machine (SVM) and other supervised learning classifiers. In this study, we have considered five different classification problems (CPs), (two-class (CP-1), three-class (CP-2), four-class (CP-3), five-class (CP-4) and six-class (CP-5)). The proposed system yielded accuracies of 98.3%, 93.9%, 92.1%, 91.7%, and 91.5% for CP-1 to CP-5, respectively, using 10-fold cross validation (CV) technique. Copyright © 2018 Elsevier Ltd. All rights reserved.

Associations of Child Insomnia, Sleep Movement, and Their Persistence With Mental Health Symptoms in Childhood and Adolescence

PubMed Central

Armstrong, Jeffrey M.; Ruttle, Paula L.; Klein, Marjorie H.; Essex, Marilyn J.; Benca, Ruth M.

2014-01-01

Study Objectives: To examine the patterns of insomnia and sleep-related movement from ages 4.5 to 9 years, their concurrent associations with mental health symptoms in childhood, and the longitudinal associations of sleep-problem persistence with mental health symptoms at ages 9 and 18 years. Design: A 14-year prospective follow-up study. Assessments included maternal report on the Children's Sleep Habits Questionnaire at ages 4.5 and 9, and child mental health symptoms via maternal report at age 4.5, multi-informant (child, teacher, mother) report at age 9, and adolescent report at age 18. Setting: Community. Participants: A total of 396 children (51% female). Interventions: N/A. Measurements and Results: Sleep problems were more common at age 4.5 than 9; symptoms of insomnia and abnormal sleep movement both had persistence rates of 9–10%. At age 4.5, insomnia was associated with hostile-aggressive and hyperactive-distractible behavior, but there were no significant associations for sleep movement. At age 9, both insomnia and sleep movement were associated with symptoms of depression, externalizing, and attention deficit hyperactivity disorder (ADHD). Insomnia persistence was associated with symptoms of depression, externalizing, and ADHD at age 9 and anxiety and externalizing at age 18; sleep- movement persistence was associated with externalizing and ADHD at age 9, and ADHD at age 18. The age 18 persistence effects for insomnia and anxiety and for sleep movement and ADHD were significant when controlling for earlier mental health. Conclusions: Childhood insomnia and sleep movement are common and associated with mental health symptoms. Their persistence from middle to late childhood predicts associations with specific types of mental health symptoms at age 18. Citation: Armstrong JM, Ruttle PL, Klein MH, Essex MJ, Benca RM. Associations of child insomnia, sleep movement, and their persistence with mental health symptoms in childhood and adolescence. SLEEP 2014;37(5):901-909. PMID:24790268

Sleep Habits, Insomnia, and Daytime Sleepiness in a Large and Healthy Community-Based Sample of New Zealanders

PubMed Central

Wilsmore, Bradley R.; Grunstein, Ronald R.; Fransen, Marlene; Woodward, Mark; Norton, Robyn; Ameratunga, Shanthi

2013-01-01

Study Objectives: To determine the relationship between sleep complaints, primary insomnia, excessive daytime sleepiness, and lifestyle factors in a large community-based sample. Design: Cross-sectional study. Setting: Blood donor sites in New Zealand. Patients or Participants: 22,389 individuals aged 16-84 years volunteering to donate blood. Interventions: N/A. Measurements: A comprehensive self-administered questionnaire including personal demographics and validated questions assessing sleep disorders (snoring, apnea), sleep complaints (sleep quantity, sleep dissatisfaction), insomnia symptoms, excessive daytime sleepiness, mood, and lifestyle factors such as work patterns, smoking, alcohol, and illicit substance use. Additionally, direct measurements of height and weight were obtained. Results: One in three participants report < 7-8 h sleep, 5 or more nights per week, and 60% would like more sleep. Almost half the participants (45%) report suffering the symptoms of insomnia at least once per week, with one in 5 meeting more stringent criteria for primary insomnia. Excessive daytime sleepiness (evident in 9% of this large, predominantly healthy sample) was associated with insomnia (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.50 to 2.05), depression (OR 2.01, CI 1.74 to 2.32), and sleep disordered breathing (OR 1.92, CI 1.59 to 2.32). Long work hours, alcohol dependence, and rotating work shifts also increase the risk of daytime sleepiness. Conclusions: Even in this relatively young, healthy, non-clinical sample, sleep complaints and primary insomnia with subsequent excess daytime sleepiness were common. There were clear associations between many personal and lifestyle factors—such as depression, long work hours, alcohol dependence, and rotating shift work—and sleep problems or excessive daytime sleepiness. Citation: Wilsmore BR; Grunstein RR; Fransen M; Woodward M; Norton R; Ameratunga S. Sleep habits, insomnia, and daytime sleepiness in a large and healthy community-based sample of New Zealanders. J Clin Sleep Med 2013;9(6):559-566. PMID:23772189

Are job strain and sleep disturbances prognostic factors for neck/shoulder/arm pain? A cohort study of a general population of working age in Sweden

PubMed Central

Rasmussen-Barr, E; Grooten, W J A; Hallqvist, J; Holm, L W; Skillgate, E

2014-01-01

Objective To study whether job strain, that is, psychological job demands and decision latitude, and sleep disturbances among persons with occasional neck/shoulder/arm pain (NSAP) are prognostic factors for having experienced at least one episode of troublesome NSAP, and to determine whether sleep disturbances modify the association between job strain and troublesome NSAP. Design Prospective cohort study. Setting Stockholm, Sweden. Participants A population-based cohort of individuals with occasional NSAP (n=6979) who answered surveys in 2006 and 2010. Outcome measures Report of at least one episode of troublesome NSAP in 2010. Results The ORs for troublesome NSAP at follow-up were in individuals exposed to passive jobs 1.2 (95% CI 0.9 to 1.4); to active jobs 1.3 (95% CI 1.1 to 1.5); to high strain 1.5 (95% CI 1.0 to 2.4); to mild sleep disturbances 1.4 (95% CI 1.3 to 1.6) and to severe sleep disturbances 2.2 (95% CI 1.6 to 3.0). High strain and active jobs were associated with having experienced at least one episode of troublesome NSAP during the previous 6 months in persons with sleep disturbances, but not in individuals without sleep disturbances. Conclusions Our results indicate that high strain, active jobs and sleep disturbances are prognostic factors that should be taken into account when implementing preventive measures to minimise the risk of troublesome NSAP among people of working age. We suggest that sleep disturbances may modify the association between high strain and troublesome NSAP. PMID:25005596

The impact of sleep loss on the facilitation of seizures: A prospective case-crossover study.

PubMed

Samsonsen, Christian; Sand, Trond; Bråthen, Geir; Helde, Grethe; Brodtkorb, Eylert

2016-11-01

The relationship between sleep and seizures is intricate. The aim of this study was to assess whether sleep loss is an independent seizure precipitant in a clinical setting. In this prospective, observational cross-over study, 179 consecutive hospital admissions for epileptic seizures were included. A semi-structured interview regarding several seizure precipitants was performed. The sleep pattern prior to the seizure, as well as alcohol, caffeine and drug use, were recorded. The interview was repeated by telephone covering the same weekday at a time when there had been no recent seizure. The Hospital Anxiety and Depression Scale (HADS) and a visual analogue scale for perceived stress were applied at admission. Student's t-test, Fisher exact test and ANOVA were used for statistical analyses. Complete data for analysis were retrieved in 144 patients. The sleep-time during the 24h prior to the seizure was lower (7.3h) compared to follow-up (8.3h; p<0.0005). Caffeine consumption and use of relevant non antiepileptic drugs (AED) were not different. HADS and stress scores at admission did not correlate with sleep-time difference. In ANOVA, controlled for alcohol consumption and AED use, the sleep-time difference remained significant (p=0.008). The interaction with alcohol intake was high, but the sleep-time difference remained highly significant also for the non- and low-consumption (≤2 units per day) subgroup (n=121, 7.50h vs 8.42h, p=0.001). Epileptic seizures are often precipitated by a combination of various clinical factors, but sleep loss stands out as an independent seizure trigger. Copyright © 2016 Elsevier B.V. All rights reserved.

Sex Differences in the Association of Regional Fat Distribution with the Severity of Obstructive Sleep Apnea

PubMed Central

Simpson, Laila; Mukherjee, Sutapa; Cooper, Matthew N.; Ward, Kim L.; Lee, Jessica D.; Fedson, Annette C.; Potter, Jane; Hillman Fanzca, David R.; Eastwood, Peter; Palmer, Lyle J.; Kirkness, Jason

2010-01-01

Study Objectives: To describe sex differences in the associations between severity of obstructive sleep apnea (OSA) and measures of obesity in body regions defined using both dual-energy absorptiometry and traditional anthropometric measures in a sleep-clinic sample. Design: A prospective case-series observational study. Setting: The Western Australian Sleep Health Study operating out of the Sir Charles Gairdner Hospital Sleep Clinic, Perth, Western Australia. Participants: Newly referred clinic patients (60 men, 36 women) suspected of having OSA. Interventions: N/A Measurements and Results: Obstructive sleep apnea severity was defined by apnea-hypopnoea index from laboratory-based overnight polysomnography. Body mass index, neck, waist and hip circumference, neck-to-waist ratio, and waist-to-hip ratio were measured. Dual energy absorptiometry measurements included percentage fat and lean tissue. Multivariate regression models for each sex were developed. In women, percentage of fat in the neck region and body mass index together explained 33% of the variance in apnea-hypopnea index. In men, percentage of fat in the abdominal region and neck-to-waist ratio together accounted for 37% of the variance in apnea-hypopnea index. Conclusions: Regional obesity is associated with obstructive sleep apnea severity, although differently in men and women. In women, a direct influence of neck fat on the upper airway patency is implicated. In men, abdominal obesity appears to be the predominant influence. The apnea-hypopnea index was best predicted by a combination of Dual Energy Absorptiometry-measured mass and traditional anthropometric measurements. Citation: Simpson L; Mukherjee S; Cooper MN; Ward KL; Lee JD; Fedson AC; Potter J; Hillman Fanzca DR; Eastwood P; Palmer LJ; Kirkness J. Sex differences in the association of regional fat distribution with the severity of obstructive sleep apnea. SLEEP 2010;33(4):467-474 PMID:20394315

Insomnia in Patients with COPD

PubMed Central

Budhiraja, Rohit; Parthasarathy, Sairam; Budhiraja, Pooja; Habib, Michael P.; Wendel, Christopher; Quan, Stuart F.

2012-01-01

Study Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality and may frequently be associated with sleep disturbances. However, the correlates of insomnia in COPD patients have not been well characterized. The aim of the current study was to describe the prevalence of insomnia disorder in COPD and to elucidate the demographic and clinical characteristics of COPD patients that are associated with insomnia. Design: Cross-sectional study. Setting: Clinic-based sample from an academic hospital. Participants: Patients with stable COPD. Measurements: An interviewer-conducted survey was administered to 183 participants with COPD. Seventy-two of these participants (30 with and 42 without insomnia) maintained a sleep diary and underwent actigraphy for 7 days. Results: Insomnia (chronic sleep disturbance associated with impaired daytime functioning) was present in 27.3% of participants. Current tobacco users (odds ratio (OR), 2.13) and those with frequent sadness/anxiety (OR, 3.57) had higher odds, but oxygen use was associated with lower odds (OR, 0.35) of insomnia. Patients with insomnia had worse quality of life and a higher prevalence of daytime sleepiness. Actigraphy revealed shorter sleep duration and lower sleep efficiency, and a sleep diary revealed worse self-reported sleep quality in participants with insomnia. Conclusion: Insomnia disorder is highly prevalent in patients with COPD; current tobacco use and sadness/anxiety are associated with a higher prevalence, and oxygen use with a lower prevalence of insomnia; patients with insomnia have poorer quality of life and increased daytime sleepiness; and insomnia is associated with worse objective sleep quality. Citation: Budhiraja R; Parthasarathy S; Budhiraja P; Habib MP; Wendel C; Quan SF. Insomnia in patients with COPD. SLEEP 2012;35(3):369-375. PMID:22379243

Detecting REM sleep from the finger: an automatic REM sleep algorithm based on peripheral arterial tone (PAT) and actigraphy.

PubMed

Herscovici, Sarah; Pe'er, Avivit; Papyan, Surik; Lavie, Peretz

2007-02-01

Scoring of REM sleep based on polysomnographic recordings is a laborious and time-consuming process. The growing number of ambulatory devices designed for cost-effective home-based diagnostic sleep recordings necessitates the development of a reliable automatic REM sleep detection algorithm that is not based on the traditional electroencephalographic, electrooccolographic and electromyographic recordings trio. This paper presents an automatic REM detection algorithm based on the peripheral arterial tone (PAT) signal and actigraphy which are recorded with an ambulatory wrist-worn device (Watch-PAT100). The PAT signal is a measure of the pulsatile volume changes at the finger tip reflecting sympathetic tone variations. The algorithm was developed using a training set of 30 patients recorded simultaneously with polysomnography and Watch-PAT100. Sleep records were divided into 5 min intervals and two time series were constructed from the PAT amplitudes and PAT-derived inter-pulse periods in each interval. A prediction function based on 16 features extracted from the above time series that determines the likelihood of detecting a REM epoch was developed. The coefficients of the prediction function were determined using a genetic algorithm (GA) optimizing process tuned to maximize a price function depending on the sensitivity, specificity and agreement of the algorithm in comparison with the gold standard of polysomnographic manual scoring. Based on a separate validation set of 30 patients overall sensitivity, specificity and agreement of the automatic algorithm to identify standard 30 s epochs of REM sleep were 78%, 92%, 89%, respectively. Deploying this REM detection algorithm in a wrist worn device could be very useful for unattended ambulatory sleep monitoring. The innovative method of optimization using a genetic algorithm has been proven to yield robust results in the validation set.

Short sleep duration and childhood obesity: cross-sectional analysis in Peru and patterns in four developing countries.

PubMed

Carrillo-Larco, Rodrigo M; Bernabé-Ortiz, Antonio; Miranda, J Jaime

2014-01-01

We aimed to describe the patterns of nutritional status and sleep duration in children from Ethiopia, India, Peru and Vietnam; to assess the association between short sleep duration and overweight and obesity, and if this was similar among boys and girls in Peru. Analysis of the Young Lives Study, younger cohort, third round. In Ethiopia there were 1,999 observations, 2,011, 2,052 and 2,000 in India, Peru and Vietnam, respectively. Analyses included participants with complete data for sleep duration, BMI, sex and age; missing data: 5.9% (Ethiopia), 4.1% (India), 6.0% (Peru) and 4.5% (Vietnam). Exposure was sleep duration per day: short (<10 hours) versus regular (10-11 hours). Outcome was overweight and obesity. Multivariable analyses were conducted using a hierarchical approach to assess the effect of variables at different levels. Overweight/obesity prevalence was 0.5%/0.2% (Ethiopia), 1.3%/0.3% (India), 6.1%/2.8% (Vietnam), and 15.8%/5.4% (Peru). Only Peruvian data was considered to explore the association between short sleep duration and overweight and obesity, with 1,929 children, aged 7.9±0.3 years, 50.3% boys. Short and regular sleep duration was 41.6% and 55.6%, respectively. Multivariable models showed that obesity was 64% more prevalent among children with short sleep duration, an estimate that lost significance after controlling for individual- and family-related variables (PR: 1.15; 95%CI: 0.81-1.64). Gender was an effect modifier of the association between short sleep duration and overweight (p = 0.030) but not obesity (p = 0.533): the prevalence ratio was greater than one across all the models for boys, yet it was less than one for girls. Childhood overweight and obesity have different profiles across developing settings. In a sample of children living in resource-limited settings in Peru there is no association between short sleep duration and obesity; the crude association was slightly attenuated by children-related variables but strongly diminished by family-related variables.

Short Sleep Duration and Childhood Obesity: Cross-Sectional Analysis in Peru and Patterns in Four Developing Countries

PubMed Central

Carrillo-Larco, Rodrigo M.; Bernabé-Ortiz, Antonio; Miranda, J. Jaime

2014-01-01

Background We aimed to describe the patterns of nutritional status and sleep duration in children from Ethiopia, India, Peru and Vietnam; to assess the association between short sleep duration and overweight and obesity, and if this was similar among boys and girls in Peru. Methods and Findings Analysis of the Young Lives Study, younger cohort, third round. In Ethiopia there were 1,999 observations, 2,011, 2,052 and 2,000 in India, Peru and Vietnam, respectively. Analyses included participants with complete data for sleep duration, BMI, sex and age; missing data: 5.9% (Ethiopia), 4.1% (India), 6.0% (Peru) and 4.5% (Vietnam). Exposure was sleep duration per day: short (<10 hours) versus regular (10–11 hours). Outcome was overweight and obesity. Multivariable analyses were conducted using a hierarchical approach to assess the effect of variables at different levels. Overweight/obesity prevalence was 0.5%/0.2% (Ethiopia), 1.3%/0.3% (India), 6.1%/2.8% (Vietnam), and 15.8%/5.4% (Peru). Only Peruvian data was considered to explore the association between short sleep duration and overweight and obesity, with 1,929 children, aged 7.9±0.3 years, 50.3% boys. Short and regular sleep duration was 41.6% and 55.6%, respectively. Multivariable models showed that obesity was 64% more prevalent among children with short sleep duration, an estimate that lost significance after controlling for individual- and family-related variables (PR: 1.15; 95%CI: 0.81–1.64). Gender was an effect modifier of the association between short sleep duration and overweight (p = 0.030) but not obesity (p = 0.533): the prevalence ratio was greater than one across all the models for boys, yet it was less than one for girls. Conclusions Childhood overweight and obesity have different profiles across developing settings. In a sample of children living in resource-limited settings in Peru there is no association between short sleep duration and obesity; the crude association was slightly attenuated by children-related variables but strongly diminished by family-related variables. PMID:25393729

Sleep Estimates Using Microelectromechanical Systems (MEMS)

PubMed Central

te Lindert, Bart H. W.; Van Someren, Eus J. W.

2013-01-01

Study Objectives: Although currently more affordable than polysomnography, actigraphic sleep estimates have disadvantages. Brand-specific differences in data reduction impede pooling of data in large-scale cohorts and may not fully exploit movement information. Sleep estimate reliability might improve by advanced analyses of three-axial, linear accelerometry data sampled at a high rate, which is now feasible using microelectromechanical systems (MEMS). However, it might take some time before these analyses become available. To provide ongoing studies with backward compatibility while already switching from actigraphy to MEMS accelerometry, we designed and validated a method to transform accelerometry data into the traditional actigraphic movement counts, thus allowing for the use of validated algorithms to estimate sleep parameters. Design: Simultaneous actigraphy and MEMS-accelerometry recording. Setting: Home, unrestrained. Participants: Fifteen healthy adults (23-36 y, 10 males, 5 females). Interventions: None. Measurements: Actigraphic movement counts/15-sec and 50-Hz digitized MEMS-accelerometry. Analyses: Passing-Bablok regression optimized transformation of MEMS-accelerometry signals to movement counts. Kappa statistics calculated agreement between individual epochs scored as wake or sleep. Bland-Altman plots evaluated reliability of common sleep variables both between and within actigraphs and MEMS-accelerometers. Results: Agreement between epochs was almost perfect at the low, medium, and high threshold (kappa = 0.87 ± 0.05, 0.85 ± 0.06, and 0.83 ± 0.07). Sleep parameter agreement was better between two MEMS-accelerometers or a MEMS-accelerometer and an actigraph than between two actigraphs. Conclusions: The algorithm allows for continuity of outcome parameters in ongoing actigraphy studies that consider switching to MEMS-accelerometers. Its implementation makes backward compatibility feasible, while collecting raw data that, in time, could provide better sleep estimates and promote cross-study data pooling. Citation: te Lindert BHW; Van Someren EJW. Sleep estimates using microelectromechanical systems (MEMS). SLEEP 2013;36(5):781-789. PMID:23633761

[Pilot study to investigate sleep disorders in the blind and persons with relevant visual impairment].

PubMed

Dirks, C; Grünewald, D; Young, P; Heidbreder, A

2018-05-22

Sleep disorders are associated with serious health problems in blind and visually impaired persons. Loss of light perception may result in a shift of sleep-wake pattern, which may lead to significant impairments in daily life--the so-called non-24-hour sleep-wake disorder. To date, epidemiologic data on non-24 only exist for the USA. This pilot study was conducted to provide first epidemiologic data for the prevalence of non-24 and other sleep disorders among blind and visually impaired persons in Germany. Recruited were 111 blind and visually impaired subjects (36 subjects without light perception; male [m] = 56, 27-85 years, average [Mx] = 59.53, standard deviation [SD] = 14.69) and 111 sighted controls (m = 41, 27-88 years, Mx = 58.32, SD = 14.21), who answered a set of validated questionnaires referring to general health status (SF-36), sleep characteristics (PSQI), and daytime sleepiness (ESS). In addition, a questionnaire to predict non-24-hour sleep-wake disorder, which is not yet validated in German, was provided. The prevalence of 72.2% for the non-24-hour sleep-wake disorder in blind people is in accordance with results from the USA. In contrast, our results indicated non-24 in only 21.3% of the subjects with residual light perception. Furthermore, other sleep disorders like problems falling asleep (100% vs. 79.9%), maintaining sleep (90% vs. 88.1%), sleep-disordered breathing (19.4% vs. 32%), or sleep-related movement disorders (28.1% vs. 32.9%) were also common in the group of blind or visually impaired persons. The non-24-hour sleep-wake disorder is a frequent problem among people with no light perception, associated with problems falling asleep, maintaining sleep, and daytime sleepiness. The perception of light as an external cue for our circadian rhythm plays a key role. However, sleep disruption is not fully explained by non-24, making a detailed sleep history essential.

Short Sleep Duration in Middle Childhood: Risk Factors and Consequences

PubMed Central

Nixon, Gillian M.; Thompson, John M. D.; Han, Dug Yeo; Becroft, David M.; Clark, Phillipa M.; Robinson, Elizabeth; Waldie, Karen E.; Wild, Chris J.; Black, Peter N.; Mitchell, Edwin A.

2008-01-01

Study Objectives: To measure sleep duration in 7-year-old children; identify the determinants of sleep duration; and assess the association between short sleep duration and obesity, cognitive functioning, and behaviour. Design: Longitudinal study with disproportionate sampling of the participants. Setting: Community. Participants: 591 seven-year-old children, of whom 519 had complete sleep data. Interventions: Not applicable. Measurements: Sleep duration was assessed by actigraphy. Other measurements included height, weight, BMI, percentage body fat as assessed by bioimpedance assay, intelligence (WISC-III) and behaviour (Strengths & Difficulties questionnaire, parent and teachers Conners Rating Scales). Results: Mean time in bed according to parental report was 10.9 hours (SD 0.8). Mean sleep duration by actigraphy was 10.1 (SD 0.8) hours. In multivariable analysis, sleep duration was longer on weekdays vs. weekend nights (31.5 min, P = 0.002), in winter (40.5 min), autumn (31.1 min), and spring (14.8 min) compared with summer (P <0.0001), and in those with younger siblings (11.7 min, P = 0.03). Sleep duration was shorter when bedtime was after 21:00 (−41.1 min, P <0.0001). In multivariable analysis, sleep duration <9 hours was associated with being overweight/obese (BMI: OR = 3.32; 95% CI = 1.40, 7.87) with an increase of 3.34% body fat (P = 0.03), and this was not explained by physical activity or television watching. Short sleep duration was also associated with higher emotional lability scores (Conners Rating Scale Parent Form; P = 0.03). IQ (WISC-III) and attention deficit / hyperactivity disorder scores (both parent and teachers Conners Rating Scales) did not differ with sleep duration. Conclusions: Sleep duration in 7-year-old children varies considerably among individuals. The duration is affected by weekday, season, and having younger siblings. Importantly, short sleep duration was shown to be an independent risk factor for obesity/overweight. Citation: Nixon GM; Thompson JMD; Han DY; Becroft DM; Clark PM; Robinson E; Waldie KE; Wild CJ; Black PN; Mitchell EA. Short sleep duration in middle childhood: risk factors and consequences. SLEEP 2008;31(1):71-78. PMID:18220080

Shared Genetic Background for Regulation of Mood and Sleep: Association of GRIA3 with Sleep Duration in Healthy Finnish Women

PubMed Central

Utge, Siddheshwar; Kronholm, Erkki; Partonen, Timo; Soronen, Pia; Ollila, Hanna M.; Loukola, Anu; Perola, Markus; Salomaa, Veikko; Porkka-Heiskanen, Tarja; Paunio, Tiina

2011-01-01

Study Objectives: Sleeping 7 to 8 hours per night appears to be optimal, since both shorter and longer sleep times are related to increased morbidity and mortality. Depressive disorder is almost invariably accompanied by disturbed sleep, leading to decreased sleep duration, and disturbed sleep may be a precipitating factor in the initiation of depressive illness. Here, we examined whether, in healthy individuals, sleep duration is associated with genes that we earlier found to be associated with depressive disorder. Design: Population-based molecular genetic study. Setting: Regression analysis of 23 risk variants for depressive disorder from 12 genes to sleep duration in healthy individuals. Participants: Three thousand, one hundred, forty-seven individuals (25–75 y) from population-based Health 2000 and FINRISK 2007 samples. Measurements and Results: We found a significant association of rs687577 from GRIA3 on the X-chromosome with sleep duration in women (permutation-based corrected empirical P = 0.00001, β = 0.27; Bonferroni corrected P = 0.0052; f = 0.11). The frequency of C/C genotype previously found to increase risk for depression in women was highest among those who slept for 8 hours or less in all age groups younger than 70 years. Its frequency decreased with the lengthening of sleep duration, and those who slept for 9 to 10 hours showed a higher frequency of C/A or A/A genotypes, when compared with the midrange sleepers (7-8 hours) (permutation-based corrected empirical P = 0.0003, OR = 1.81). Conclusions: The GRIA3 polymorphism that was previously found to be associated with depressive disorder in women showed an association with sleep duration in healthy women. Mood disorders and short sleep may share a common genetic background and biologic mechanisms that involve glutamatergic neurotransmission. Citation: Utge S; Kronholm E; Partonen T; Soronen P; Ollila HM; Loukola A; Perola M; Salomaa V; Porkka-Heiskanen T; Paunio T. Shared genetic background for regulation of mood and sleep: association of GRIA3 with sleep duration in healthy Finnish women. SLEEP 2011;34(10):1309-1316. PMID:21966062

Short- and Long-Term Sleep Stability in Insomniacs and Healthy Controls

PubMed Central

Gaines, Jordan; Vgontzas, Alexandros N.; Fernandez-Mendoza, Julio; Basta, Maria; Pejovic, Slobodanka; He, Fan; Bixler, Edward O.

2015-01-01

Study Objectives: Assess the short- and long-term stability of sleep duration in patients with insomnia and normal-sleeping controls. Design: Observational short-term and prospective studies. Setting: Sleep laboratory. Participants: Patients with insomnia (n = 150) and controls (n = 151) were recruited from the local community or sleep disorders clinic. A subsample of 95 men from the Penn State Adult Cohort (PSAC) were followed up 2.6 y after their initial visit. Measurements: Participants underwent a physical examination and 8-h polysomnography (PSG) recording for 3 consecutive nights (controls and insomniacs), or 2 single nights separated by several years (PSAC). Intraclass correlation coefficients (ICCs) assessed the stability of the variables total sleep time (TST), sleep onset latency (SOL), and wake after sleep onset (WASO). We also examined persistence of the first-night classification of “short” versus “normal” sleep duration on subsequent nights. Results: Stability of TST, SOL, and WASO based on 1 night were slight to moderate in both patients with insomnia (ICC = 0.37–0.57) and controls (ICC = 0.39–0.59), and became substantial to almost perfect when based on the average of 3 nights (ICC = 0.64–0.81). We observed similar degrees of stability for TST and WASO in the longitudinal sample, with moderate stability based on a single night and substantial stability based on both nights. In examining the persistence of “short” and “normal” sleep duration, 71.4% (controls), 74.7% (patients with insomnia), and 72.6% (longitudinal sample) of participants retained their first-night classifications over subsequent nights. Conclusions: Sleep duration variables, particularly total sleep time based on 3 consecutive nights in both patients with insomnia and controls or two single-night recordings separated by several years, are stable and reflect a person's habitual sleep. Furthermore, a single night in the laboratory may be useful for reliably classifying one's sleep duration. Citation: Gaines J, Vgontzas AN, Fernandez-Mendoza J, Basta M, Pejovic S, He F, Bixler EO. Short- and long-term sleep stability in insomniacs and healthy controls. SLEEP 2015;38(11):1727–1734. PMID:26237768

Factors influencing maternal decision-making for the infant sleep environment in families at higher risk of SIDS: a qualitative study

PubMed Central

Ingram, Jenny; Blair, Peter S; Fleming, Peter J

2017-01-01

Objective Qualitative interviews with mothers of babies at higher risk of sudden infant death syndrome (SIDS) were carried out to understand their views and decision-making process on the infant sleep environment and safe sleep messages. Design and setting Twenty semi-structured interviews were conducted between February and November 2014 in deprived areas of Bristol, UK. Mothers were asked about their decision-making for the infant sleep environment and safe sleep messages including infant sleep position, co-sleeping, smoking, dummy use, feeding and disrupted routines. The interviews were transcribed, coded and thematic analysis carried out. Participants Participants were invited based on an algorithm developed in a previous SIDS case control study that identified an increased risk of SIDS from four demographic characteristics: young maternal age, smoking during pregnancy, three or more children, and a measure of deprivation. The presence of three, or more characteristics led to being invited to take part in the qualitative study. Results Factors influencing mothers’ adherence to the safe sleep messages included previous experience and the credibility of the advice given. They described disrupted routines that led to risky scenarios with a belief that occasional risks were acceptable. Where circumstances made following the advice more difficult they found alternative strategies to reduce the risk, including the use of movement monitors, regular checking and a belief that lighter maternal sleep in the presence of a baby was protective. Conclusions Safer sleep messages should be tailored to fit with the lived realities of mothers, especially those at higher risk. The traditional list of ‘do’s’ and ‘don’ts’ was not well accepted by this group. Interventions that seek to influence this higher-risk group should acknowledge mothers’ own protective instincts and consider their beliefs and understanding behind the safer sleep messages if they are to be effective and encourage this group to change. PMID:29637151

Testosterone Conversion Blockade Increases Breathing Stability in Healthy Men during NREM Sleep

PubMed Central

Chowdhuri, Susmita; Bascom, Amy; Mohan, David; Diamond, Michael P.; Badr, M. Safwan

2013-01-01

Study Objectives: Gender differences in the prevalence of sleep apnea/hypopnea syndrome may be mediated via male sex hormones. Our objective was to determine the exact pathway for a testosterone-mediated increased propensity for central sleep apnea via blockade of the 5α-reductase pathway of testosterone conversion by finasteride. Design: Randomization to oral finasteride vs. sham, single-center study. Setting: Sleep research laboratory. Participants: Fourteen healthy young males without sleep apnea Intervention: Hypocapnia was induced via brief nasal noninvasive positive pressure ventilation during stable NREM sleep. Cessation of mechanical ventilation resulted in hypocapnic central apnea or hypopnea. Measurements and Results: The apnea threshold (AT) was defined as the end-tidal CO2 (PETCO2) that demarcated the central apnea closest to the eupneic PETCO2. The CO2 reserve was defined as the difference in PETCO2 between eupnea and AT. The apneic threshold and CO2 reserve were measured at baseline and repeated after at a minimum of 1 month. Administration of finasteride resulted in decreased serum dihydrotestosterone. In the finasteride group, the eupneic ventilatory parameters were unchanged; however, the AT was decreased (38.9 ± 0.6 mm Hg vs.37.7 ± 0.9 mm Hg, P = 0.02) and the CO2 reserve was increased (-2.5 ± 0.3 mm Hg vs. -3.8 ± 0.5 mm Hg, P = 0.003) at follow-up, with a significantly lower hypocapnic ventilatory response, thus indicating increased breathing stability during sleep. No significant changes were noted in the sham group on follow-up study. Conclusions: Inhibition of testosterone action via the 5α-reductase pathway may be effective in alleviating breathing instability during sleep, presenting an opportunity for novel therapy for central sleep apnea in selected populations. Citation: Chowdhuri S; Bascom A; Mohan D; Diamond MP; Badr MS. Testosterone conversion blockade increases breathing stability in healthy men during NREM sleep. SLEEP 2013;36(12):1793-1798. PMID:24293753

Trends in Self-Reported Sleep Duration among US Adults from 1985 to 2012

PubMed Central

Ford, Earl S.; Cunningham, Timothy J.; Croft, Janet B.

2015-01-01

Study Objective: The trend in sleep duration in the United States population remains uncertain. Our objective was to examine changes in sleep duration from 1985 to 2012 among US adults. Design: Trend analysis. Setting: Civilian noninstitutional population of the United States. Participants: 324,242 US adults aged ≥ 18 y of the National Health Interview Survey (1985, 1990, and 2004–2012). Measurements and Results: Sleep duration was defined on the basis of the question “On average, how many hours of sleep do you get in a 24-h period?” The age-adjusted mean sleep duration was 7.40 h (standard error [SE] 0.01) in 1985, 7.29 h (SE 0.01) in 1990, 7.18 h (SE 0.01) in 2004, and 7.18 h (SE 0.01) in 2012 (P 2012 versus 1985 < 0.001; P trend 2004–2012 = 0.982). The age-adjusted percentage of adults sleeping ≤ 6 h was 22.3% (SE 0.3) in 1985, 24.4% (SE 0.3) in 1990, 28.6% (SE 0.3) in 2004, and 29.2% (SE 0.3) in 2012 (P 2012 versus 1985 < 0.001; P trend 2004–2012 = 0.050). In 2012, approximately 70.1 million US adults reported sleeping ≤ 6 h. Conclusions: Since 1985, age-adjusted mean sleep duration has decreased slightly and the percentage of adults sleeping ≤ 6 h increased by 31%. Since 2004, however, mean sleep duration and the percentage of adults sleeping ≤ 6 h have changed little. Citation: Ford ES, Cunningham TJ, Croft JB. Trends in self-reported sleep duration among US adults from 1985 to 2012. SLEEP 2015;38(5):829–832. PMID:25669182

Using Repeated Measures of Sleep Disturbances to Predict Future Diagnosis-Specific Work Disability: A Cohort Study

PubMed Central

Salo, Paula; Vahtera, Jussi; Hall, Martica; Rod, Naja Hulvej; Virtanen, Marianna; Pentti, Jaana; Sjösten, Noora; Oksanen, Tuula; Kivimäki, Mika

2012-01-01

Context: It is unknown whether or not measuring sleep disturbances repeatedly, rather than at only one point in time, improves prediction of work disability. Study Objective: o examine sleep disturbance patterns over time as a risk marker for diagnosis-specific work disability. Design: rospective cohort study linking repeatedly measured self-reported sleep disturbances with records of physician-certified work disability (sickness absence) from a national register. Participants responded to surveys in 2000–2002, and 2004, and were followed up for 12 mo. Setting: Public sector employees in Finland. Participants: 25,639 participants (mean age 45.6 yr, 82% female). Main Outcome Measure: Incident diagnosis-specific sickness absence of > 9 days. Results: During a mean follow-up of 323 days, 4,975 employees (19%) had a new episode of sickness absence. In multivariable-adjusted models corrected for multiple testing, stable severe sleep disturbances, in comparison with no sleep disturbances, were associated with an increased risk of sickness absence due to diseases of the musculoskeletal system (hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.45–1.95), and injuries and poisonings (HR 1.64, 95% CI 1.23–2.18). Increases in sleep disturbances predicted subsequent sickness absence due to mental disorders (HR 1.59, 95% CI 1.32–1.91), and diseases of the musculoskeletal system (HR 1.44, 95% CI 1.27–1.64) According to net reclassification improvement analyses, measurement of sleep disturbance patterns rather than the level of sleep disturbances at one point in time improved prediction of all-cause sickness absence by 14%, and diagnosis-specific sickness absences up to 17% (P for improvement < 0.001). Conclusions: Increasing and severe chronic sleep disturbances mark an increased risk of diagnosis-specific work disability. Citation: Salo P; Vahtera J; Hall M; Rod NH; Virtanen M; Pentti J; Sjösten N; Oksanen T; Kivimäki M. Using repeated measures of sleep disturbances to predict future diagnosis-specific work disability: a cohort study. SLEEP 2012;35(4):559-569. PMID:22467994

Is sexual minority status associated with poor sleep quality among adolescents? Analysis of a national cross-sectional survey in Chinese adolescents

PubMed Central

Li, Pengsheng; Huang, Yeen; Guo, Lan; Wang, Wanxin; Xi, Chuhao; Lei, Yiling; Luo, Min; Pan, Siyuan; Deng, Xueqing; Zhang, Wei-hong; Lu, Ciyong

2017-01-01

Objectives Recent studies have suggested that sexual minorities are more likely to have poor sleep quality. This study aims to explore sleep quality among sexual minority adolescents and examines the association between sexual minority status and sleep quality. Design Cross-sectional survey. Setting A total of 506 high schools in seven Chinese provinces. Participants A total of 150 822 students in grades 7–12 completed the questionnaires, and 123 459 students who reported being aware of their sexual orientation were included in analyses. Main outcome measures The Pittsburgh Sleep Quality Index, sexual attraction and school bullying victimisation. Results Of the 123 459 students who were analysed, 5.00% self-reported as sexual minorities. Only 26.67% of sexual minority students slept 8 or more hours/day, which is less than their heterosexual peers (35.70%; χ2=130.04, P<0.001). Of the total sample, 22.41% of the students reported poor sleep quality, and this prevalence was significantly higher in sexual minority students than in heterosexual students (32.56% vs 21.87%; χ2=281.70, P<0.001). After controlling for social demographics, lifestyle and depressive symptoms, sexual minority students had higher odds of poor sleep quality (adjusted OR=1.41, 95% CI 1.31 to 1.51) than their heterosexual peers. The indirect effect of school bullying victimisation (standardised β estimate=0.007, 95% CI 0.006 to 0.009) was significant, indicating that school bullying victimisation partially mediated the association between sexual minority status and sleep quality. Conclusions Our study suggested that poor sleep quality was common in sexual minority adolescents, and more attention should be paid to sleep problems in this population. Conducting interventions to reduce school bullying behaviours is an important step to improving sleep quality in sexual minority adolescents. Further, studies are warranted that focus on the risk factors and mechanisms of and interventions for sleep problems in sexual minority adolescents. PMID:29282258

Cytokine Polymorphisms are Associated with Poor Sleep Maintenance in Adults Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome

PubMed Central

Lee, Kathryn A.; Gay, Caryl; Pullinger, Clive R.; Hennessy, Mary Dawn; Zak, Rochelle S.; Aouizerat, Bradley E.

2014-01-01

Study Objectives: Cytokine activity and polymorphisms have been associated with sleep outcomes in prior animal and human research. The purpose of this study was to determine whether circulating plasma cytokines and cytokine polymorphisms are associated with the poor sleep maintenance commonly experienced by adults living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Design: Cross-sectional descriptive study. Setting: HIV clinics and community sites in the San Francisco Bay area. Participants: A convenience sample of 289 adults (193 men, 73 women, and 23 transgender) living with HIV/AIDS. Interventions: None. Measurements and Results: A wrist actigraph was worn for 72 h to estimate the percentage of wake after sleep onset (WASO%) and total sleep time (TST), plasma cytokines were analyzed, and genotyping was conducted for 15 candidate genes involved in cytokine signaling: interferon-gamma (IFNG), IFNG receptor 1 (IFNGR1), interleukins (IL1B, IL1R2, IL1R2, IL2, IL4, IL6, IL8, IL10, IL13, IL17A), nuclear factor of kappa light polypeptide gene enhancer in B cells (NFKB1 and NFKB2), and tumor necrosis factor-alpha (TNFA). Controlling for demographic variables such as race and sex, and clinical variables such as CD4+ count and medications, higher WASO% was associated with single nucleotide polymorphisms (SNPs) of IL1R2 rs11674595 and TNFA rs1041981 and less WASO% was associated with IL2 rs2069776. IL1R2 rs11674595 and TNFA rs1041981 were also associated with short sleep duration. Conclusions: This study strengthens the evidence for an association between inflammation and sleep maintenance problems. In this chronic illness population, cytokine polymorphisms associated with wake after sleep onset provide direction for intervention research aimed at comparing anti-inflammatory mechanisms with hypnotic agents for improving sleep maintenance and total sleep time. Citation: Lee KA; Gay C; Pullinger CR; Hennessy MD; Zak RS; Aouizerat BE. Cytokine polymorphisms are associated with poor sleep maintenance in adults living with human immunodeficiency virus/acquired immunodeficiency syndrome. SLEEP 2014;37(3):453-463. PMID:24587567

Detection of flow limitation in obstructive sleep apnea with an artificial neural network.

PubMed

Norman, Robert G; Rapoport, David M; Ayappa, Indu

2007-09-01

During sleep, the development of a plateau on the inspiratory airflow/time contour provides a non-invasive indicator of airway collapsibility. Humans recognize this abnormal contour easily, and this study replicates this with an artificial neural network (ANN) using a normalized shape. Five 10 min segments were selected from each of 18 sleep records (respiratory airflow measured with a nasal cannula) with varying degrees of sleep disordered breathing. Each breath was visually scored for shape, and breaths split randomly into a training and test set. Equally spaced, peak amplitude normalized flow values (representing breath shape) formed the only input to a back propagation ANN. Following training, breath-by-breath agreement of the ANN with the manual classification was tabulated for the training and test sets separately. Agreement of the ANN was 89% in the training set and 70.6% in the test set. When the categories of 'probably normal' and 'normal', and 'probably flow limited' and 'flow limited' were combined, the agreement increased to 92.7% and 89.4% respectively, similar to the intra- and inter-rater agreements obtained by a visual classification of these breaths. On a naive dataset, the agreement of the ANN to visual classification was 57.7% overall and 82.4% when the categories were collapsed. A neural network based only on the shape of inspiratory airflow succeeded in classifying breaths as to the presence/absence of flow limitation. This approach could be used to provide a standardized, reproducible and automated means of detecting elevated upper airway resistance.

Is the Relationship between Race and Continuous Positive Airway Pressure Adherence Mediated by Sleep Duration?

PubMed Central

Billings, Martha E.; Rosen, Carol L.; Wang, Rui; Auckley, Dennis; Benca, Ruth; Foldvary-Schaefer, Nancy; Iber, Conrad; Zee, Phyllis; Redline, Susan; Kapur, Vishesh K.

2013-01-01

Study Objectives: Black race has been associated with decreased continuous positive airway pressure (CPAP) adherence. Short sleep duration, long sleep latency, and insomnia complaints may affect CPAP adherence as they affect sleep and opportunity to use CPAP. We assessed whether self-reported sleep measures were associated with CPAP adherence and if racial variations in these sleep characteristics may explain racial differences in CPAP adherence. Design: Analysis of data from a randomized controlled trial (HomePAP), which investigated home versus laboratory-based diagnosis and treatment of obstructive sleep apnea. Setting: Seven American Academy of Sleep Medicine-accredited sleep centers in five cities in the United States. Patients or Participants: Enrolled subjects (n = 191) with apnea-hypopnea index ≥ 15 and sleepiness (Epworth Sleepiness Scale > 12). Interventions: N/A. Measurements and Results: Multivariable regression was used to assess if subjective sleep measures and symptoms predicted 3-mo CPAP use. Mediation analysis was used to assess if sleep measures mediated the association of race with CPAP adherence. Black participants reported shorter sleep duration and longer sleep latency at baseline than white and Hispanic participants. Shorter sleep duration and longer sleep latency predicted worse CPAP adherence. Sleep duration mediated the association of black race with lower CPAP adherence. However, insomnia symptoms were not associated with race or CPAP adherence. Conclusions: Among subjects with similar severity of obstructive sleep apnea and sleepiness, baseline self-reported sleep duration and latency, but not perceived insomnia, predicted CPAP adherence over 3 mo. Sleep duration explains some of the observed differences in CPAP use by race. Sleep duration and latency should be considered when evaluating poor CPAP adherence. Clinical Trial Information: Portable Monitoring for Diagnosis and Management of Sleep Apnea (HomePAP) URL: http://clinicaltrials.gov/show/NCT00642486. NIH clinical trials registry number: NCT00642486. Citation: Billings ME; Rosen CL; Wang R; Auckley D; Benca R; Foldvary-Schaefer N; Iber C; Zee P; Redline S; Kapur VK. Is the relationship between race and continuous positive airway pressure adherence mediated by sleep duration? SLEEP 2013;36(2):221-227. PMID:23372269

Can sleep quality and burnout affect the job performance of shift-work nurses? A hospital cross-sectional study.

PubMed

Giorgi, Fabio; Mattei, Antonella; Notarnicola, Ippolito; Petrucci, Cristina; Lancia, Loreto

2018-03-01

The aim of this study was to investigate any possible relationship between sleep disorders, burnout and job performance in a shift-work population of nurses. Sleep disorders and burnout can affect the job performance of nurses in terms of efficiency, productivity, task execution speed and supervision, which can be compromised when work shifts are organized on a 24-hour schedule and when the shift itself is irregular. A cross-sectional observational study was conducted from August 2014 - January 2015 on a sample of 315 shift-work nurses across 39 wards in seven central Italian hospitals. The Pittsburgh Sleep Quality Index was used to detect the presence of sleep disorders, the Copenhagen Burnout Inventory was used to detect the presence of any possible type of burnout and the Job Performance Scale was used to measure job performance. Data analysis was mainly based on a multivariate logistic regression to identify variables significantly associated with investigated outcomes. On shift-work nurses' sleep quality and burnout correlated positively. The female gender and personal burnout were significantly associated with impaired sleep quality, while working in the psychiatric setting, working a long cycle shift pattern and experiencing daytime dysfunction were significantly associated with burnout. A significant negative association between patient-related burnout and job performance was observed. Specific characteristics of shift-work nurses can directly affect sleep quality and burnout and indirectly job performance. This evidence offers healthcare administrators opportunities to intervene with measures to promote nurse's health, well-being and safety. © 2017 John Wiley & Sons Ltd.

Propofol Anesthesia and Sleep: A High-Density EEG Study

PubMed Central

Murphy, Michael; Bruno, Marie-Aurelie; Riedner, Brady A.; Boveroux, Pierre; Noirhomme, Quentin; Landsness, Eric C.; Brichant, Jean-Francois; Phillips, Christophe; Massimini, Marcello; Laureys, Steven; Tononi, Giulio; Boly, Melanie

2011-01-01

Study Objectives: The electrophysiological correlates of anesthetic sedation remain poorly understood. We used high-density electroencephalography (hd-EEG) and source modeling to investigate the cortical processes underlying propofol anesthesia and compare them to sleep. Design: 256-channel EEG recordings in humans during propofol anesthesia. Setting: Hospital operating room. Patients or Participants: 8 healthy subjects (4 males) Interventions: N/A Measurements and Results: Initially, propofol induced increases in EEG power from 12–25 Hz. Loss of consciousness (LOC) was accompanied by the appearance of EEG slow waves that resembled the slow waves of NREM sleep. We compared slow waves in propofol to slow waves recorded during natural sleep and found that both populations of waves share similar cortical origins and preferentially propagate along the mesial components of the default network. However, propofol slow waves were spatially blurred compared to sleep slow waves and failed to effectively entrain spindle activity. Propofol also caused an increase in gamma (25–40 Hz) power that persisted throughout LOC. Source modeling analysis showed that this increase in gamma power originated from the anterior and posterior cingulate cortices. During LOC, we found increased gamma functional connectivity between these regions compared to the wakefulness. Conclusions: Propofol anesthesia is a sleep-like state and slow waves are associated with diminished consciousness even in the presence of high gamma activity. Citation: Murphy M; Bruno MA; Riedner BA; Boveroux P; Noirhomme Q; Landsness EC; Brichant JF; Phillips C; Massimini M; Laureys S; Tononi G; Boly M. Propofol anesthesia and sleep: a high-density EEG study. SLEEP 2011;34(3):283-291. PMID:21358845

Family and cultural influences on sleep development.

PubMed

Giannotti, Flavia; Cortesi, Flavia

2009-10-01

Sleep is a biopsychosocial process that is influenced by the complex interaction of biologic rhythms, including sleep homeostatic mechanisms, chronobiologic factors, parenting, and temperament. However, family structure, culturally specific values, and beliefs are all elements that impact the ecology of a child's sleep. Dramatic demographic changes in many countries have been witnessed in recent years, which have resulted in health professionals and pediatricians being confronted with families of widely differing cultural origins. Attitudes and beliefs on infant sleeping strongly influence whether or not infant sleep behavior is perceived as problematic. Thus, it is advantageous to explore a child's sleep behavior in a multicultural setting. Cultural comparisons are of intrinsic value because they allow not only a better understanding of sleep in different contexts but also an evaluation of the eventual benefits and consequences of different cultural sleep practices. This article provides an overview of some specific sleep-related behaviors and practices highly influenced by different cultural contexts.

Development and Validation of the Sleep Inertia Questionnaire (SIQ) and Assessment of Sleep Inertia in Analogue and Clinical Depression

PubMed Central

Kanady, Jennifer C.; Harvey, Allison G.

2015-01-01

Sleep inertia is the transitional state from sleep to wake. Research on sleep inertia is important in depression because many people with depression report having difficulty getting out of bed, which contributes to impairment and can impede the implementation of interventions. The first aim was to develop and validate the first self-report measure of sleep inertia, the Sleep Inertia Questionnaire (SIQ). The second aim was to compare reports of sleep inertia across three groups: (1) No-to-Mild-Depression, (2) Analogue-Depression, and (3) Syndromal-Depression. The SIQ demonstrates strong psychometric properties; it has good to excellent internal consistency, strong construct validity, and SIQ severity is associated with less prior sleep duration. Sleep inertia is more severe in the Analogue-Depression and Syndromal-Depression groups compared to the No-to-Mild-Depression group. In conclusion, the SIQ is a reliable measure of sleep inertia and has potential for improving the assessment of sleep inertia in clinical and research settings. PMID:26451063

Development and Validation of the Sleep Inertia Questionnaire (SIQ) and Assessment of Sleep Inertia in Analogue and Clinical Depression.

PubMed

Kanady, Jennifer C; Harvey, Allison G

2015-10-01

Sleep inertia is the transitional state from sleep to wake. Research on sleep inertia is important in depression because many people with depression report having difficulty getting out of bed, which contributes to impairment and can impede the implementation of interventions. The first aim was to develop and validate the first self-report measure of sleep inertia, the Sleep Inertia Questionnaire (SIQ). The second aim was to compare reports of sleep inertia across three groups: (1) No-to-Mild-Depression, (2) Analogue-Depression, and (3) Syndromal-Depression. The SIQ demonstrates strong psychometric properties; it has good to excellent internal consistency, strong construct validity, and SIQ severity is associated with less prior sleep duration. Sleep inertia is more severe in the Analogue-Depression and Syndromal-Depression groups compared to the No-to-Mild-Depression group. In conclusion, the SIQ is a reliable measure of sleep inertia and has potential for improving the assessment of sleep inertia in clinical and research settings.

Coronary Heart Disease Incidence in Sleep Disordered Breathing: The Wisconsin Sleep Cohort Study

PubMed Central

Hla, Khin Mae; Young, Terry; Hagen, Erika W.; Stein, James H.; Finn, Laurel A.; Nieto, F. Javier; Peppard, Paul E.

2015-01-01

Study Objectives: The aim of the study was to determine the association of objectively measured sleep disordered breathing (SDB) with incident coronary heart disease (CHD) or heart failure (HF) in a nonclinical population. Design: Longitudinal analysis of a community-dwelling cohort followed up to 24 y. Setting: Sleep laboratory at the Clinical Research Unit of the University of Wisconsin Hospital and Clinics. Participants: There were 1,131 adults who completed one or more overnight polysomnography studies, were free of CHD or HF at baseline, were not treated by continuous positive airway pressure (CPAP), and followed over 24 y. Interventions: None. Measurements and Results: In-laboratory overnight polysomnography was used to assess SDB, defined by the apnea-hypopnea index (AHI) using apnea and hypopnea events per hour of sleep. Incident CHD or HF was defined by new reports of myocardial infarction, coronary revascularization procedures, congestive heart failure, and cardiovascular deaths. We used baseline AHI as the predictor variable in survival analysis models predicting CHD or HF incidence adjusted for traditional confounders. The incidence of CHD or HF was 10.9/1,000 person-years. The mean time to event was 11.2 ± 5.8 y. After adjusting for age, sex, body mass index, and smoking, estimated hazard ratios (95% confidence interval) of incident CHD or HF were 1.5 (0.9–2.6) for AHI > 0–5, 1.9 (1.05–3.5) for AHI 5 ≤ 15, 1.8 (0.85–4.0) for AHI 15 ≤ 30, and 2.6 (1.1–6.1) for AHI > 30 compared to AHI = 0 (P trend = 0.02). Conclusions: Participants with untreated severe sleep disordered breathing (AHI > 30) were 2.6 times more likely to have an incident coronary heart disease or heart failure compared to those without sleep disordered breathing. Our findings support the postulated adverse effects of sleep disordered breathing on coronary heart disease and heart failure. Citation: Hla KM, Young T, Hagen EW, Stein JH, Finn LA, Nieto FJ, Peppard PE. Coronary heart disease incidence in sleep disordered breathing: the Wisconsin Sleep Cohort Study. SLEEP 2015;38(5):677–684. PMID:25515104

Association of Sleep Duration with Mortality from Cardiovascular Disease and Other Causes for Japanese Men and Women: the JACC Study

PubMed Central

Ikehara, Satoyo; Iso, Hiroyasu; Date, Chigusa; Kikuchi, Shogo; Watanabe, Yoshiyuki; Wada, Yasuhiko; Inaba, Yutaka; Tamakoshi, Akiko

2009-01-01

Study Objectives: To examine sex-specific associations between sleep duration and mortality from cardiovascular disease and other causes. Design: Cohort study. Setting: Community-based study. Participants: A total of 98,634 subjects (41,489 men and 57,145 women) aged 40 to 79 years from 1988 to 1990 and were followed until 2003. Interventions: N/A. Measurements and Results: During a median follow-up of 14.3 years, there were 1964 deaths (men and women: 1038 and 926) from stroke, 881 (508 and 373) from coronary heart disease, 4287 (2297 and 1990) from cardiovascular disease, 5465 (3432 and 2033) from cancer, and 14,540 (8548 and 5992) from all causes. Compared with a sleep duration of 7 hours, sleep duration of 4 hours or less was associated with increased mortality from coronary heart disease for women and noncardiovascular disease/noncancer and all causes in both sexes. The respective multivariable hazard ratios were 2.32 (1.19–4.50) for coronary heart disease in women, 1.49 (1.02–2.18) and 1.47 (1.01–2.15) for noncardiovascular disease/noncancer, and 1.29 (1.02–1.64) and 1.28 (1.03–1.60) for all causes in men and women, respectively. Long sleep duration of 10 hours or longer was associated with 1.5- to 2-fold increased mortality from total and ischemic stroke, total cardiovascular disease, noncardiovascular disease/noncancer, and all causes for men and women, compared with 7 hours of sleep in both sexes. There was no association between sleep duration and cancer mortality in either sex. Conclusions: Both short and long sleep duration were associated with increased mortality from cardiovascular disease, noncardiovascular disease/noncancer, and all causes for both sexes, yielding a U-shaped relationship with total mortality with a nadir at 7 hours of sleep. Citation: Ikehara S; Iso H; Date C; Kikuchi S; Watanabe Y; Wada Y; Inaba Y; Tamakoshi A. Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. SLEEP 2009;32(3):259–301. PMID:19294949

Association of Poor Subjective Sleep Quality With Risk for Death by Suicide During a 10-Year Period

PubMed Central

Bernert, Rebecca A.; Turvey, Carolyn L.; Conwell, Yeates; Joiner, Thomas E.

2014-01-01

IMPORTANCE Older adults have high rates of sleep disturbance, die by suicide at disproportionately higher rates compared with other age groups, and tend to visit their physician in the weeks preceding suicide death. To our knowledge, to date, no study has examined disturbed sleep as an independent risk factor for late-life suicide. OBJECTIVE To examine the relative independent risk for suicide associated with poor subjective sleep quality in a population-based study of older adults during a 10-year observation period. DESIGN, SETTING, AND PARTICIPANTS A longitudinal case-control cohort study of late-life suicide among a multisite, population-based community sample of older adults participating in the Established Populations for Epidemiologic Studies of the Elderly. Of 14 456 community older adults sampled, 400 control subjects were matched (on age, sex, and study site) to 20 suicide decedents. MAIN OUTCOMES AND MEASURES Primary measures included the Sleep Quality Index, the Center for Epidemiologic Studies–Depression Scale, and vital statistics. RESULTS Hierarchical logistic regressions revealed that poor sleep quality at baseline was significantly associated with increased risk for suicide (odds ratio [OR], 1.39; 95% CI, 1.14-1.69; P < .001) by 10 follow-up years. In addition, 2 sleep items were individually associated with elevated risk for suicide at 10-year follow-up: difficulty falling asleep (OR, 2.24; 95% CI, 1.27-3.93; P < .01) and nonrestorative sleep (OR, 2.17; 95% CI, 1.28-3.67; P < .01). Controlling for depressive symptoms, baseline self-reported sleep quality was associated with increased risk for death by suicide (OR, 1.30; 95% CI, 1.04-1.63; P < .05). CONCLUSIONS AND RELEVANCE Our results indicate that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. Disturbed sleep appears to confer considerable risk, independent of depressed mood, for the most severe suicidal behaviors and may warrant inclusion in suicide risk assessment frameworks to enhance detection of risk and intervention opportunity in late life. PMID:25133759

Nonlinear aspects of the EEG during sleep in children

NASA Astrophysics Data System (ADS)

Berryman, Matthew J.; Coussens, Scott W.; Pamula, Yvonne; Kennedy, Declan; Lushington, Kurt; Shalizi, Cosma; Allison, Andrew; Martin, A. James; Saint, David; Abbott, Derek

2005-05-01

Electroencephalograph (EEG) analysis enables the dynamic behavior of the brain to be examined. If the behavior is nonlinear then nonlinear tools can be used to glean information on brain behavior, and aid in the diagnosis of sleep abnormalities such as obstructive sleep apnea syndrome (OSAS). In this paper the sleep EEGs of a set of normal children and children with mild OSAS are evaluated for nonlinear brain behaviour. We found that there were differences in the nonlinearity of the brain behaviour between different sleep stages, and between the two groups of children.

Sleeping in fits and starts: a practical guide to distinguishing nocturnal epilepsy from sleep disorders.

PubMed

Derry, Christopher P

2014-12-01

Accurately diagnosing sleep-related events, and particularly distinguishing nocturnal frontal lobe seizures from other sleep disorders such as parasomnias, can be challenging. This article reviews the differential diagnosis of paroxysmal events from sleep, epileptic and non-epileptic, considers important diagnostic points in the history, and evaluates the role of investigations in this setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Blood-gene expression reveals reduced circadian rhythmicity in individuals resistant to sleep deprivation.

PubMed

Arnardottir, Erna S; Nikonova, Elena V; Shockley, Keith R; Podtelezhnikov, Alexei A; Anafi, Ron C; Tanis, Keith Q; Maislin, Greg; Stone, David J; Renger, John J; Winrow, Christopher J; Pack, Allan I

2014-10-01

To address whether changes in gene expression in blood cells with sleep loss are different in individuals resistant and sensitive to sleep deprivation. Blood draws every 4 h during a 3-day study: 24-h normal baseline, 38 h of continuous wakefulness and subsequent recovery sleep, for a total of 19 time-points per subject, with every 2-h psychomotor vigilance task (PVT) assessment when awake. Sleep laboratory. Fourteen subjects who were previously identified as behaviorally resistant (n = 7) or sensitive (n = 7) to sleep deprivation by PVT. Thirty-eight hours of continuous wakefulness. We found 4,481 unique genes with a significant 24-h diurnal rhythm during a normal sleep-wake cycle in blood (false discovery rate [FDR] < 5%). Biological pathways were enriched for biosynthetic processes during sleep. After accounting for circadian effects, two genes (SREBF1 and CPT1A, both involved in lipid metabolism) exhibited small, but significant, linear changes in expression with the duration of sleep deprivation (FDR < 5%). The main change with sleep deprivation was a reduction in the amplitude of the diurnal rhythm of expression of normally cycling probe sets. This reduction was noticeably higher in behaviorally resistant subjects than sensitive subjects, at any given P value. Furthermore, blood cell type enrichment analysis showed that the expression pattern difference between sensitive and resistant subjects is mainly found in cells of myeloid origin, such as monocytes. Individual differences in behavioral effects of sleep deprivation are associated with differences in diurnal amplitude of gene expression for genes that show circadian rhythmicity. © 2014 Associated Professional Sleep Societies, LLC.

Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication

PubMed Central

Williamson, A; Feyer, A.

2000-01-01

OBJECTIVES—To compare the relative effects on performance of sleep deprivation and alcohol.
METHODS—Performance effects were studied in the same subjects over a period of 28 hours of sleep deprivation and after measured doses of alcohol up to about 0.1% blood alcohol concentration (BAC). There were 39 subjects, 30 employees from the transport industry and nine from the army.
RESULTS—After 17-19 hours without sleep, corresponding to 2230 and 0100, performance on some tests was equivalent or worse than that at a BAC of 0.05%. Response speeds were up to 50% slower for some tests and accuracy measures were significantly poorer than at this level of alcohol. After longer periods without sleep, performance reached levels equivalent to the maximum alcohol dose given to subjects (BAC of 0.1%).
CONCLUSIONS—These findings reinforce the evidence that the fatigue of sleep deprivation is an important factor likely to compromise performance of speed and accuracy of the kind needed for safety on the road and in other industrial settings.


Keywords: sleep deprivation; performance; alcohol PMID:10984335

Oscillating square wave Transcranial Direct Current Stimulation (tDCS) delivered during slow wave sleep does not improve declarative memory more than sham: A randomized sham controlled crossover study

PubMed Central

Sahlem, Gregory L.; Badran, Bashar W.; Halford, Jonathan J.; Williams, Nolan R.; Korte, Jeffrey E.; Leslie, Kimberly; Strachan, Martha; Breedlove, Jesse L.; Runion, Jennifer; Bachman, David L.; Uhde, Thomas W.; Borckardt, Jeffery J.; George, Mark S.

2015-01-01

Background A 2006 trial in healthy medical students found that anodal slow oscillating tDCS delivered bi-frontally during slow wave sleep had an enhancing effect in declarative, but not procedural memory. Although there have been supporting animal studies, and similar findings in pathological groups, this study has not been replicated, or refuted, in the intervening years. We therefore tested these earlier results for replication using similar methods with the exception of current wave form (square in our study, nearly sinusoidal in the original). Objective/Hypothesis Our objective was to test the findings of a 2006 trial suggesting bi-frontal anodal tDCS during slow wave sleep enhances declarative memory. Methods Twelve students (mean age 25, 9 women) free of medical problems underwent two testing conditions (active, sham) in a randomized counterbalanced fashion. Active stimulation consisted of oscillating square wave tDCS delivered during early Non-Rapid Eye Movement (NREM) sleep. The sham condition consisted of setting-up the tDCS device and electrodes, but not turning it on during sleep. tDCS was delivered bi-frontally with anodes placed at F3/F4, and cathodes placed at mastoids. Current density was 0.517mA/CM2, and oscillated between zero and maximal current at a frequency of 0.75Hz. Stimulation occurred during five-five minute blocks with one-minute inter-block intervals (25 minutes total stimulation). The primary outcomes were both declarative memory consolidation measured by a paired word association test (PWA), and non-declarative memory, measured by a non-dominant finger-tapping test (FTT). We also recorded and analyzed sleep EEG. Results There was no difference in the number of paired word associations remembered before compared to after sleep [(active = 3.1±3.0SD more associations) (sham = 3.8±3.1S.D more associations)]. Finger tapping improved, (non-significantly) following active stimulation [(3.6±2.7 S.D. correctly typed sequences) compared to sham stimulation (2.3± 2.2 S.D. correctly typed sequences)]. Conclusion In this study, we failed to find improvements in declarative or performance memory and could not replicate an earlier study using nearly identical settings. Specifically we failed to find a beneficial effect on either overnight declarative or non-declarative memory consolidation via square-wave oscillating tDCS intervention applied bi-frontally during early NREM sleep. It is unclear if the morphology of the tDCS pulse is critical in any memory related improvements. PMID:25795621

Oscillating Square Wave Transcranial Direct Current Stimulation (tDCS) Delivered During Slow Wave Sleep Does Not Improve Declarative Memory More Than Sham: A Randomized Sham Controlled Crossover Study.

PubMed

Sahlem, Gregory L; Badran, Bashar W; Halford, Jonathan J; Williams, Nolan R; Korte, Jeffrey E; Leslie, Kimberly; Strachan, Martha; Breedlove, Jesse L; Runion, Jennifer; Bachman, David L; Uhde, Thomas W; Borckardt, Jeffery J; George, Mark S

2015-01-01

A 2006 trial in healthy medical students found that anodal slow oscillating tDCS delivered bi-frontally during slow wave sleep had an enhancing effect in declarative, but not procedural memory. Although there have been supporting animal studies, and similar findings in pathological groups, this study has not been replicated, or refuted, in the intervening years. We therefore tested these earlier results for replication using similar methods with the exception of current waveform (square in our study, nearly sinusoidal in the original). Our objective was to test the findings of a 2006 trial suggesting bi-frontal anodal tDCS during slow wave sleep enhances declarative memory. Twelve students (mean age 25, 9 women) free of medical problems underwent two testing conditions (active, sham) in a randomized counterbalanced fashion. Active stimulation consisted of oscillating square wave tDCS delivered during early Non-Rapid Eye Movement (NREM) sleep. The sham condition consisted of setting-up the tDCS device and electrodes, but not turning it on during sleep. tDCS was delivered bi-frontally with anodes placed at F3/F4, and cathodes placed at mastoids. Current density was 0.517 mA/cm(2), and oscillated between zero and maximal current at a frequency of 0.75 Hz. Stimulation occurred during five-five minute blocks with 1-min inter-block intervals (25 min total stimulation). The primary outcomes were both declarative memory consolidation measured by a paired word association test (PWA), and non-declarative memory, measured by a non-dominant finger-tapping test (FTT). We also recorded and analyzed sleep EEG. There was no difference in the number of paired word associations remembered before compared to after sleep [(active = 3.1 ± 3.0 SD more associations) (sham = 3.8 ± 3.1 SD more associations)]. Finger tapping improved, (non-significantly) following active stimulation [(3.6 ± 2.7 SD correctly typed sequences) compared to sham stimulation (2.3 ± 2.2 SD correctly typed sequences)]. In this study, we failed to find improvements in declarative or performance memory and could not replicate an earlier study using nearly identical settings. Specifically we failed to find a beneficial effect on either overnight declarative or non-declarative memory consolidation via square-wave oscillating tDCS intervention applied bi-frontally during early NREM sleep. It is unclear if the morphology of the tDCS pulse is critical in any memory related improvements. Copyright © 2015 Elsevier Inc. All rights reserved.

A study on fear memory retrieval and REM sleep in maternal separation and isolation stressed rats.

PubMed

Sampath, Dayalan; Sabitha, K R; Hegde, Preethi; Jayakrishnan, H R; Kutty, Bindu M; Chattarji, Sumantra; Rangarajan, Govindan; Laxmi, T R

2014-10-15

As rapid brain development occurs during the neonatal period, environmental manipulation during this period may have a significant impact on sleep and memory functions. Moreover, rapid eye movement (REM) sleep plays an important role in integrating new information with the previously stored emotional experience. Hence, the impact of early maternal separation and isolation stress (MS) during the stress hyporesponsive period (SHRP) on fear memory retention and sleep in rats were studied. The neonatal rats were subjected to maternal separation and isolation stress during postnatal days 5-7 (6h daily/3d). Polysomnographic recordings and differential fear conditioning was carried out in two different sets of rats aged 2 months. The neuronal replay during REM sleep was analyzed using different parameters. MS rats showed increased time in REM stage and total sleep period also increased. MS rats showed fear generalization with increased fear memory retention than normal control (NC). The detailed analysis of the local field potentials across different time periods of REM sleep showed increased theta oscillations in the hippocampus, amygdala and cortical circuits. Our findings suggest that stress during SHRP has sensitized the hippocampus-amygdala-cortical loops which could be due to increased release of corticosterone that generally occurs during REM sleep. These rats when subjected to fear conditioning exhibit increased fear memory and increased fear generalization. The development of helplessness, anxiety and sleep changes in human patients, thus, could be related to the reduced thermal, tactile and social stimulation during SHRP on brain plasticity and fear memory functions. Copyright © 2014 Elsevier B.V. All rights reserved.

REM Sleep Behavioral Events and Dreaming

PubMed Central

Muntean, Maria-Lucia; Trenkwalder, Claudia; Walters, Arthur S.; Mollenhauer, Brit; Sixel-Döring, Friederike

2015-01-01

Study Objectives: To clarify whether motor behaviors and/ or vocalizations during REM sleep, which do not yet fulfill diagnostic criteria for REM sleep behavior disorder (RBD) and were defined as REM sleep behavioral events (RBEs), correspond to dream enactments. Methods: 13 subjects (10 patients with Parkinson disease [PD] and 3 healthy controls) originally identified with RBE in a prospective study (DeNoPa cohort) were reinvestigated 2 years later with 2 nights of video-supported polysomnography (vPSG). The first night was used for sleep parameter analysis. During the 2nd night, subjects were awakened and questioned for dream recall and dream content when purposeful motor behaviors and/or vocalizations became evident during REM sleep. REM sleep without atonia (RWA) was analyzed on chin EMG and the cutoff set at 18.2% as specific for RBD. Results: At the time of this investigation 9 of 13 subjects with previous RBE were identified with RBD based upon clinical and EMG criteria. All recalled vivid dreams, and 7 subjects were able to describe dream content in detail. Four of 13 subjects with RBE showed RWA values below cutoff values for RBD. Three of these 4 subjects recalled having non-threatening dreams, and 2 (of these 3) were able to describe these dreams in detail. Conclusion: RBE with RWA below the RBD defining criteria correlate to dreaming in this selected cohort. There is evidence that RBEs are a precursor to RBD. Citation: Muntean ML, Trenkwalder C, Walters AS, Mollenhauer B, Sixel-Döring F. REM sleep behavioral events and dreaming. J Clin Sleep Med 2015;11(5):537–541. PMID:25665694

EEG quantification of alertness: methods for early identification of individuals most susceptible to sleep deprivation

NASA Astrophysics Data System (ADS)

Berka, Chris; Levendowski, Daniel J.; Westbrook, Philip; Davis, Gene; Lumicao, Michelle N.; Olmstead, Richard E.; Popovic, Miodrag; Zivkovic, Vladimir T.; Ramsey, Caitlin K.

2005-05-01

Electroencephalographic (EEG) and neurocognitive measures were simultaneously acquired to quantify alertness from 24 participants during 44-hours of sleep deprivation. Performance on a three-choice vigilance task (3C-VT), paired-associate learning/memory task (PAL) and modified Maintenance of Wakefulness Test (MWT), and sleep technician-observed drowsiness (eye-closures, head-nods, EEG slowing) were quantified. The B-Alert system automatically classifies each second of EEG on an alertness/drowsiness continuum. B-Alert classifications were significantly correlated with technician-observations, visually scored EEG and performance measures. B-Alert classifications during 3C-VT, and technician observations and performance during the 3C-VT and PAL evidenced progressively increasing drowsiness as a result of sleep deprivation with a stabilizing effect observed at the batteries occurring between 0600 and 1100 suggesting a possible circadian effect similar to those reported in previous sleep deprivation studies. Participants were given an opportunity to take a 40-minute nap approximately 24-hours into the sleep deprivation portion of the study (i.e., 7 PM on Saturday). The nap was followed by a transient period of increased alertness. Approximately 8 hours after the nap, behavioral and physiological measures of drowsiness returned to levels prior to the nap. Cluster analysis was used to stratify individuals into three groups based on their level of impairment as a result of sleep deprivation. The combination of B-Alert and neuro-behavioral measures may identify individuals whose performance is most susceptible to sleep deprivation. These objective measures could be applied in an operational setting to provide a "biobehavioral assay" to determine vulnerability to sleep deprivation.

Sleep, Affect, and Social Competence from Preschool to Preadolescence: Distinct Pathways to Emotional and Social Adjustment for Boys and for Girls

PubMed Central

Foley, Joan E.; Weinraub, Marsha

2017-01-01

Using a normative sample of 1,057 children studied across 4 waves over 6 years with multiple informants, we investigated transactional relations for sleep problems, anxious-depressed symptoms, and social functioning from preschool to preadolescence, assessing cumulative effects on children's emotional and social adjustment. To examine sex differences in the developmental processes, we conducted separate analyses for boys and girls. For both boys and girls, longitudinal cross-lagged panel analyses showed that preschool sleep problems directly predicted anxious-depressed symptoms 2 years later; indirect effects continued into preadolescence. For girls, early and later sleep problems directly or indirectly predicted a wide variety of preadolescent emotional and social adjustment domains (e.g., depressive symptoms, school competence, emotion regulation, risk-taking behaviors). For boys, social competence played a more important role than sleep problems in predicting preadolescent adjustment. Among the first set of findings that demonstrate longitudinal relations between sleep problems and social functioning in middle childhood and preadolescence, these results support Dahl's and Walker's neurological models of sleep and emotional functioning. We discuss these findings in light of relations between sleep and affect during pre-pubertal development and discuss differential findings for boys and girls. PMID:28588517

Effect of lavender aromatherapy on vital signs and perceived quality of sleep in the intermediate care unit: a pilot study.

PubMed

Lytle, Jamie; Mwatha, Catherine; Davis, Karen K

2014-01-01

Sleep deprivation in hospitalized patients is common and can have serious detrimental effects on recovery from illness. Lavender aromatherapy has improved sleep in a variety of clinical settings, but the effect has not been tested in the intermediate care unit. To determine the effect of inhalation of 100% lavender oil on patients' vital signs and perceived quality of sleep in an intermediate care unit. A randomized controlled pilot study was conducted in 50 patients. Control patients received usual care. The treatment group had 3 mL of 100% pure lavender oil in a glass jar in place at the bedside from 10 pm until 6 am. Vital signs were recorded at intervals throughout the night. At 6 am all patients completed the Richard Campbell Sleep Questionnaire to assess quality of sleep. Blood pressure was significantly lower between midnight and 4 am in the treatment group than in the control group (P = .03) According to the overall mean change score in blood pressure between the baseline and 6 am measurements, the treatment group had a decrease in blood pressure and the control group had an increase; however, the difference between the 2 groups was not significant (P = .12). Mean overall sleep score was higher in the intervention group (48.25) than in the control group (40.10), but the difference was not significant. Lavender aromatherapy may be an effective way to improve sleep in an intermediate care unit.

Diseases in Patients Coming to a Sleep Center with Symptoms Related to Restless Legs Syndrome

PubMed Central

Kao, Kuo-Chin; Yang, Cheng-Ta; Chuang, Li-Pang; Chou, Yu-Ting; Lai, Szu-Chia; Chen, Rou-Shayn; Chen, Ning-Hung

2013-01-01

Study Objective To explore the profile of patients who visit a sleep center with symptoms that fulfill the four essential criteria for restless legs syndrome (RLS). Design A prospective study. Setting Outpatients from one sleep disorders clinic in Taiwan. Participants 1,200 consecutive patients visit sleep disorders clinic with any sleep complaints. Interventions After completing a history and physical examination, all participants answered the RLS questionnaire. Subjects who fulfilled the four essential criteria for RLS were referred to a special clinic. A work-up including blood tests, polysomnography, and specialized neurological tests etc. was performed to make the final diagnosis. Measurements and Results A total of 1,185 participants were enrolled, and, of these, 131(11.1%) fulfilled the four essential criteria for RLS, and 121 completed the supplemental work-up. Their mean age was 47.6±13.3 and 52.9% were male. Insomnia and snoring were the most common chief complaints. Obstructive sleep apnea syndrome and other diseases were found in 103 patients. Only 18 (14.9%) patients had no comorbid condition and were diagnosed with primary RLS. Conclusions Symptoms of RLS are common in patients with sleep complaints. Even in a sleep clinic, using a questionnaire approach for identification of RLS has a low positive predictive value. Clinicians should pay attention to the limitations of the 4-item questionnaire in diagnosis of RLS and also the importance of a careful differential diagnosis to identify possible secondary causes of RLS. PMID:23977057

The Natural History of Insomnia: Acute Insomnia and First-onset Depression

PubMed Central

Ellis, Jason G.; Perlis, Michael L.; Bastien, Célyne H.; Gardani, Maria; Espie, Colin A.

2014-01-01

Study Objectives: While many studies have examined the association between insomnia and depression, no studies have evaluated these associations (1) within a narrow time frame, (2) with specific reference to acute and chronic insomnia, and (3) using polysomnography. In the present study, the association between insomnia and first-onset depression was evaluated taking into account these considerations. Design: A mixed-model inception design. Setting: Academic research laboratory. Participants: Fifty-four individuals (acute insomnia [n = 33], normal sleepers [n = 21]) with no reported history of a sleep disorder, chronic medical condition, or psychiatric illness. Interventions: N/A. Measurements and Results: Participants were assessed at baseline (2 nights of polysomnography and psychometric measures of stress and mood) and insomnia and depression status were reassessed at 3 months. Individuals with acute insomnia exhibited more stress, poorer mood, worse subjective sleep continuity, increased N2 sleep, and decreased N3 sleep. Individuals who transitioned to chronic insomnia exhibited (at baseline) shorter REM latencies and reduced N3 sleep. Individuals who exhibited this pattern in the transition from acute to chronic insomnia were also more likely to develop first-onset depression (9.26%) as compared to those who remitted from insomnia (1.85%) or were normal sleepers (1.85%). Conclusion: The transition from acute to chronic insomnia is presaged by baseline differences in sleep architecture that have, in the past, been ascribed to Major Depression, either as heritable traits or as acquired traits from prior episodes of depression. The present findings suggest that the “sleep architecture stigmata” of depression may actually develop over the course transitioning from acute to chronic insomnia. Citation: Ellis JG; Perlis ML; Bastien CH; Gardani M; Espie CA. The natural history of insomnia: acute insomnia and first-onset depression. SLEEP 2014;37(1):97-106. PMID:24470699

Cold Exposure and Sleep in the Rat: REM Sleep Homeostasis and Body Size

PubMed Central

Amici, Roberto; Cerri, Matteo; Ocampo-Garcés, Adrian; Baracchi, Francesca; Dentico, Daniela; Jones, Christine Ann; Luppi, Marco; Perez, Emanuele; Parmeggiani, Pier Luigi; Zamboni, Giovanni

2008-01-01

Study Objectives: Exposure to low ambient temperature (Ta) depresses REM sleep (REMS) occurrence. In this study, both short and long-term homeostatic aspects of REMS regulation were analyzed during cold exposure and during subsequent recovery at Ta 24°C. Design: EEG activity, hypothalamic temperature, and motor activity were studied during a 24-h exposure to Tas ranging from 10°C to −10°C and for 4 days during recovery. Setting: Laboratory of Physiological Regulation during the Wake-Sleep Cycle, Department of Human and General Physiology, Alma Mater Studiorum-University of Bologna. Subjects: 24 male albino rats. Interventions: Animals were implanted with electrodes for EEG recording and a thermistor to measure hypothalamic temperature. Measurements and Results: REMS occurrence decreased proportionally with cold exposure, but a fast compensatory REMS rebound occurred during the first day of recovery when the previous loss went beyond a “fast rebound” threshold corresponding to 22% of the daily REMS need. A slow REMS rebound apparently allowed the animals to fully restore the previous REMS loss during the following 3 days of recovery. Conclusion: Comparing the present data on rats with data from earlier studies on cats and humans, it appears that small mammals have less tolerance for REMS loss than large ones. In small mammals, this low tolerance may be responsible on a short-term basis for the shorter wake-sleep cycle, and on long-term basis, for the higher percentage of REMS that is quickly recovered following REMS deprivation. Citation: Amici R; Cerri M; Ocampo-Garcés A; Baracchi F; Dentico D; Jones CA; Luppi M; Perez E; Parmeggiani PL; Zamboni G. Cold exposure and sleep in the rat: REM sleep homeostasis and body size. SLEEP 2008;31(5):708–715. PMID:18517040

Idiopathic Hypersomnia: A Study of 77 Cases

PubMed Central

Anderson, Kirstie N.; Pilsworth, Samantha; Sharples, Linda D.; Smith, Ian E.; Shneerson, John M.

2007-01-01

Study Objectives: To review the clinical and polysomnographic characteristics of idiopathic hypersomnia as well as the long-term response to treatment. Setting: The Respiratory Support and Sleep Centre at Papworth Hospital, Cambridge, UK. Patients and Design: A large database of more than 6000 patients with sleep disorders was reviewed. A retrospective study of the clinical and polysomnographic characteristics of 77 patients with idiopathic hypersomnia was performed. Comparison with a similar group of patients with narcolepsy was performed. The response to drug treatment was assessed in 61 patients over a mean follow-up of 3.8 years. Measurements and Results: Idiopathic hypersomnia was 60% as prevalent as narcolepsy. Comparison with a similar group of patients with narcolepsy showed that those with idiopathic hypersomnia were more likely to have prolonged unrefreshing daytime naps, a positive family history, increased slow-wave sleep, and a longer sleep latency on the Multiple Sleep Latency Test. The results of the Multiple Sleep Latency Test were not helpful in predicting disease severity or treatment response. The clinical features were heterogeneous and of variable severity. The majority of patients with idiopathic hypersomnia had symptoms that remained stable over many years, but 11% had spontaneous remission, which was never seen in narcolepsy. Two thirds of patients with idiopathic hypersomnolence had a sustained improvement in daytime somnolence with medication, although a third needed high doses or combinations of drugs. Conclusions: Idiopathic hypersomnolence has characteristic clinical and polysomnographic features but the prolonged latency on the Multiple Sleep Latency Test raises doubt about the validity of this test within the current diagnostic criteria. The disease often responds well to treatment and a substantial minority of patients appear to spontaneously improve. Citation: Anderson KN; Pilsworth S; Sharples LD; Smith IE; Shneerson JM. Idiopathic hypersomnia: a study of 77 cases. SLEEP 2007;30(10):1274-1281. PMID:17969461

Perfectionism related to self-reported insomnia severity, but not when controlled for stress and emotion regulation.

PubMed

Brand, Serge; Kirov, Roumen; Kalak, Nadeem; Gerber, Markus; Pühse, Uwe; Lemola, Sakari; Correll, Christoph U; Cortese, Samuele; Meyer, Till; Holsboer-Trachsler, Edith

2015-01-01

Perfectionism is understood as a set of personality traits such as unrealistically high and rigid standards for performance, fear of failure, and excessive self-criticism. Previous studies showed a direct association between increased perfectionism and poor sleep, though without taking into account possible mediating factors. Here, we tested the hypothesis that perfectionism was directly associated with poor sleep, and that this association collapsed, if mediating factors such as stress and poor emotion regulation were taken into account. Three hundred and forty six young adult students (M=23.87 years) completed questionnaires relating to perfectionism traits, sleep, and psychological functioning such as stress perception, coping with stress, emotion regulation, and mental toughness. Perfectionism was directly associated with poor sleep and poor psychological functioning. When stress, poor coping, and poor emotion regulation were entered in the equation, perfectionism traits no longer contributed substantively to the explanation of poor sleep. Though perfectionism traits seem associated with poor sleep, the direct role of such traits seemed small, when mediating factors such as stress perception and emotion regulation were taken into account.

Sleep stages identification in patients with sleep disorder using k-means clustering

NASA Astrophysics Data System (ADS)

Fadhlullah, M. U.; Resahya, A.; Nugraha, D. F.; Yulita, I. N.

2018-05-01

Data mining is a computational intelligence discipline where a large dataset processed using a certain method to look for patterns within the large dataset. This pattern then used for real time application or to develop some certain knowledge. This is a valuable tool to solve a complex problem, discover new knowledge, data analysis and decision making. To be able to get the pattern that lies inside the large dataset, clustering method is used to get the pattern. Clustering is basically grouping data that looks similar so a certain pattern can be seen in the large data set. Clustering itself has several algorithms to group the data into the corresponding cluster. This research used data from patients who suffer sleep disorders and aims to help people in the medical world to reduce the time required to classify the sleep stages from a patient who suffers from sleep disorders. This study used K-Means algorithm and silhouette evaluation to find out that 3 clusters are the optimal cluster for this dataset which means can be divided to 3 sleep stages.

Perfectionism related to self-reported insomnia severity, but not when controlled for stress and emotion regulation

PubMed Central

Brand, Serge; Kirov, Roumen; Kalak, Nadeem; Gerber, Markus; Pühse, Uwe; Lemola, Sakari; Correll, Christoph U; Cortese, Samuele; Meyer, Till; Holsboer-Trachsler, Edith

2015-01-01

Background Perfectionism is understood as a set of personality traits such as unrealistically high and rigid standards for performance, fear of failure, and excessive self-criticism. Previous studies showed a direct association between increased perfectionism and poor sleep, though without taking into account possible mediating factors. Here, we tested the hypothesis that perfectionism was directly associated with poor sleep, and that this association collapsed, if mediating factors such as stress and poor emotion regulation were taken into account. Methods Three hundred and forty six young adult students (M=23.87 years) completed questionnaires relating to perfectionism traits, sleep, and psychological functioning such as stress perception, coping with stress, emotion regulation, and mental toughness. Results Perfectionism was directly associated with poor sleep and poor psychological functioning. When stress, poor coping, and poor emotion regulation were entered in the equation, perfectionism traits no longer contributed substantively to the explanation of poor sleep. Conclusion Though perfectionism traits seem associated with poor sleep, the direct role of such traits seemed small, when mediating factors such as stress perception and emotion regulation were taken into account. PMID:25678791

Insomnia with objective short sleep duration is associated with longer duration of insomnia in the Freiburg Insomnia Cohort compared to insomnia with normal sleep duration, but not with hypertension

PubMed Central

Johann, Anna F.; Hertenstein, Elisabeth; Kyle, Simon D.; Baglioni, Chiara; Feige, Bernd; Nissen, Christoph; McGinness, Alastair J.; Riemann, Dieter; Spiegelhalder, Kai

2017-01-01

Study objectives To replicate the association between insomnia with objective short sleep duration and hypertension, type 2 diabetes and duration of insomnia. Design Retrospective case-control study. Setting Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg. Participants 328 patients with primary insomnia classified according to DSM-IV criteria (125 males, 203 females, 44.3 ± 12.2 years). Interventions N/A Measurements All participants were investigated using polysomnography, blood pressure measurements, and fasting routine laboratory. Results Insomnia patients with short sleep duration (< 6 hours) in the first night of laboratory sleep presented with a longer duration of insomnia compared to those with normal sleep duration (≥ 6 hours) in the first night of laboratory sleep. Insomnia patients who were categorised as short sleepers in either night were not more likely to suffer from hypertension (systolic blood pressure of ≥ 140 mm Hg, diastolic blood pressure of ≥ 90 mm Hg, or a previously established diagnosis). Data analysis showed that insomnia patients with objective short sleep duration were not more likely to suffer from type 2 diabetes (fasting plasma glucose level of ≥ 126 mg/dl, or a previously established diagnosis). However, the diabetes analysis was only based on a very small number of diabetes cases. As a new finding, insomnia patients who were categorised as short sleepers in either night presented with increases in liver enzyme levels. Conclusions The finding on insomnia duration supports the concept of two distinct sub-groups of insomnia, namely insomnia with, and without, objectively determined short sleep duration. However, our data challenges previous findings that insomnia patients with short sleep duration are more likely to suffer from hypertension. PMID:28746413

Text Mining of Journal Articles for Sleep Disorder Terminologies.

PubMed

Lam, Calvin; Lai, Fu-Chih; Wang, Chia-Hui; Lai, Mei-Hsin; Hsu, Nanly; Chung, Min-Huey

2016-01-01

Research on publication trends in journal articles on sleep disorders (SDs) and the associated methodologies by using text mining has been limited. The present study involved text mining for terms to determine the publication trends in sleep-related journal articles published during 2000-2013 and to identify associations between SD and methodology terms as well as conducting statistical analyses of the text mining findings. SD and methodology terms were extracted from 3,720 sleep-related journal articles in the PubMed database by using MetaMap. The extracted data set was analyzed using hierarchical cluster analyses and adjusted logistic regression models to investigate publication trends and associations between SD and methodology terms. MetaMap had a text mining precision, recall, and false positive rate of 0.70, 0.77, and 11.51%, respectively. The most common SD term was breathing-related sleep disorder, whereas narcolepsy was the least common. Cluster analyses showed similar methodology clusters for each SD term, except narcolepsy. The logistic regression models showed an increasing prevalence of insomnia, parasomnia, and other sleep disorders but a decreasing prevalence of breathing-related sleep disorder during 2000-2013. Different SD terms were positively associated with different methodology terms regarding research design terms, measure terms, and analysis terms. Insomnia-, parasomnia-, and other sleep disorder-related articles showed an increasing publication trend, whereas those related to breathing-related sleep disorder showed a decreasing trend. Furthermore, experimental studies more commonly focused on hypersomnia and other SDs and less commonly on insomnia, breathing-related sleep disorder, narcolepsy, and parasomnia. Thus, text mining may facilitate the exploration of the publication trends in SDs and the associated methodologies.

Effects of Sinoaortic Denervation on Hemodynamic Parameters During Natural Sleep in Rats

PubMed Central

Silveira, Neide P.; Moreira, Edson D.; Drager, Luciano F.; Silva, Gustavo J. J.; Krieger, Eduardo M.

2008-01-01

Study Objectives: To analyze the role of arterial baroreflex on hemodynamic changes during synchronized and desynchronized sleep phases of natural sleep in rats. Design: Experimental study. Setting: Laboratory. Participants: Seventeen male Wistar rats. Interventions: No intervention (control, n = 8) or sinoaortic denervation (SAD, n = 9). Measurements and Results: Sleep phases were monitored by electrocorticogram, and blood pressure was measured directly by a catheter in the carotid artery. Cardiac output, as well as total and regional vascular resistances, were determined by measuring the subdiaphragmatic aorta and iliac artery flows with Doppler flow probes, respectively. In contrast to the control group, the SAD group had a strong reduction in blood pressure (−19.9% ± 2.6% vs −0.7% ± 2.1%) during desynchronized sleep, and cardiac output showed an exacerbated reduction (−10.4% ± 3.5% vs 1.1% ± 1.7%). In SAD rats, total vascular resistance decreased during desynchronized sleep (−10.1% ± 3.5% vs −1.0% ± 1.7%), and the increase in regional vascular resistance observed in the control group was abolished (27.5% ± 8.3% vs −0.8% ± 9.4%). Conclusions: SAD caused profound changes in blood pressure, cardiac output, and total vascular resistance, with a significant increase in muscle vascular resistance during synchronized sleep. Our results suggest that baroreflex plays an important role in maintaining the normal balance of cardiac output and total vascular resistance during sleep. Citation: Silveira NP; Moreira ED; Drager LF; Silva GJJ; Krieger EM. Effects of sinoaortic denervation on hemodynamic parameters during natural sleep in rats. SLEEP 2008;31(3):328-333. PMID:18363308

Does Recall after Sleep-Dependent Memory Consolidation Reinstate Sensitivity to Retroactive Interference?

PubMed Central

Deliens, Gaétane; Schmitz, Rémy; Caudron, Isaline; Mary, Alison; Leproult, Rachel; Peigneux, Philippe

2013-01-01

Previous studies have shown that newly encoded memories are more resistant to retroactive interference when participants are allowed to sleep after learning the original material, suggesting a sleep-related strengthening of memories. In the present study, we investigated delayed, long-term effects of sleep vs. sleep deprivation (SD) on the first post-training night on memory consolidation and resistance to interference. On day 1, participants learned a list of unrelated word pairs (AB), either in the morning or in the evening, then spent the post-training night in a sleep or sleep deprivation condition, in a within-subject paradigm. On day 4, at the same time of day, they learned a novel list of word pairs (AC) in which 50% of the word pairs stemmed with the same word than in the AB list, resulting in retroactive interference. Participants had then to recall items from the AB list upon presentation of the “A” stem. Recall was marginally improved in the evening, as compared to the morning learning group. Most importantly, retroactive interference effects were found in the sleep evening group only, contrary to the hypothesis that sleep exerts a protective role against intrusion by novel but similar learning. We tentatively suggest that these results can be explained in the framework of the memory reconsolidation theory, stating that exposure to similar information sets back consolidated items in a labile form again sensitive to retroactive interference. In this context, sleep might not protect against interference but would promote an update of existing episodic memories while preventing saturation of the memory network due to the accumulation of dual traces. PMID:23874738

A dietary supplement to improve the quality of sleep: a randomized placebo controlled trial

PubMed Central

2010-01-01

Background To evaluate the effect of a dietary supplement containing polyunsaturated fatty acids, in association with Humulus lupulus extract, on the quality of sleep using the Leeds sleep evaluation questionnaire (LSEQ) in subjects with moderate to severe sleep disorders. Methods Randomized placebo-controlled trial, in a Population-based setting. Participants were adult patients 25 to 65 years old with a chronic primary insomnia who volunteered for the study. The tested intervention consisted of two soft gelatine capsules per day, containing either the dietary supplement (active group) or olive oil (placebo group) for a month. Subjects could also volunteer for two ancillary studies on melatonin and actigraphy. Evaluation criteria included i) perception of the quality of sleep at the end of treatment using the LSEQ questionnaire, ii) sleep efficiency measured by one-week actigraphic movement measurement performed before and during the treatment in a subsample of subjects, iii) night melatonin and 6 sulfatoxymelatonin (aMT6S) urine rates in a subsample of subjects. Results The average of Leeds score was similar in both groups (p = 0.95). A marked improvement in the quality of sleep was observed in both placebo (62%) and active (65%) group (p = 0.52). The evolution of urinary melatonin, aMT6S, and of the Mel/aMT6S ratio showed no differences between the two groups. Sleep efficiency, as measured by actigraphy, improved similarly in both groups during the treatment period, from 72% to 76% and 75% in the active and placebo group respectively (p = 0.91). Conclusions The dietary supplement had neither effect on the perceived quality of sleep, nor on the melatonin metabolism and sleep-wake cycle. Trial registration: clinical trials.gov:NCT00484497 PMID:20569455

A dietary supplement to improve the quality of sleep: a randomized placebo controlled trial.

PubMed

Cornu, Catherine; Remontet, Laurent; Noel-Baron, Florence; Nicolas, Alain; Feugier-Favier, Nathalie; Roy, Pascal; Claustrat, Bruno; Saadatian-Elahi, Mitra; Kassaï, Behrouz

2010-06-22

To evaluate the effect of a dietary supplement containing polyunsaturated fatty acids, in association with Humulus lupulus extract, on the quality of sleep using the Leeds sleep evaluation questionnaire (LSEQ) in subjects with moderate to severe sleep disorders. Randomized placebo-controlled trial, in a Population-based setting. Participants were adult patients 25 to 65 years old with a chronic primary insomnia who volunteered for the study. The tested intervention consisted of two soft gelatine capsules per day, containing either the dietary supplement (active group) or olive oil (placebo group) for a month. Subjects could also volunteer for two ancillary studies on melatonin and actigraphy. Evaluation criteria included i) perception of the quality of sleep at the end of treatment using the LSEQ questionnaire, ii) sleep efficiency measured by one-week actigraphic movement measurement performed before and during the treatment in a subsample of subjects, iii) night melatonin and 6 sulfatoxymelatonin (aMT6S) urine rates in a subsample of subjects. The average of Leeds score was similar in both groups (p = 0.95). A marked improvement in the quality of sleep was observed in both placebo (62%) and active (65%) group (p = 0.52). The evolution of urinary melatonin, aMT6S, and of the Mel/aMT6S ratio showed no differences between the two groups. Sleep efficiency, as measured by actigraphy, improved similarly in both groups during the treatment period, from 72% to 76% and 75% in the active and placebo group respectively (p = 0.91). The dietary supplement had neither effect on the perceived quality of sleep, nor on the melatonin metabolism and sleep-wake cycle. clinical trials.gov:NCT00484497.

Sleep quality in nurses: a randomized clinical trial of day and night shift workers.

PubMed

Niu, Shu-Fen; Chu, Hsin; Chung, Min-Huey; Lin, Chun-Chieh; Chang, Yu-Shiun; Chou, Kuei-Ru

2013-07-01

The study investigated the number of days off nurses working night shifts need to recover their sleep quality to the level of daytime workers during their days off. This study included 30 day-shift nurses and 32 night-shift nurses. It was conducted as a randomized clinical trial in the medical and surgical wards of a medical center in northern Taiwan in May and June 2010 using sleep diaries and sleep parameters collected by actigraphy on different workdays and days off. On workdays, the night-shift group had significantly less total sleep time (TST) on Day 5 and significantly lower sleep efficiency (SE) on Day 3 than the day-shift group. TSTs of the two groups on days off were higher than those on workdays. On the 4th consecutive day off, higher TST, a decrease in WASO, and an increase in SE suggests that the night-shift group had recovered their sleep quality to the level of the day-shift group on their days off. The SE of the night-shift group exceeded that of the day-shift group after the 4th consecutive day off, though the difference was not statistically significant in the present study. Based on these data, it is recommended that night-shift workers arrange a period of at least 4 days off after 5 consecutive night shifts and at least 5 days off if the staff who have previously worked night shifts are being assigned a set of different shifts.

Experimental Sleep Restriction Facilitates Pain and Electrically Induced Cortical Responses

PubMed Central

Matre, Dagfinn; Hu, Li; Viken, Leif A.; Hjelle, Ingri B.; Wigemyr, Monica; Knardahl, Stein; Sand, Trond; Nilsen, Kristian Bernhard

2015-01-01

Study Objectives: Sleep restriction (SR) has been hypothesized to sensitize the pain system. The current study determined whether experimental sleep restriction had an effect on experimentally induced pain and pain-elicited electroencephalographic (EEG) responses. Design: A paired crossover study. Intervention: Pain testing was performed after 2 nights of 50% SR and after 2 nights with habitual sleep (HS). Setting: Laboratory experiment at research center. Participants: Self-reported healthy volunteers (n = 21, age range: 18–31 y). Measurements and Results: Brief high-density electrical stimuli to the forearm skin produced pinprick-like pain. Subjective pain ratings increased after SR, but only in response to the highest stimulus intensity (P = 0.018). SR increased the magnitude of the pain-elicited EEG response analyzed in the time-frequency domain (P = 0.021). Habituation across blocks did not differ between HS and SR. Event-related desynchronization (ERD) was reduced after SR (P = 0.039). Pressure pain threshold of the trapezius muscle region also decreased after SR (P = 0.017). Conclusion: Sleep restriction (SR) increased the sensitivity to pressure pain and to electrically induced pain of moderate, but not low, intensity. The increased electrical pain could not be explained by a difference in habituation. Increased response magnitude is possibly related to reduced processing within the somatosensory cortex after partial SR. Citation: Matre D, Hu L, Viken LA, Hjelle IB, Wigemyr M, Knardahl S, Sand T, Nilsen KB. Experimental sleep restriction facilitates pain and electrically induced cortical responses. SLEEP 2015;38(10):1607–1617. PMID:26194577

A systematic review of non-pharmacological interventions to improve nighttime sleep among residents of long-term care settings.

PubMed

Capezuti, Elizabeth; Sagha Zadeh, Rana; Pain, Kevin; Basara, Aleksa; Jiang, Nancy Ziyan; Krieger, Ana C

2018-06-18

Disturbances in sleep and circadian rhythms are common among residents of long-term care facilities. In this systematic review, we aim to identify and evaluate the literature documenting the outcomes associated with non-pharmacological interventions to improve nighttime sleep among long-term care residents. The Preferred Reporting Items for Systematic Reviews guided searches of five databases (MEDLINE, Embase, CINAHL, Scopus, and Cochrane Library) for articles reporting results of experimental or quasi-experimental studies conducted in long-term care settings (nursing homes, assisted-living facilities, or group homes) in which nighttime sleep was subjectively or objectively measured as a primary outcome. We categorized each intervention by its intended use and how it was administered. Of the 54 included studies evaluating the effects of 25 different non-pharmacological interventions, more than half employed a randomized controlled trial design (n = 30); the others used a pre-post design with (n = 11) or without (n = 13) a comparison group. The majority of randomized controlled trials were at low risk for most types of bias, and most other studies met the standard quality criteria. The interventions were categorized as environmental interventions (n = 14), complementary health practices (n = 12), social/physical stimulation (n = 11), clinical care practices (n = 3), or mind-body practices (n = 3). Although there was no clear pattern of positive findings, three interventions had the most promising results: increased daytime light exposure, nighttime use of melatonin, and acupressure. Non-pharmacological interventions have the potential to improve sleep for residents of long-term care facilities. Further research is needed to better standardize such interventions and provide clear implementation guidelines using cost-effective practices.

Classifying performance impairment in response to sleep loss using pattern recognition algorithms on single session testing

PubMed Central

St. Hilaire, Melissa A.; Sullivan, Jason P.; Anderson, Clare; Cohen, Daniel A.; Barger, Laura K.; Lockley, Steven W.; Klerman, Elizabeth B.

2012-01-01

There is currently no “gold standard” marker of cognitive performance impairment resulting from sleep loss. We utilized pattern recognition algorithms to determine which features of data collected under controlled laboratory conditions could most reliably identify cognitive performance impairment in response to sleep loss using data from only one testing session, such as would occur in the “real world” or field conditions. A training set for testing the pattern recognition algorithms was developed using objective Psychomotor Vigilance Task (PVT) and subjective Karolinska Sleepiness Scale (KSS) data collected from laboratory studies during which subjects were sleep deprived for 26 – 52 hours. The algorithm was then tested in data from both laboratory and field experiments. The pattern recognition algorithm was able to identify performance impairment with a single testing session in individuals studied under laboratory conditions using PVT, KSS, length of time awake and time of day information with sensitivity and specificity as high as 82%. When this algorithm was tested on data collected under real-world conditions from individuals whose data were not in the training set, accuracy of predictions for individuals categorized with low performance impairment were as high as 98%. Predictions for medium and severe performance impairment were less accurate. We conclude that pattern recognition algorithms may be a promising method for identifying performance impairment in individuals using only current information about the individual’s behavior. Single testing features (e.g., number of PVT lapses) with high correlation with performance impairment in the laboratory setting may not be the best indicators of performance impairment under real-world conditions. Pattern recognition algorithms should be further tested for their ability to be used in conjunction with other assessments of sleepiness in real-world conditions to quantify performance impairment in response to sleep loss. PMID:22959616

Acculturation and Sleep among a Multiethnic Sample of Women: The Study of Women's Health Across the Nation (SWAN)

PubMed Central

Hale, Lauren; Troxel, Wendy M.; Kravitz, Howard M.; Hall, Martica H.; Matthews, Karen A.

2014-01-01

Study Objectives: Mexican immigrants to the United States report longer sleep duration and fewer sleep complaints than their US-born counterparts. To investigate whether this effect extends to other immigrant groups, we examined whether the prevalence of self-reported sleep complaints is higher among US-born Hispanic/Latina, Chinese, and Japanese immigrant women compared to their first-generation immigrant ethnic counterparts as well as to US-born whites. We examined whether these associations persisted after adjusting for sociodemographic and health characteristics and whether acculturation mediated the effects. Design: Cross-sectional observational study. Setting: Multisite study in Oakland, CA; Los Angeles, CA; and Newark, NJ. Participants: Hispanic/Latina (n = 196), Chinese (n = 228), Japanese (n = 271) and non-Hispanic white (n = 485) women (mean age = 46 y, range 42-52 y) participating in the Study of Women's Health Across the Nation (SWAN); 410 or 59.0% of the nonwhites were first-generation immigrants. Interventions: None. Measurements and Results: Questionnaires were used to assess sleep complaints, race/ethnicity, immigrant status, language acculturation (use of English language), and sociodemographic and health variables. Approximately 25% of first-generation immigrant women reported sleep complaints compared to 37% of those who were US-born nonwhites and 42% of US-born whites. Multivariable adjusted logistic regression analyses showed that US-born nonwhites had higher odds of reporting any sleep complaints (odds ratio = 2.1, 95% confidence interval [CI] 1.5-3.0), compared to first-generation immigrants. Women with higher levels of language acculturation had greater odds of reporting any sleep complaint compared to those with less language acculturation. Adjustment for language acculturation mediated 40.4% (95% CI 28.5-69.8) of the association between immigrant status and any sleep complaint. When results were stratified by race/ethnicity, significant mediation effects of acculturation were only found for Hispanic/Latina and Japanese women, but not for Chinese women. Conclusion: US-born Hispanic/Latina, Chinese, and Japanese immigrants were more likely to report sleep complaints than their first-generation ethnic counterparts, a finding largely explained by language acculturation and unmeasured factors associated with language acculturation. Citation: Hale L; Troxel WM; Kravitz HM; Hall MH; Matthews KA. Acculturation and sleep among a multiethnic sample of women: the Study of Women's Health Across the Nation (SWAN). SLEEP 2014;37(2):309-317. PMID:24497659

Tai Chi Improves Sleep Quality in Healthy Adults and Patients with Chronic Conditions: A Systematic Review and Meta-analysis

PubMed Central

Raman, Gowri; Zhang, Yuan; Minichiello, Vincent J; D'Ambrosio, Carolyn M.; Wang, Chenchen

2017-01-01

Background Physical activity and exercise appear to improve sleep quality. However, the quantitative effects of Tai Chi on sleep quality in the adult population have rarely been examined. We conducted a systematic review and meta-analysis evaluating the effects of Tai Chi on sleep quality in healthy adults and disease populations. Methods Medline, Cochrane Central databases, and review of references were searched through July 31, 2013. English-language studies of all designs evaluating Tai Chi’s effect on sleep outcomes in adults were examined. Data were extracted and verified by 2 reviewers. Extracted information included study setting and design, population characteristics, type and duration of interventions, outcomes, risk of bias and main results. Random effect models meta-analysis was used to assess the magnitude of treatment effect when at least 3 trials reported on the same sleep outcomes. Results Eleven studies (9 randomized and 2 non-randomized trials) totaling 994 subjects published between 2004 and 2012 were identified. All studies except one reported Pittsburg Sleep Quality Index. Nine randomized trials reported that 1.5 to 3 hour each week for a duration of 6 to 24 weeks of Tai Chi significantly improved sleep quality (Effect Size, 0.89; 95% confidence interval [CI], 0.28 to 1.50), in community-dwelling healthy participants and in patients with chronic conditions. Improvement in health outcomes including physical performance, pain reduction, and psychological well-being occurred in the Tai Chi group compared with various controls. Limitations Studies were heterogeneous and some trials were lacking in methodological rigor. Conclusions Tai Chi significantly improved sleep quality in both healthy adults and patients with chronic health conditions, which suggests that Tai Chi may be considered as an alternative behavioral therapy in the treatment of insomnia. High-quality, well-controlled randomized trials are needed to better inform clinical decisions. PMID:28845367

A Randomized, Double Crossover Study to Investigate the Influence of Saline Infusion on Sleep Apnea Severity in Men

PubMed Central

Yadollahi, Azadeh; Gabriel, Joseph M.; White, Laura H.; Taranto Montemurro, Luigi; Kasai, Takatoshi; Bradley, T. Douglas

2014-01-01

Study Objectives: Obstructive sleep apnea (OSA) is commoner in patients with fluid-retaining states than in those without fluid retention, in men than in women, and worsens with aging. In men, OSA severity is related to the amount of fluid shifting out of the legs overnight, but a cause-effect relationship is not established. Our objective was to test the hypothesis that mimicking fluid overload during sleep would increase severity of OSA more in older (≥ 40 years) than in younger men (< 40 years). Design: Randomized, single-blind, double crossover study. Setting: Research sleep laboratory. Patients or Participants: Seven older and 10 younger men with non-severe or no sleep apnea, matched for body mass index. Interventions: During the control arm, normal saline was infused to keep the vein open. During intervention, subjects received an intravenous bolus of normal saline (22 mL/kg body weight) after sleep onset while they were wearing compression stockings to prevent fluid accumulation in the legs. Measurements and Results: Compared to younger men, infusion of similar amounts of saline in older men caused a greater increase in neck circumference (P < 0.05) and in the AHI (32.2 ± 22.1 vs. 2.2 ± 7.1, P = 0.002). Conclusions: Older men are more susceptible to the adverse effects of intravenous fluid loading on obstructive sleep apnea severity than younger men. This may be due to age-related differences in the amount of fluid accumulating in the neck or upper airway collapsibility in response to intravenous fluid loading. These possibilities remain to be tested in future studies. Citation: Yadollahi A, Gabriel JM, White LH, Taranto Montemurro L, Kasai T, Bradley TD. A randomized, double crossover study to investigate the influence of saline infusion on sleep apnea severity in men. SLEEP 2014;37(10):1699-1705. PMID:25197812

Automated determination of wakefulness and sleep in rats based on non-invasively acquired measures of movement and respiratory activity

PubMed Central

Zeng, Tao; Mott, Christopher; Mollicone, Daniel; Sanford, Larry D.

2012-01-01

The current standard for monitoring sleep in rats requires labor intensive surgical procedures and the implantation of chronic electrodes which have the potential to impact behavior and sleep. With the goal of developing a non-invasive method to determine sleep and wakefulness, we constructed a non-contact monitoring system to measure movement and respiratory activity using signals acquired with pulse Doppler radar and from digitized video analysis. A set of 23 frequency and time-domain features were derived from these signals and were calculated in 10 s epochs. Based on these features, a classification method for automated scoring of wakefulness, non-rapid eye movement sleep (NREM) and REM in rats was developed using a support vector machine (SVM). We then assessed the utility of the automated scoring system in discriminating wakefulness and sleep by comparing the results to standard scoring of wakefulness and sleep based on concurrently recorded EEG and EMG. Agreement between SVM automated scoring based on selected features and visual scores based on EEG and EMG were approximately 91% for wakefulness, 84% for NREM and 70% for REM. The results indicate that automated scoring based on non-invasively acquired movement and respiratory activity will be useful for studies requiring discrimination of wakefulness and sleep. However, additional information or signals will be needed to improve discrimination of NREM and REM episodes within sleep. PMID:22178621

Mobile usage and sleep patterns among medical students.

PubMed

Yogesh, Saxena; Abha, Shrivastava; Priyanka, Singh

2014-01-01

Exposure of humans to radio frequency electromagnetic field (EMF) both during receiving and transmitting the signals has amplified public and scientific debate about possible adverse effects on human health. The study was designed with the objective of assessing the extent of mobile phone use amongst medical students and finding correlation if any between the hours of usage of mobile to sleep pattern and quality. hundred medical students grouped as cases (n = 57) (> 2 hours/day of mobile usage) and control (n = 43) (≤ 2 hours/day of mobile usage) were examined for their sleep quality & pattern by Pittsburg sleep Quality Index (PSQI). Differences between groups were examined with the Mann Whitney "U" test for proportions (Quantitative values) and with Student't' test for continuous variables. The association of variables was analyzed by Spearman Rank's correlation. Probability was set at < 0.05 as significant. Sleep disturbance, latency and day dysfunction was more in cases especially females. A significant association of hours of usage and sleep indices were observed in both genders (males r = 0.25; p = 0.04, females r = 0.31; p = 0.009). Evening usage of mobile phone in cases showed a statistically significant negative association (-0.606; p = 0.042) with Sleep quality (higher PSQI means sleep deprivation). Students using mobile for > 2 hours/day may cause sleep deprivation and day sleepiness affecting cognitive and learning abilities of medical students.

The Prioritization of Clinical Risk Factors of Obstructive Sleep Apnea Severity Using Fuzzy Analytic Hierarchy Process

PubMed Central

Maranate, Thaya; Pongpullponsak, Adisak; Ruttanaumpawan, Pimon

2015-01-01

Recently, there has been a problem of shortage of sleep laboratories that can accommodate the patients in a timely manner. Delayed diagnosis and treatment may lead to worse outcomes particularly in patients with severe obstructive sleep apnea (OSA). For this reason, the prioritization in polysomnography (PSG) queueing should be endorsed based on disease severity. To date, there have been conflicting data whether clinical information can predict OSA severity. The 1,042 suspected OSA patients underwent diagnostic PSG study at Siriraj Sleep Center during 2010-2011. A total of 113 variables were obtained from sleep questionnaires and anthropometric measurements. The 19 groups of clinical risk factors consisting of 42 variables were categorized into each OSA severity. This study aimed to array these factors by employing Fuzzy Analytic Hierarchy Process approach based on normalized weight vector. The results revealed that the first rank of clinical risk factors in Severe, Moderate, Mild, and No OSA was nighttime symptoms. The overall sensitivity/specificity of the approach to these groups was 92.32%/91.76%, 89.52%/88.18%, 91.08%/84.58%, and 96.49%/81.23%, respectively. We propose that the urgent PSG appointment should include clinical risk factors of Severe OSA group. In addition, the screening for Mild from No OSA patients in sleep center setting using symptoms during sleep is also recommended (sensitivity = 87.12% and specificity = 72.22%). PMID:26221183

Identification of Causal Genes, Networks, and Transcriptional Regulators of REM Sleep and Wake

PubMed Central

Millstein, Joshua; Winrow, Christopher J.; Kasarskis, Andrew; Owens, Joseph R.; Zhou, Lili; Summa, Keith C.; Fitzpatrick, Karrie; Zhang, Bin; Vitaterna, Martha H.; Schadt, Eric E.; Renger, John J.; Turek, Fred W.

2011-01-01

Study Objective: Sleep-wake traits are well-known to be under substantial genetic control, but the specific genes and gene networks underlying primary sleep-wake traits have largely eluded identification using conventional approaches, especially in mammals. Thus, the aim of this study was to use systems genetics and statistical approaches to uncover the genetic networks underlying 2 primary sleep traits in the mouse: 24-h duration of REM sleep and wake. Design: Genome-wide RNA expression data from 3 tissues (anterior cortex, hypothalamus, thalamus/midbrain) were used in conjunction with high-density genotyping to identify candidate causal genes and networks mediating the effects of 2 QTL regulating the 24-h duration of REM sleep and one regulating the 24-h duration of wake. Setting: Basic sleep research laboratory. Patients or Participants: Male [C57BL/6J × (BALB/cByJ × C57BL/6J*) F1] N2 mice (n = 283). Interventions: None. Measurements and Results: The genetic variation of a mouse N2 mapping cross was leveraged against sleep-state phenotypic variation as well as quantitative gene expression measurement in key brain regions using integrative genomics approaches to uncover multiple causal sleep-state regulatory genes, including several surprising novel candidates, which interact as components of networks that modulate REM sleep and wake. In particular, it was discovered that a core network module, consisting of 20 genes, involved in the regulation of REM sleep duration is conserved across the cortex, hypothalamus, and thalamus. A novel application of a formal causal inference test was also used to identify those genes directly regulating sleep via control of expression. Conclusion: Systems genetics approaches reveal novel candidate genes, complex networks and specific transcriptional regulators of REM sleep and wake duration in mammals. Citation: Millstein J; Winrow CJ; Kasarskis A; Owens JR; Zhou L; Summa KC; Fitzpatrick K; Zhang B; Vitaterna MH; Schadt EE; Renger JJ; Turek FW. Identification of causal genes, networks, and transcriptional regulators of REM sleep and wake. SLEEP 2011;34(11):1469-1477. PMID:22043117

Deficiency of FK506-binding protein (FKBP) 51 alters sleep architecture and recovery sleep responses to stress in mice.

PubMed

Albu, Stefana; Romanowski, Christoph P N; Letizia Curzi, M; Jakubcakova, Vladimira; Flachskamm, Cornelia; Gassen, Nils C; Hartmann, Jakob; Schmidt, Mathias V; Schmidt, Ulrike; Rein, Theo; Holsboer, Florian; Hausch, Felix; Paez-Pereda, Marcelo; Kimura, Mayumi

2014-04-01

FK506-binding protein 51 (FKBP51) is a co-chaperone of the glucocorticoid receptor, functionally linked to its activity via an ultra-short negative feedback loop. Thus, FKBP51 plays an important regulatory role in the hypothalamic-pituitary-adrenocortical (HPA) axis necessary for stress adaptation and recovery. Previous investigations illustrated that HPA functionality is influenced by polymorphisms in the gene encoding FKBP51, which are associated with both increased protein levels and depressive episodes. Because FKBP51 is a key molecule in stress responses, we hypothesized that its deletion impacts sleep. To study FKBP51-involved changes in sleep, polysomnograms of FKBP51 knockout (KO) mice and wild-type (WT) littermates were compared at baseline and in the recovery phase after 6-h sleep deprivation (SD) and 1-h restraint stress (RS). Using another set of animals, the 24-h profiles of hippocampal free corticosterone levels were also determined. The most dominant effect of FKBP51 deletion appeared as increased nocturnal wake, where the bout length was significantly extended while non-rapid eye movement sleep (NREMS) and rapid eye movement sleep were rather suppressed. After both SD and RS, FKBP51KO mice exhibited less recovery or rebound sleep than WTs, although slow-wave activity during NREMS was higher in KOs, particularly after SD. Sleep compositions of KOs were nearly opposite to sleep profiles observed in human depression. This might result from lower levels of free corticosterone in FKBP51KO mice, confirming reduced HPA reactivity. The results indicate that an FKBP51 deletion yields a pro-resilience sleep phenotype. FKBP51 could therefore be a therapeutic target for stress-induced mood and sleep disorders. © 2013 European Sleep Research Society.

Latino Parents' Insight on Optimal Sleep for Their Preschool-Age Child: Does Context Matter?

PubMed

Martinez, Suzanna M; Thompson-Lastad, Ariana

2015-01-01

Insufficient sleep is a risk factor for pediatric obesity. Latino children are among those groups in which both short sleep duration and obesity are prevalent. Therefore, this study sought to explore Latino parents' views about ideal sleep duration and sleep-related practices for their preschool-age children in an urban setting. Between October 2013 and January 2014, Latino parents of 2- to 5-year-old children were interviewed at 3 pediatric clinics (San Francisco, Calif). Using a semistructured interview guide, parents were asked to describe bedtime routines and sleep practices of their preschool-age children, including behavioral, parental, social, and contextual factors that may affect children's sleep. Interviews were conducted in Spanish and English. Parents also completed a brief survey on demographic information. Interviews were analyzed on the basis of a priori and emergent themes. Latino parents (n = 18) were mostly female, with a mean age of 31 years; most were foreign born; and more than half had a monthly household income of $2000 or less. The following themes emerged: parents' ideas about optimal sleep duration for their preschool-age child, consistent bedtime routines, room sharing and bed sharing, parent work and child school schedules that affect children's sleep, and crowded housing and neighborhood noise that disrupt children's sleep. These findings increase our understanding of the factors related to achieving optimal sleep duration among Latino children living in urban and often crowded housing. Findings could be used to inform future research on how to increase parental knowledge of healthy sleep practices and adequate sleep among Latino parents of young children. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

The Circadian System Contributes to Apnea Lengthening across the Night in Obstructive Sleep Apnea

PubMed Central

Butler, Matthew P.; Smales, Carolina; Wu, Huijuan; Hussain, Mohammad V.; Mohamed, Yusef A.; Morimoto, Miki; Shea, Steven A.

2015-01-01

Study Objective: To test the hypothesis that respiratory event duration exhibits an endogenous circadian rhythm. Design: Within-subject and between-subjects. Settings: Inpatient intensive physiologic monitoring unit at the Brigham and Women's Hospital. Participants: Seven subjects with moderate/severe sleep apnea and four controls, age 48 (SD = 12) years, 7 males. Interventions: Subjects completed a 5-day inpatient protocol in dim light. Polysomnography was recorded during an initial control 8-h night scheduled at the usual sleep time, then through 10 recurrent cycles of 2 h 40 min sleep and 2 h 40 min wake evenly distributed across all circadian phases, and finally during another 8-h control sleep period. Measurements and Results: Event durations, desaturations, and apnea-hypopnea index for each sleep opportunity were assessed according to circadian phase (derived from salivary melatonin), time into sleep, and sleep stage. Average respiratory event durations in NREM sleep significantly lengthened across both control nights (21.9 to 28.2 sec and 23.7 to 30.2 sec, respectively). During the circadian protocol, event duration in NREM increased across the circadian phases that corresponded to the usual sleep period, accounting for > 50% of the increase across normal 8-h control nights. AHI and desaturations were also rhythmic: AHI was highest in the biological day while desaturations were greatest in the biological night. Conclusions: The endogenous circadian system plays an important role in the prolongation of respiratory events across the night, and might provide a novel therapeutic target for modulating sleep apnea. Citation: Butler MP, Smales C, Wu H, Hussain MV, Mohamed YA, Morimoto M, Shea SA. The circadian system contributes to apnea lengthening across the night in obstructive sleep apnea. SLEEP 2015;38(11):1793–1801. PMID:26039970

Poor Sleep Quality and Functional Decline in Older Women

PubMed Central

Spira, Adam P.; Covinsky, Kenneth; Rebok, George W.; Punjabi, Naresh M.; Stone, Katie L.; Hillier, Teresa A.; Ensrud, Kristine; Yaffe, Kristine

2012-01-01

OBJECTIVES To determine whether objectively measured sleep quality predicts five-year incident instrumental activities of daily living (IADL) impairment and decline in grip strength and gait speed in older women. DESIGN Prospective cohort SETTING Participants’ homes, Study of Osteoporotic Fractures sites PARTICIPANTS 817 women (mean 82.4 years at baseline) MEASUREMENTS Participants completed 4.1 ±0.7 nights of wrist actigraphy at baseline, and measures of IADL impairment, grip strength, and gait speed at baseline and five-year follow-up. RESULTS After five years of follow-up, approximately 41% of participants had incident impairment in ≥1 IADL. The quartile of women with the shortest total sleep time had a 93% greater odds of incident IADL impairment than the longest sleepers (adjusted odds ratio (AOR) = 1.93, 95% confidence interval (CI) 1.25, 2.97). Similarly, the quartile of women with the lowest sleep efficiency had a 65% greater odds of impairment than those with the highest (AOR = 1.65, 95% CI 1.06, 2.57). Women in the shortest total sleep time quartile had double the odds of declining grip strength, compared to those with the longest total sleep time (AOR = 1.97, 95% CI 1.17, 3.32). Finally, women in the quartiles with the most wake after sleep onset and the lowest sleep efficiency had an approximately 90% greater odds of grip strength decline than those with the least wake after sleep onset (AOR = 1.90, 95% CI 1.11, 3.24) and sleep efficiency (AOR = 1.92, 95% CI 1.12, 3.29). CONCLUSION Findings indicate that shorter sleep duration, greater wake after sleep onset, and lower sleep efficiency are risk factors for functional or physical decline in older women. PMID:22690985

Sleep duration and mortality in the elderly: a systematic review with meta-analysis

PubMed Central

da Silva, Andressa Alves; de Mello, Renato Gorga Bandeira; Schaan, Camila Wohlgemuth; Fuchs, Flávio D; Redline, Susan; Fuchs, Sandra C

2016-01-01

Objective The purpose of our study was to evaluate the association between short and long sleep duration and all-cause and cardiovascular mortality among elderly individuals. Design Systematic review and meta-analysis of population-based cohort studies. Setting Articles were retrieved from international and national electronic databases. Study selection Studies were identified in PubMed, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), IBECS (Bibliographic Index on Health Sciences from Spain) and CAPES (PhD thesis repository) between 1980 and 2015. Studies which met all criteria were eligible: participants aged 60 years or over, assessment of sleep duration as 24 h, nighttime or daytime sleep, evaluation of all-cause or cause-specific mortality, population-based cohort studies conducted on representative samples. There was no language restriction and studies published as abstracts were excluded. Data extraction Data were analysed using the Comprehensive Meta-Analysis software (V.3.3.070), and summary estimates (relative risk (RR), 95% CI) were calculated using a random effects model. Heterogeneity and consistency were evaluated through Cochran's Q and the I2 statistics, respectively, and sensitivity analyses were conducted. Primary and secondary outcome measures All-cause and cardiovascular mortality. Results Overall, 27 cohort studies were selected, comprising >70 000 elderly individuals, and followed up from 3.4 to 35 years. In the pooled analysis, long and short sleep duration were associated with increased all-cause mortality (RR 1.33; 95% CI 1.24 to 1.43 and RR 1.07; 95% CI 1.03 to 1.11, respectively), compared with the reference category. For cardiovascular mortality, the pooled relative risks were 1.43 (95% CI 1.15 to 1.78) for long sleep, and 1.18 (95% CI 0.76 to 1.84) for short sleep. Daytime napping ≥30 min was associated with risk of all-cause mortality (RR 1.27; 95% CI 1.08 to 1.49), compared with no daytime sleep, but longer sleep duration (≥2.0 h) was not (RR 1.34; 95% CI 1.95 to 1.90). Conclusions Among elderly individuals, long and short sleep duration are associated with increased risk for all-cause mortality. Long sleep duration is associated with cardiovascular mortality. PMID:26888725

Bench test evaluation of adaptive servoventilation devices for sleep apnea treatment.

PubMed

Zhu, Kaixian; Kharboutly, Haissam; Ma, Jianting; Bouzit, Mourad; Escourrou, Pierre

2013-09-15

Adaptive servoventilation devices are marketed to overcome sleep disordered breathing with apneas and hypopneas of both central and obstructive mechanisms often experienced by patients with chronic heart failure. The clinical efficacy of these devices is still questioned. This study challenged the detection and treatment capabilities of the three commercially available adaptive servoventilation devices in response to sleep disordered breathing events reproduced on an innovative bench test. The bench test consisted of a computer-controlled piston and a Starling resistor. The three devices were subjected to a flow sequence composed of central and obstructive apneas and hypopneas including Cheyne-Stokes respiration derived from a patient. The responses of the devices were separately evaluated with the maximum and the clinical settings (titrated expiratory positive airway pressure), and the detected events were compared to the bench-scored values. The three devices responded similarly to central events, by increasing pressure support to raise airflow. All central apneas were eliminated, whereas hypopneas remained. The three devices responded differently to the obstructive events with the maximum settings. These obstructive events could be normalized with clinical settings. The residual events of all the devices were scored lower than bench test values with the maximum settings, but were in agreement with the clinical settings. However, their mechanisms were misclassified. The tested devices reacted as expected to the disordered breathing events, but not sufficiently to normalize the breathing flow. The device-scored results should be used with caution to judge efficacy, as their validity depends upon the initial settings.

Differential Sleep, Sleepiness, and Neurophysiology in the Insomnia Phenotypes of Shift Work Disorder

PubMed Central

Gumenyuk, Valentina; Belcher, Ren; Drake, Christopher L.; Roth, Thomas

2015-01-01

Study Objectives: To characterize and compare insomnia symptoms within two common phenotypes of Shift Work Disorder. Design: Observational laboratory and field study. Setting: Hospital sleep center. Participants: 34 permanent night workers. Subjects were classified by Epworth Sleepiness Scale and Insomnia Severity Index into 3 subgroups: asymptomatic controls, alert insomniacs (AI), and sleepy insomniacs (SI). Measurements: Sleep parameters were assessed by sleep diary. Circadian phase was evaluated by dim-light salivary melatonin onset (DLMO). Objective sleepiness was measured using the multiple sleep latency test (MSLT). Brain activity was measured using the N1 event-related potential (ERP). A tandem repeat in PER3 was genotyped from saliva DNA. Results: (1) AI group showed normal MSLT scores but elevated N1 amplitudes indicating cortical hyperarousal. (2) SI group showed pathologically low MSLT scores but normal N1 amplitudes. (3) AI and SI groups were not significantly different from one another in circadian phase, while controls were significantly phase-delayed relative to both SWD groups. (4) AI showed significantly longer sleep latencies and lower sleep efficiency than controls during both nocturnal and diurnal sleep. SI significantly differed from controls in nocturnal sleep parameters, but differences during diurnal sleep periods were smaller and not statistically significant. (5) Genotype × phenotype χ2 analysis showed significant differences in the PER3 VNTR: 9 of 10 shift workers reporting sleepiness in a post hoc genetic substudy were found to carry the long tandem repeat on PER3, while 4 of 14 shift workers without excessive sleepiness carried the long allele. Conclusions: Our results suggest that the sleepy insomnia phenotype is comprehensively explained by circadian misalignment, while the alert insomnia phenotype resembles an insomnia disorder precipitated by shift work. Citation: Gumenyuk V, Belcher R, Drake CL, Roth T. Differential sleep, sleepiness, and neurophysiology in the insomnia phenotypes of shift work disorder. SLEEP 2015;38(1):119–126. PMID:25325466

Rapid Eye Movement and Non-Rapid Eye Movement Sleep Contributions in Memory Consolidation and Resistance to Retroactive Interference for Verbal Material

PubMed Central

Deliens, Gaétane; Leproult, Rachel; Neu, Daniel; Peigneux, Philippe

2013-01-01

Study Objectives: To test the hypothesis that rapid eye movement (REM) sleep contributes to the consolidation of new memories, whereas non-rapid eye movement (NREM) sleep contributes to the prevention of retroactive interference. Design: Randomized, crossover study. Setting: Two sessions of either a morning nap or wakefulness. Participants: Twenty-five healthy young adults. Interventions: Declarative learning of word pairs followed by a nap or a wake interval, then learning of interfering word pairs and delayed recall of list A. Measurements and Results: After a restricted night (24:00-06:00), participants learned a list of word pairs (list A). They were then required to either take a nap or stay awake during 45 min, after which they learned a second list of word pairs (list B) and then had to recall list A. Fifty percent of word pairs in list B shared the first word with list A, resulting in interference. Ten subjects exhibited REM sleep whereas 13 subjects exhibited NREM stage 3 (N3) sleep. An interference effect was observed in the nap but not in the wake condition. In post-learning naps, N3 sleep was associated with a reduced interference effect, which was not the case for REM sleep. Moreover, participants exhibiting N3 sleep in the post-learning nap condition also showed a reduced interference effect in the wake condition, suggesting a higher protection ability against interference. Conclusion: Our results partly support the hypothesis that non-rapid eye movement sleep contributes in protecting novel memories against interference. However, rapid eye movement sleep-related consolidation is not evidenced. Citation: Deliens G; Leproult R; Neu D; Peigneux P. Rapid eye movement and non-rapid eye movement sleep contributions in memory consolidation and resistance to retroactive interference for verbal material. SLEEP 2013;36(12):1875-1883. PMID:24293762

Sleep disturbance, stroke, and heart disease events: evidence from the Caerphilly cohort

PubMed Central

Elwood, Peter; Hack, Melissa; Pickering, Janet; Hughes, Janie; Gallacher, John

2006-01-01

Objective To test the hypothesis that sleep disorders are relevant to the risk of ischaemic stroke and ischaemic heart disease events in older men. Design A cohort study. Setting The Caerphilly cohort, a representative population sample of older men in South Wales, UK. Participants 1986 men aged 55–69 years completed a questionnaire on sleep patterns with help from their partners. This asked about symptoms of disturbed sleep: insomnia, snoring, restless legs, obstructive sleep apnoea, and about daytime sleepiness. During the following 10 years 107 men experienced an ischaemic stroke and 213 had an ischaemic heart disease event. Main results Up to one third of the men reported at least one symptom suggestive of sleep disturbance, and one third reported daytime sleepiness. Compared with men who reported no such symptoms, the adjusted relative odds of an ischaemic stroke were significantly increased in men with any sleep disturbance, the strongest association being with sleep apnoea (relative odds 1.97; 1.26 to 3.09). The association with daytime sleepiness was not significant for stroke. Relations with ischaemic heart disease events were all raised in men with symptoms of sleep disturbance, but none was significant, other than daytime sleepiness (relative odds: 1.41; 1.04 to 1.92). There were no significant relations with blood pressure. Conclusion The risk of an ischaemic stroke is increased in men whose sleep is frequently disturbed, and daytime sleepiness is associated with a significant increase in ischaemic heart disease events. PMID:16361457

Sleep and Psychiatric Disorders in Persons With Mild Traumatic Brain Injury.

PubMed

Mollayeva, Tatyana; D'Souza, Andrea; Mollayeva, Shirin

2017-08-01

Mild traumatic brain injury (mTBI) frequently challenges the integrity of sleep function by affecting multiple brain areas implicated in controlling the switch between wakefulness and sleep and those involved in circadian and homeostatic processes; the malfunction of each causes a variety of disorders. In this review, we discuss recent data on the dynamics between disorders of sleep and mental/psychiatric disorders in persons with mTBI. This analysis sets the stage for understanding how a variety of physiological, emotional and environmental influences affect sleep and mental activities after injury to the brain. Consideration of the intricate links between sleep and mental functions in future research can increase understanding on the underlying mechanisms of sleep-related and psychiatric comorbidity in mTBI.

Bedtime activities, sleep environment, and sleep/wake patterns of Japanese elementary school children.

PubMed

Oka, Yasunori; Suzuki, Shuhei; Inoue, Yuich

2008-01-01

Bedtime activities, sleep environment, and their impact on sleep/wake patterns were assessed in 509 elementary school children (6-12 years of age; 252 males and 257 females). Television viewing, playing video games, and surfing the Internet had negative impact on sleep/wake parameters. Moreover, presence of a television set or video game in the child's bedroom increased their activity before bedtime. Time to return home later than 8 p.m. from after-school activity also had a negative impact on sleep/wake patterns. Health care practitioners should be aware of the potential negative impact of television, video games, and the Internet before bedtime, and also the possibility that late after-school activity can disturb sleep/wake patterns.

A decision support system for automatic sleep staging from EEG signals using tunable Q-factor wavelet transform and spectral features.

PubMed

Hassan, Ahnaf Rashik; Bhuiyan, Mohammed Imamul Hassan

2016-09-15

Automatic sleep scoring is essential owing to the fact that conventionally a large volume of data have to be analyzed visually by the physicians which is onerous, time-consuming and error-prone. Therefore, there is a dire need of an automated sleep staging scheme. In this work, we decompose sleep-EEG signal segments using tunable-Q factor wavelet transform (TQWT). Various spectral features are then computed from TQWT sub-bands. The performance of spectral features in the TQWT domain has been determined by intuitive and graphical analyses, statistical validation, and Fisher criteria. Random forest is used to perform classification. Optimal choices and the effects of TQWT and random forest parameters have been determined and expounded. Experimental outcomes manifest the efficacy of our feature generation scheme in terms of p-values of ANOVA analysis and Fisher criteria. The proposed scheme yields 90.38%, 91.50%, 92.11%, 94.80%, 97.50% for 6-stage to 2-stage classification of sleep states on the benchmark Sleep-EDF data-set. In addition, its performance on DREAMS Subjects Data-set is also promising. The performance of the proposed method is significantly better than the existing ones in terms of accuracy and Cohen's kappa coefficient. Additionally, the proposed scheme gives high detection accuracy for sleep stages non-REM 1 and REM. Spectral features in the TQWT domain can discriminate sleep-EEG signals corresponding to various sleep states efficaciously. The proposed scheme will alleviate the burden of the physicians, speed-up sleep disorder diagnosis, and expedite sleep research. Copyright © 2016 Elsevier B.V. All rights reserved.

The role of sleep hygiene in promoting public health: A review of empirical evidence.

PubMed

Irish, Leah A; Kline, Christopher E; Gunn, Heather E; Buysse, Daniel J; Hall, Martica H

2015-08-01

The ineffectiveness of sleep hygiene as a treatment in clinical sleep medicine has raised some interesting questions. If it is known that, individually, each specific component of sleep hygiene is related to sleep, why wouldn't addressing multiple individual components (i.e., sleep hygiene education) improve sleep? Is there still a use for sleep hygiene? Global public health concern over sleep has increased demand for sleep promotion strategies accessible to the population. However, the extent to which sleep hygiene strategies apply outside clinical settings is not well known. The present review sought to evaluate the empirical evidence for sleep hygiene recommendations regarding exercise, stress management, noise, sleep timing, and avoidance of caffeine, nicotine, alcohol, and daytime napping, with a particular emphasis on their public health utility. Thus, our review is not intended to be exhaustive regarding the clinical application of these techniques, but rather to focus on broader applications. Overall, though epidemiologic and experimental research generally supported an association between individual sleep hygiene recommendations and nocturnal sleep, the direct effects of individual recommendations on sleep remains largely untested in the general population. Suggestions for clarification of sleep hygiene recommendations and considerations for the use of sleep hygiene in nonclinical populations are discussed. Copyright © 2014 Elsevier Ltd. All rights reserved.

Recovery of Neurological Function Despite Immediate Sleep Disruption Following Diffuse Brain Injury in the Mouse: Clinical Relevance to Medically Untreated Concussion

PubMed Central

Rowe, Rachel K.; Harrison, Jordan L.; O'Hara, Bruce F.; Lifshitz, Jonathan

2014-01-01

Study Objective: We investigated the relationship between immediate disruption of posttraumatic sleep and functional outcome in the diffuse brain-injured mouse. Design: Adult male C57BL/6 mice were subjected to moderate midline fluid percussion injury (n = 65; 1.4 atm; 6-10 min righting reflex time) or sham injury (n = 44). Cohorts received either intentional sleep disruption (minimally stressful gentle handling) or no sleep disruption for 6 h following injury. Following disruption, serum corticosterone levels (enzyme-linked immunosorbent assay) and posttraumatic sleep (noninvasive piezoelectric sleep cages) were measured. For 1-7 days postinjury, sensorimotor outcome was assessed by Rotarod and a modified Neurological Severity Score (NSS). Cognitive function was measured using Novel Object Recognition (NOR) and Morris water maze (MWM) in the first week postinjury. Setting: Neurotrauma research laboratory. Measurements and Results: Disrupting posttraumatic sleep for 6 h did not affect serum corticosterone levels or functional outcome. In the hour following the first dark onset, sleep-disrupted mice exhibited a significant increase in sleep; however, this increase was not sustained and there was no rebound of lost sleep. Regardless of sleep disruption, mice showed a time-dependent improvement in Rotarod performance, with brain-injured mice having significantly shorter latencies on day 7 compared to sham. Further, brain-injured mice, regardless of sleep disruption, had significantly higher NSS scores postinjury compared with sham. Cognitive behavioral testing showed no group differences among any treatment group measured by MWM and NOR. Conclusion: Short-duration disruption of posttraumatic sleep did not affect functional outcome, measured by motor and cognitive performance. These data raise uncertainty about posttraumatic sleep as a mechanism of recovery from diffuse brain injury. Citation: Rowe RK; Harrison JL; O'Hara BF; Lifshitz J. Recovery of neurological function despite immediate sleep disruption following diffuse brain injury in the mouse: clinical relevance to medically untreated concussion. SLEEP 2014;37(4):743-752. PMID:24899763

Association between Total Sleep Duration and Suicidal Ideation among the Korean General Adult Population

PubMed Central

Kim, Jae-Hyun; Park, Eun-Cheol; Cho, Woo-Hyun; Park, Jong-Yeon; Choi, Won-Jung; Chang, Hoo-Sun

2013-01-01

Study Objectives: Examine the association between sleep duration and suicidal ideation in Korean adults. Design: Cross-sectional survey. Setting: Data obtained by the Korea National Health and Nutrition Examination Survey IV (2007-2009) using a rolling sampling design involving a complex, stratified, multistage, and probability-cluster survey of civilian non-institutionalized Korean residents. Participants: A total of 15,236 subjects (6,638 males and 8,598 females) ≥ 19 years old. Measurements and Results: The weighted prevalence of self-reported short sleep duration (≤ 5 h/day) was 11.7% in males and 15% in females, and of long sleep duration (≥ 9 h/day) was 6.7% in males and 8.9% in females. A U-shaped relationship existed, with both short and long sleep durations associated with a higher suicidal ideation risk. Multiple logistic regression analysis was used to analyze the relationship between sleep duration and suicidal ideation, adjusting for sociodemographic factors, health behavior, and health status. After controlling for covariates, people with short sleep were 38.1% more likely to have suicidal ideation (OR = 1.381, 95% CI 1.156-1.650) than people with sleep duration of 7 h/day. Suicidal ideation was 1.196 times higher (95% CI: 0.950-1.507) in long-sleeping people than people sleeping 7 h/day, although statistically not significant. Inclusion of depressive mood (a potential confounder) in multiple logistic regression models attenuated but did not eliminate the sleep duration/suicidal ideation association. Limitations: Sleep duration and suicidal ideation were assessed only by self-report. Conclusions: The sleep duration/suicidal ideation relationship is U-shaped in the Korean adult population. Self-reported habitual sleep duration may be a useful behavioral indicator for both individual and societal suicidal ideation risk. Citation: Kim JH; Park EC; Cho WH; Park JY; Choi WJ; Chang HS. Association between total sleep duration and suicidal ideation among the Korean general adult population. SLEEP 2013;36(10):1563-1572. PMID:24082316

Homeostatic and Circadian Contribution to EEG and Molecular State Variables of Sleep Regulation

PubMed Central

Curie, Thomas; Mongrain, Valérie; Dorsaz, Stéphane; Mang, Géraldine M.; Emmenegger, Yann; Franken, Paul

2013-01-01

Study Objectives: Besides their well-established role in circadian rhythms, our findings that the forebrain expression of the clock-genes Per2 and Dbp increases and decreases, respectively, in relation to time spent awake suggest they also play a role in the homeostatic aspect of sleep regulation. Here, we determined whether time of day modulates the effects of elevated sleep pressure on clock-gene expression. Time of day effects were assessed also for recognized electrophysiological (EEG delta power) and molecular (Homer1a) markers of sleep homeostasis. Design: EEG and qPCR data were obtained for baseline and recovery from 6-h sleep deprivation starting at ZT0, -6, -12, or -18. Setting: Mouse sleep laboratory. Participants: Male mice. Interventions: Sleep deprivation. Results: The sleep-deprivation induced changes in Per2 and Dbp expression importantly varied with time of day, such that Per2 could even decrease during sleep deprivations occurring at the decreasing phase in baseline. Dbp showed similar, albeit opposite dynamics. These unexpected results could be reliably predicted assuming that these transcripts behave according to a driven damped harmonic oscillator. As expected, the sleep-wake distribution accounted for a large degree of the changes in EEG delta power and Homer1a. Nevertheless, the sleep deprivation-induced increase in delta power varied also with time of day with higher than expected levels when recovery sleep started at dark onset. Conclusions: Per2 and delta power are widely used as exclusive state variables of the circadian and homeostatic process, respectively. Our findings demonstrate a considerable cross-talk between these two processes. As Per2 in the brain responds to both sleep loss and time of day, this molecule is well positioned to keep track of and to anticipate homeostatic sleep need. Citation: Curie T; Mongrain V; Dorsaz S; Mang GM; Emmenegger Y; Franken P. Homeostatic and circadian contribution to EEG and molecular state variables of sleep regulation. SLEEP 2013;36(3):311-323. PMID:23450268

Associations of Self-Reported Sleep Duration and Snoring with Colorectal Cancer Risk in Men and Women

PubMed Central

Zhang, Xuehong; Giovannucci, Edward L.; Wu, Kana; Gao, Xiang; Hu, Frank; Ogino, Shuji; Schernhammer, Eva S.; Fuchs, Charles S.; Redline, Susan; Willett, Walter C.; Ma, Jing

2013-01-01

Study Objectives: We assessed the relationship between sleep duration, snoring and colorectal cancer risk. Design: Prospective cohort studies. Setting: United States. Participants: A total of 30,121 men aged 41 to 79 years in the Health Professionals Follow-up Study and 76,368 women aged 40 to 73 years in the Nurses' Health Study. Interventions: None. Measurements and Results: We queried information on sleep duration and snoring in 1986/87. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs, 95% CIs). We documented 1,973 incident colorectal cancer cases (709 men and 1,264 women) over a 22-year follow-up period. Compared to sleep an average 7 h, ≥ 9 h of sleep was significantly associated with a higher risk of colorectal cancer among men (HR = 1.35, 95% CI: 1.00, 1.82), and to a lesser degree, among women (HR = 1.11, 95% CI: 0.85, 1.44). The risk associated with longer sleep was restricted to individuals who regularly snored (men: HR = 1.80, 95% CI: 1.14, 2.84; women: HR = 2.32, 95% CI: 1.24, 4.36) and to overweight individuals (i.e., BMI ≥ 25 kg/m2) (men: HR = 1.52, 95% CI: 1.04, 2.21; women: HR = 1.37, 95% CI: 0.97, 1.94). Short sleep duration (≤ 5 h) was not associated with an increased risk of colorectal cancer in the entire sample or in subgroups stratified by snoring or BMI. Conclusions: Longer sleep duration was associated with an increased risk of developing colorectal cancer among individuals who were overweight or snored regularly. This observation raises the possibility that sleep apnea and its attendant intermittent hypoxemia may contribute to cancer risk. Citation: Zhang X; Giovannucci EL; Wu K; Gao X; Hu F; Ogino S; Schernhammer ES; Fuchs CS; Redline S; Willett WC; Ma J. Associations of self-reported sleep duration and snoring with colorectal cancer risk in men and women. SLEEP 2013;36(5):681-688. PMID:23633750

Sleep spindle and K-complex detection using tunable Q-factor wavelet transform and morphological component analysis

PubMed Central

Lajnef, Tarek; Chaibi, Sahbi; Eichenlaub, Jean-Baptiste; Ruby, Perrine M.; Aguera, Pierre-Emmanuel; Samet, Mounir; Kachouri, Abdennaceur; Jerbi, Karim

2015-01-01

A novel framework for joint detection of sleep spindles and K-complex events, two hallmarks of sleep stage S2, is proposed. Sleep electroencephalography (EEG) signals are split into oscillatory (spindles) and transient (K-complex) components. This decomposition is conveniently achieved by applying morphological component analysis (MCA) to a sparse representation of EEG segments obtained by the recently introduced discrete tunable Q-factor wavelet transform (TQWT). Tuning the Q-factor provides a convenient and elegant tool to naturally decompose the signal into an oscillatory and a transient component. The actual detection step relies on thresholding (i) the transient component to reveal K-complexes and (ii) the time-frequency representation of the oscillatory component to identify sleep spindles. Optimal thresholds are derived from ROC-like curves (sensitivity vs. FDR) on training sets and the performance of the method is assessed on test data sets. We assessed the performance of our method using full-night sleep EEG data we collected from 14 participants. In comparison to visual scoring (Expert 1), the proposed method detected spindles with a sensitivity of 83.18% and false discovery rate (FDR) of 39%, while K-complexes were detected with a sensitivity of 81.57% and an FDR of 29.54%. Similar performances were obtained when using a second expert as benchmark. In addition, when the TQWT and MCA steps were excluded from the pipeline the detection sensitivities dropped down to 70% for spindles and to 76.97% for K-complexes, while the FDR rose up to 43.62 and 49.09%, respectively. Finally, we also evaluated the performance of the proposed method on a set of publicly available sleep EEG recordings. Overall, the results we obtained suggest that the TQWT-MCA method may be a valuable alternative to existing spindle and K-complex detection methods. Paths for improvements and further validations with large-scale standard open-access benchmarking data sets are discussed. PMID:26283943

Sleep-related Issues for Recovery and Performance in Athletes.

PubMed

Kölling, Sarah; Duffield, Rob; Erlacher, Daniel; Venter, Ranel; Halson, Shona L

2018-04-13

The body of research that reports the relevance of sleep in high-performance sports is growing steadily. While the identification of sleep cycles and diagnosis of sleep disorders is limited to lab-based assessment via polysomnography, the development of activity-based devices estimating sleep patterns provides greater insight into the sleep behaviour of athletes in ecological settings. Overall, small sleep quantity and/or poor quality appears to exist in many athletic populations, though this may be related to training and competition context. Typical sleep-affecting factors are the scheduling of training sessions and competitions as well as impaired sleep-onset as a result of increased arousal prior to competition or due to the use of electronic devices before bedtime. Further challenges are travel demands which may be accompanied by jet-lag symptoms and disruption of sleep habits. Promotion of sleep may be approached via behavioural strategies, such as sleep hygiene, extending night-time sleep or daytime napping. Pharmacological interventions should be limited to clinically-induced treatments as evidence among healthy and athletic populations is lacking. To optimise and manage sleep in athletes, it is recommended to implement routine sleep monitoring on an individual basis.

Narcolepsy and Predictors of Positive MSLTs in the Wisconsin Sleep Cohort

PubMed Central

Goldbart, Aviv; Peppard, Paul; Finn, Laurel; Ruoff, Chad M.; Barnet, Jodi; Young, Terry; Mignot, Emmanuel

2014-01-01

Study Objectives: To study whether positive multiple sleep latency tests (MSLTs, mean sleep latency [MSL] ≤ 8 minutes, ≥ 2 sleep onset REM sleep periods [SOREMPs]) and/or nocturnal SOREMP (REM sleep latency ≤ 15 minutes during nocturnal polysomonography [NPSG]) are stable traits and can reflect incipient narcolepsy. Design and Setting: Cross-sectional and longitudinal investigation of the Wisconsin Sleep Cohort Study. Participants: Adults (44% females, 30-81 years) underwent NPSG (n = 4,866 in 1,518 subjects), and clinical MSLT (n = 1,135), with 823 having a repeat NPSG-MSLT at 4-year intervals, totaling 1725 NPSG with MSLT studies. Data were analyzed using linear mixed-effects models, and the stability of positive MSLTs was explored using κ statistics. Measurements and Results: Prevalence of a nocturnal SOREMP on a NPSG, of ≥ 2 SOREMPs on the MSLT, of MSL ≤ 8 minutes on the MSLT, and of a positive MSLT (MSL ≤ 8 minutes plus ≥ 2 SOREMPs) were 0.35%, 7.0%, 22%, and 3.4%, respectively. Correlates of a positive MSLT were shift work (OR = 7.8, P = 0.0001) and short sleep (OR = 1.51/h, P = 0.04). Test-retest for these parameters was poor, with κ < 0.2 (n.s.) after excluding shift workers and short sleepers. Excluding shift-work, short sleep, and subjects with negative MSLTs, we found one undiagnosed subject with possible cataplexy (≥ 1/month) and a NPSG SOREMPs; one subject previously diagnosed with narcolepsy without cataplexy with 2 NPSG SOREMPs and a positive MSLT, and two subjects with 2 independently positive MSLTs (66% human leukocyte antigen [HLA] positive). The proportions for narcolepsy with and without cataplexy were 0.07% (95% CI: 0.02-0.37%) and 0.20% (95% CI: 0.07-0.58%), respectively. Conclusions: The diagnostic value of multiple sleep latency tests is strongly altered by shift work and to a lesser extent by chronic sleep deprivation. The prevalence of narcolepsy without cataplexy may be 3-fold higher than that of narcolepsy-cataplexy. Citation: Goldbart A, Peppard P, Finn L, Ruoff CM, Barnet J, Young T, Mignot E. Narcolepsy and predictors of positive MSLTs in the Wisconsin Sleep Cohort. SLEEP 2014;37(6):1043-1051. PMID:24882899

Can't Make 'em Do It: Sleeping, Eating, Toileting

ERIC Educational Resources Information Center

Duffy, Roslyn

2008-01-01

Sleeping, eating, and toileting battles frustrate most adults--mainly because they cannot make children do it. Falling asleep (or not) is within a child's control. The same is true for chewing and swallowing, or withholding and releasing urine and feces. Sleeping, Eating, and Toileting (S.E.T.) create lots of frustration. An exhausted adult wants…

Melanopsin Regulates Both Sleep-Promoting and Arousal-Promoting Responses to Light

PubMed Central

Tam, Shu K. E.; Hughes, Steven; Jagannath, Aarti; Hankins, Mark W.; Bannerman, David M.; Lightman, Stafford L.; Vyazovskiy, Vladyslav V.; Nolan, Patrick M.; Foster, Russell G.; Peirson, Stuart N.

2016-01-01

Light plays a critical role in the regulation of numerous aspects of physiology and behaviour, including the entrainment of circadian rhythms and the regulation of sleep. These responses involve melanopsin (OPN4)-expressing photosensitive retinal ganglion cells (pRGCs) in addition to rods and cones. Nocturnal light exposure in rodents has been shown to result in rapid sleep induction, in which melanopsin plays a key role. However, studies have also shown that light exposure can result in elevated corticosterone, a response that is not compatible with sleep. To investigate these contradictory findings and to dissect the relative contribution of pRGCs and rods/cones, we assessed the effects of light of different wavelengths on behaviourally defined sleep. Here, we show that blue light (470 nm) causes behavioural arousal, elevating corticosterone and delaying sleep onset. By contrast, green light (530 nm) produces rapid sleep induction. Compared to wildtype mice, these responses are altered in melanopsin-deficient mice (Opn4-/-), resulting in enhanced sleep in response to blue light but delayed sleep induction in response to green or white light. We go on to show that blue light evokes higher Fos induction in the SCN compared to the sleep-promoting ventrolateral preoptic area (VLPO), whereas green light produced greater responses in the VLPO. Collectively, our data demonstrates that nocturnal light exposure can have either an arousal- or sleep-promoting effect, and that these responses are melanopsin-mediated via different neural pathways with different spectral sensitivities. These findings raise important questions relating to how artificial light may alter behaviour in both the work and domestic setting. PMID:27276063

Melanopsin Regulates Both Sleep-Promoting and Arousal-Promoting Responses to Light.

PubMed

Pilorz, Violetta; Tam, Shu K E; Hughes, Steven; Pothecary, Carina A; Jagannath, Aarti; Hankins, Mark W; Bannerman, David M; Lightman, Stafford L; Vyazovskiy, Vladyslav V; Nolan, Patrick M; Foster, Russell G; Peirson, Stuart N

2016-06-01

Light plays a critical role in the regulation of numerous aspects of physiology and behaviour, including the entrainment of circadian rhythms and the regulation of sleep. These responses involve melanopsin (OPN4)-expressing photosensitive retinal ganglion cells (pRGCs) in addition to rods and cones. Nocturnal light exposure in rodents has been shown to result in rapid sleep induction, in which melanopsin plays a key role. However, studies have also shown that light exposure can result in elevated corticosterone, a response that is not compatible with sleep. To investigate these contradictory findings and to dissect the relative contribution of pRGCs and rods/cones, we assessed the effects of light of different wavelengths on behaviourally defined sleep. Here, we show that blue light (470 nm) causes behavioural arousal, elevating corticosterone and delaying sleep onset. By contrast, green light (530 nm) produces rapid sleep induction. Compared to wildtype mice, these responses are altered in melanopsin-deficient mice (Opn4-/-), resulting in enhanced sleep in response to blue light but delayed sleep induction in response to green or white light. We go on to show that blue light evokes higher Fos induction in the SCN compared to the sleep-promoting ventrolateral preoptic area (VLPO), whereas green light produced greater responses in the VLPO. Collectively, our data demonstrates that nocturnal light exposure can have either an arousal- or sleep-promoting effect, and that these responses are melanopsin-mediated via different neural pathways with different spectral sensitivities. These findings raise important questions relating to how artificial light may alter behaviour in both the work and domestic setting.

Increased Sleep Promotes Survival during a Bacterial Infection in Drosophila

PubMed Central

Kuo, Tzu-Hsing; Williams, Julie A.

2014-01-01

Study Objectives: The relationship between sleep and immune function is not well understood at a functional or molecular level. We therefore used a genetic approach in Drosophila to manipulate sleep and evaluated effects on the ability of flies to fight bacterial infection. Setting: Laboratory. Participants: Drosophila melanogaster. Methods and Results: We used a genetic approach to transiently alter neuronal excitability in the mushroom body, a region in the central brain that is known to regulate sleep. Flies with increased sleep for up to two days prior to a bacterial infection showed increased resistance to the infection and improved survival. These flies also had increased expression levels of a subset of anti-microbial peptide mRNA prior to infection, as well as increased NFκB activity during infection as indicated by in vivo luciferase reporter activity. In contrast, flies that experienced reduced sleep for up to two days prior to infection had no effect on survival or on NFκB activity during infection. However, flies with reduced sleep showed an altered defense mechanism, such that resistance to infection was increased, but at the expense of reduced tolerance. This effect was dependent on environmental condition. Conclusions: Increasing sleep enhanced activity of an NFκB transcription factor, increased resistance to infection, and strongly promoted survival. Together, these findings support the hypothesis that sleep is beneficial to the host by maintaining a robust immune system. Citation: Kuo TH, Williams JA. Increased sleep promotes survival during a bacterial infection in Drosophila. SLEEP 2014;37(6):1077-1086. PMID:24882902

Upregulation of gene expression in reward-modulatory striatal opioid systems by sleep loss.

PubMed

Baldo, Brian A; Hanlon, Erin C; Obermeyer, William; Bremer, Quentin; Paletz, Elliott; Benca, Ruth M

2013-12-01

Epidemiological studies have shown a link between sleep loss and the obesity 'epidemic,' and several observations indicate that sleep curtailment engenders positive energy balance via increased palatable-food 'snacking.' These effects suggest alterations in reward-modulatory brain systems. We explored the effects of 10 days of sleep deprivation in rats on the expression of striatal opioid peptide (OP) genes that subserve food motivation and hedonic reward, and compared effects with those seen in hypothalamic energy balance-regulatory systems. Sleep-deprived (Sleep-Dep) rats were compared with yoked forced-locomotion apparatus controls (App-Controls), food-restricted rats (Food-Restrict), and unmanipulated controls (Home-Cage). Detection of mRNA levels with in situ hybridization revealed a subregion-specific upregulation of striatal preproenkephalin and prodynorhin gene expression in the Sleep-Dep group relative to all other groups. Neuropeptide Y (NPY) gene expression in the hippocampal dentate gyrus and throughout neocortex was also robustly upregulated selectively in the Sleep-Dep group. In contrast, parallel gene expression changes were observed in the Sleep-Dep and Food-Restrict groups in hypothalamic energy-sensing systems (arcuate nucleus NPY was upregulated, and cocaine- and amphetamine-regulated transcript was downregulated), in alignment with leptin suppression in both groups. Together, these results reveal a novel set of sleep deprivation-induced transcriptional changes in reward-modulatory peptide systems, which are dissociable from the energy-balance perturbations of sleep loss or the potentially stressful effects of the forced-locomotion procedure. The recruitment of telencephalic food-reward systems may provide a feeding drive highly resistant to feedback control, which could engender obesity through the enhancement of palatable feeding.

Sleep duration, life satisfaction and disability.

PubMed

Pagan, Ricardo

2017-04-01

Although sleep is considered an essential part of individuals' lives, there are no previous studies analysing how sleep duration affects the levels of life satisfaction reported by males and females with disabilities. To analyse and compare the impact of hours of sleep on life satisfaction scores reported by people without and with disabilities (stratified by sex) in Germany. Using data taken from the German Socio-Economic Panel for the period 2008-2013, we estimate life satisfaction equations for males and females (running a fixed-effects model) which include a set of variables measuring the number of sleep hours on workdays and weekends. A higher number of sleep hours on workdays increase life satisfaction for all males and females. However, the contribution of each hour of sleep on workdays is greater for males with disabilities in terms of life satisfaction, whereas for females no significant differences by disability status have been found. Although sleep hours on weekends also increase life satisfaction, the magnitude of the coefficients is relatively higher than that found for the corresponding hours of sleep on workdays, but only for the male sample (disabled or not). The participation and commitment of policymakers, governments, trade unions, employers, and health care professionals are key aspects for developing and formulating new guidelines and specific measures that promote a healthy lifestyle and increase sleep duration. Such guidelines and measures are of essence for people with disabilities who are employed (e.g. using brief sleep opportunities during prolonged work periods, which can contribute to reducing fatigue, stress and anxiety). Copyright © 2016 Elsevier Inc. All rights reserved.