Showing papers in "Journal of Sleep Research in 2020"

Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy.

Abstract: Italy is one of the major COVID-19 hotspots. To reduce the spread of the infections and the pressure on Italian healthcare systems, since March 10, 2020, Italy has been under a total lockdown, forcing people into home confinement. Here we present data from 1,310 people living in the Italian territory (Mage = 23.91 ± 3.60 years, 880 females, 501 workers, 809 university students), who completed an online survey from March 24 to March 28, 2020. In the survey, we asked participants to think about their use of digital media before going to bed, their sleep pattern and their subjective experience of time in the previous week (March 17-23, which was the second week of the lockdown) and up to the first week of February (February 3-10, before any restriction in any Italian area). During the lockdown, people increased the usage of digital media near bedtime, but this change did not affect sleep habits. Nevertheless, during home confinement, sleep timing markedly changed, with people going to bed and waking up later, and spending more time in bed, but, paradoxically, also reporting a lower sleep quality. The increase in sleep difficulties was stronger for people with a higher level of depression, anxiety and stress symptomatology, and associated with the feeling of elongation of time. Considering that the lockdown is likely to continue for weeks, research data are urgently needed to support decision making, to build public awareness and to provide timely and supportive psychosocial interventions.

Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy.

Abstract: In the current global home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels, but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation, sleep disturbance can have direct consequences upon next day emotional functioning. In this paper, we summarize what is known about the stress-sleep link and confinement as well as effective insomnia treatment. We discuss those effects of the current home confinement situation that can disrupt sleep but also those that could benefit sleep quality. We suggest adaptions of cognitive behavioural therapy elements that are feasible to implement for those facing changed work schedules and requirements, those with health anxiety and those handling childcare and home-schooling, whilst also recognizing the general limitations imposed on physical exercise and social interaction. Managing sleep problems as best as possible during home confinement can limit stress and possibly prevent disruptions of social relationships.

On the rise and fall of the apnea-hypopnea index: A historical review and critical appraisal.

Abstract: The publication of "The Sleep Apnea Syndromes" by Guilleminault et al. in the 1970s hallmarked the discovery of a new disease entity involving serious health consequences. Obstructive sleep apnea was shown to be the most important disorder among the sleep apnea syndromes (SAS). In the course of time, it was found that the prevalence of obstructive sleep apnea reached the proportions of a global epidemic, with a major impact on public health, safety and the economy. Early on, a metric was introduced to gauge the seriousness of obstructive sleep apnea, based on the objective measurement of respiratory events during nocturnal sleep. The apnea index and later on the apnea-hypopnea index, being the total count of overnight respiratory events divided by the total sleep time in hours, were embraced as principle measures to establish the diagnosis of obstructive sleep apnea and to rate its severity. The current review summarises the historical evolution of the apnea-hypopnea index, which has been subject to many changes, and has been criticised for not capturing relevant clinical features of obstructive sleep apnea. In fact, the application of the apnea-hypopnea index as a continuous exposure variable is based on assumptions that it represents a disease state of obstructive sleep apnea and that evocative clinical manifestations are invariably caused by obstructive sleep apnea if the apnea-hypopnea index is above diagnostic threshold. A critical appraisal of the extensive literature shows that both assumptions are invalid. This conclusion prompts a reconsideration of the role of the apnea-hypopnea index as the prime diagnostic metric of clinically relevant obstructive sleep apnea.

The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment.

Abstract: Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT-I) should be the first-line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT-I Academy that would enable a Europe-wide system of standardized CBT-I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT-I, preconditions for health professionals to teach CBT-I, the way in which CBT-I should be taught, who should be taught CBT-I and to whom CBT-I should be administered. Furthermore, diverse aspects of CBT-I care and delivery were discussed and incorporated into a stepped-care model for insomnia.

Exploring the associations between shift work disorder, depression, anxiety and sick leave taken amongst nurses

Abstract: This study aimed to evaluate the association between shift work disorder and mental health in hospital-based nurses. Staff completed an online survey comprising demographic questions, the Shift Work Disorder Questionnaire, Patient Health-9 and the General Anxiety Disorder-7 scale. Sick leave data were collected from archival records from the Human Resources Department. Two hundred and two nurses (95% female; age M = 35.28 years ± SD = 12) participated (42% of eligible staff). Those at high risk of shift work disorder had higher depression (M = 7.54 ± SD = 4.28 vs. M = 3.78 ± SD = 3.24; p < 0.001) and anxiety (M = 5.66 ± SD = 3.82 vs. M = 2.83 ± SD = 3.33, p < 0.001) compared to those at low risk. Linear regression models showed that being at high risk of shift work disorder was the most significant predictor of depression, explaining 18.8% of the variance in depression (R2 = 0.188, adjusted R2 = 0.184, F(1, 200) = 46.20, p < 0.001). Shift work disorder combined with the number of night shifts and alcoholic drinks on non-work days accounted for 49.7% of the variance in anxiety scores (R2 = 0.497, adjusted R2 = 0.453, F(3, 35) = 11.51, p < 0.001). Mean sick leave in those with high risk of shift work disorder was 136.17 hr (SD = 113.11) versus 103.98 hr (SD = 94.46) in others (p = 0.057). Depression and years of shift work accounted for 18.9% of the variance in sick leave taken (R2 = 0.189, adjusted R2 = 0.180, F(2, 175) = 20.36, p < 0.001). Shift work disorder is strongly associated with depression and anxiety, providing a potential target to improve mental health in shift workers. Depression, in turn, is a significant contributing factor to sick leave. © 2019 European Sleep Research Society

Validity, potential clinical utility, and comparison of consumer and research-grade activity trackers in Insomnia Disorder I: In-lab validation against polysomnography.

Abstract: Consumer activity trackers claiming to measure sleep/wake patterns are ubiquitous within clinical and consumer settings. However, validation of these devices in sleep disorder populations are lacking. We examined 1 night of sleep in 42 individuals with insomnia (mean = 49.14 ± 17.54 years) using polysomnography, a wrist actigraph (Actiwatch Spectrum Pro: AWS) and a consumer activity tracker (Fitbit Alta HR: FBA). Epoch-by-epoch analysis and Bland-Altman methods evaluated each device against polysomnography for sleep/wake detection, total sleep time, sleep efficiency, wake after sleep onset and sleep latency. FBA sleep stage classification of light sleep (N1 + N2), deep sleep (N3) and rapid eye movement was also compared with polysomnography. Compared with polysomnography, both activity trackers displayed high accuracy (81.12% versus 82.80%, AWS and FBA respectively; ns) and sensitivity (sleep detection; 96.66% versus 96.04%, respectively; ns) but low specificity (wake detection; 39.09% versus 44.76%, respectively; p = .037). Both trackers overestimated total sleep time and sleep efficiency, and underestimated sleep latency and wake after sleep onset. FBA demonstrated sleep stage sensitivity and specificity, respectively, of 79.39% and 58.77% (light), 49.04% and 95.54% (deep), 65.97% and 91.53% (rapid eye movement). Both devices were more accurate in detecting sleep than wake, with equivalent sensitivity, but statistically different specificity. FBA provided equivalent estimates as AWS for all traditional actigraphy sleep parameters. FBA also showed high specificity when identifying N3, and rapid eye movement, though sensitivity was modest. Thus, it underestimates these sleep stages and overestimates light sleep, demonstrating more shallow sleep than actually obtained. Whether FBA could serve as a low-cost substitute for actigraphy in insomnia requires further investigation.

Sexual and gender minority sleep: A narrative review and suggestions for future research

Abstract: This article reviews a growing body of research that examines sleep among lesbian, gay, bisexual and transgender (LGBT) populations. An extensive search of the literature was conducted using multiple medical and psychological search engine platforms. In total, this search yielded 31 reports that included sleep data collected from sexual and gender minority participants. Overall, research findings are mixed and include several publications of studies conducted in the same sample. Our review suggests that sleep health among LGBT individuals may be an unmet health need. Critically, sleep disturbances affected LGBT subgroups differently based on sex/gender and diverse sexual orientations (e.g., bisexual women). Although not directly tested, evidence from parallel LGBT health research suggests that minority stress may contribute to these observed sleep disparities and will need to be directly assessed in future studies. In sum, continued investigation of sleep disparities among sexual and gender minority communities is needed, as is the inclusion of sleep health in theoretical models of LGBT health disparities. Given the importance of sleep in overall mental and physical health, addressing sleep health may serve to promote and protect healthy functioning among LGBT individuals.

Does insomnia predict a high risk of cancer? A systematic review and meta‐analysis of cohort studies

Abstract: Recently, emerging studies on the relationship between insomnia, the most common sleep disorder, and cancer have been published, but with inconsistent results. With the development of society and the accelerated pace of life, more and more people experience insomnia. Therefore, it is important to clarify the association. Relevant literature was obtained through a search of seven databases and supplementary searches. After a strict screening, eight cohort studies (seven prospective and one retrospective) involving 578,809 participants and 7,451 cancer events were incorporated into our analysis. The results demonstrate a modest 24% overall increased risk of cancer for individuals with insomnia in comparison to those without insomnia. The sensitivity analysis shows that the correlation between the two is stable. Subgroup analyses show that the risk of developing cancer was significantly higher in studies conducted in women (HR = 1.24; 95% CI, 1.01-1.53), but not in men (HR = 1.28; 95% CI, 0.90-1.80). Similarly, in terms of specific cancer types, the pooled HR was only significantly higher in thyroid cancer (HR = 1.36; 95% CI, 1.12-1.65) and not in other types of cancer (p > 0.05). Our findings suggest that insomnia may serve as an early warning sign of the onset of cancer and provide an opportunity for early detection and early intervention. Our findings should be treated with caution because of the limited number of included studies and potential bias. More additional studies are warranted to provide more information on the carcinogenic effect of insomnia.

Application of health behaviour theory to sleep health improvement.

Abstract: Although sleep hygiene is often used for broad sleep health promotion efforts, sleep hygiene education programmes are largely ineffective. These programmes are limited by their lack of a theoretical foundation. Health behaviour theory (HBT) has been used for decades to successfully predict and modify many health behaviours, but its use in the study of sleep health is rare. The purpose of this review is threefold. First, four dominant HBTs will be introduced. Second, the brief literature on HBT and sleep health will be reviewed. Lastly, a translational research agenda will be proposed. The present review concludes that HBT shows potential in both the prediction and modification of sleep health, and that there are several short- and long- term research goals to advance these efforts.

Reciprocal relations between work stress and insomnia symptoms: A prospective study.

Abstract: Work stress and poor sleep are closely related in cross-sectional data, but evidence from prospective data is limited. We analysed how perceived stress and work stressors (work demands, decision authority and workplace social support) are related to key dimensions of insomnia over time, using structural equation modelling. Biennial measurements from a large sample of the working population in Sweden enabled us to analyse both the relationship from stress to sleep as well as that from sleep to stress. Overall, we found reciprocal relations between insomnia and all four stress measures. However, looking at the relation between each dimension of insomnia and each stress measure, there were some differences in direction of effects. In the direction from stress to sleep, all work stressors as well as perceived stress predicted both difficulties initiating sleep and difficulties maintaining sleep. The same was found for non-restorative sleep, with the exception for decision authority. In the opposite direction, difficulties maintaining sleep predicted increased levels of work demands and perceived stress. Difficulties initiating sleep stood out among the insomnia symptoms as not predicting any of the stress measures, while non-restorative sleep was the only symptom predicting all stress measures. The results advance the understanding of the stress-sleep relationship and indicate a potential vicious circle between insomnia and perceived stress as well as work stressors, suggesting that the workplace could be an arena for interventions to alleviate insomnia.

A thorough psychometric comparison between Athens Insomnia Scale and Insomnia Severity Index among patients with advanced cancer.

Abstract: For patients with cancer, sleep disturbance is commonplace. Using classical test theory and Rasch analyses, the present study compared two commonly used psychometric instruments for insomnia - Athens Insomnia Scale and Insomnia Severity Index - among patients with advanced cancer. Through convenience sampling, patients with cancer at stage III or IV (n = 573; 326 males; mean age = 61.3 years; SD = 10.7) from eight oncology units of university hospitals in Iran participated in the study. All the participants completed the Athens Insomnia Scale, Insomnia Severity Index, Edmonton Symptom Assessment Scale, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Additionally, 433 participants wore an Actigraph device for two continuous weekdays. Classical test theory and Rasch analysis both supported the construct validity for Athens Insomnia Scale (factor loadings from confirmatory factor analysis = 0.61-0.87; test-retest reliability = 0.72-0.82; infit mean square = 0.81-1.17; outfit MnSq = 0.79-1.14) and for Insomnia Severity Index (factor loadings from confirmatory factor analysis = 0.61-0.81; test-retest reliability = 0.72-0.82; infit mean square = 0.72-1.14; outfit mean square = 0.76-1.11). Both Athens Insomnia Scale and Insomnia Severity Index had significant associations with Edmonton Symptom Assessment Scale, Hospital Anxiety and Depression Scale, General Health Questionnaire-12, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index, as well as having good sensitivity and specificity. Significant differences in the actigraphy measure were found between insomniacs and non-insomniacs based on Athens Insomnia Scale or Insomnia Severity Index score. With promising results, healthcare providers can use either Athens Insomnia Scale or Insomnia Severity Index to understand the insomnia of patients with advanced cancer.

Pharmacological and non-pharmacological interventions to enhance sleep in mild cognitive impairment and mild Alzheimer's disease: A systematic review.

Abstract: Suboptimal sleep causes cognitive decline and probably accelerates Alzheimer's Disease (AD) progression. Several sleep interventions have been tested in established AD dementia cases. However early intervention is needed in the course of AD at Mild Cognitive Impairment (MCI) or mild dementia stages to help prevent decline and maintain good quality of life. This systematic review aims to summarize evidence on sleep interventions in MCI and mild AD dementia. Seven databases were systematically searched for interventional studies where ≥ 75% of participants met diagnostic criteria for MCI/mild AD dementia, with a control group and validated sleep outcome measures. Studies with a majority of participants diagnosed with Moderate to Severe AD were excluded. After removal of duplicates, 22,133 references were returned in two separate searches (August 2019 and September 2020). 325 full papers were reviewed with 18 retained. Included papers reported 16 separate studies, total sample (n = 1,056), mean age 73.5 years. 13 interventions were represented: Cognitive Behavioural Therapy - Insomnia (CBT-I), A Multi-Component Group Based Therapy, A Structured Limbs Exercise Programme, Aromatherapy, Phase Locked Loop Acoustic Stimulation, Transcranial Stimulation, Suvorexant, Melatonin, Donepezil, Galantamine, Rivastigmine, Tetrahydroaminoacridine and Continuous Positive Airway Pressure (CPAP). Psychotherapeutic approaches utilising adapted CBT-I and a Structured Limbs Exercise Programme each achieved statistically significant improvements in the Pittsburgh Sleep Quality Index with one study reporting co-existent improved actigraphy variables. Suvorexant significantly increased Total Sleep Time and Sleep Efficiency whilst reducing Wake After Sleep Onset time. Transcranial Stimulation enhanced cortical slow oscillations and spindle power during daytime naps. Melatonin significantly reduced sleep latency in two small studies and sleep to wakefulness transitions in a small sample. CPAP demonstrated efficacy in participants with Obstructive Sleep Apnoea. Evidence to support other interventions was limited. Whilst new evidence is emerging, there remains a paucity of evidence for sleep interventions in MCI and mild AD highlighting a pressing need for high quality experimental studies exploring alternative sleep interventions.

Maladaptive coping with the infodemic and sleep disturbance in the COVID-19 pandemic.

Abstract: COVID-19 is caused by a novel virus with an unknown aetiology. People across the globe are dealing with not only a health crisis but also an 'infodemic', a term coined by the World Health Organization to refer to the avalanche of contradictory information that is arousing widespread confusion and anxiety. This study aimed to examine the prevalence of anxiety and sleep disturbance at the early stage of the pandemic, and unveil the information coping process underlying differential susceptibility to COVID-19 infection anxiety and sleep disturbance. The participants were 1,270 adults (47% men, Mage = 42.82) from the UK and US who completed initial (Time 1) and follow-up (Time 2) surveys from 16 to 22 March and 18 to 24 May 2020, respectively. The prevalence of probable clinically relevant anxiety was 61% and 45% at the first and second time points, and more than half of the participants in this anxiety group also reported mild to severe sleep disturbance. Moreover, 41% of the participants perceived themselves as not having enough COVID-19-related information and reported higher levels of COVID-19 infection anxiety and sleep disturbance over time than those who perceived themselves as having enough of such information. Moderated mediation analysis identified two groups who were more vulnerable to both psychological problems: high blunters who sought COVID-19-related information online more frequently and high monitors who sought such information offline less frequently. These findings highlight the importance of a good match between information coping style and strategy deployment in dealing with an infodemic surrounding a novel disease.

The wrist is not the brain: Estimation of sleep by clinical and consumer wearable actigraphy devices is impacted by multiple patient- and device-specific factors.

Abstract: Clinical actigraphy devices provide adequate estimates of some sleep measures across large groups. In practice, providers are asked to apply clinical or consumer wearable data to individual patient assessments. Inter-individual variability in device performance will impact such patient-specific interpretation. We assessed two devices, clinical and consumer, to determine the magnitude and predictors of this individual-level variability. One hundred and two patients (55 [53.9%] female; 56.4 [±16.3] years old) undergoing polysomnography wore Jawbone UP3 and/or Actiwatch2. Device total sleep time, sleep efficiency, wake after sleep onset and sleep latency were compared with polysomnography. Demographics, sleep architecture and clinical measures were compared to device performance. Actiwatch overestimated total sleep time by 27.2 min (95% confidence limits [CL], 138.3 min over to 84.0 under), overestimated sleep efficiency by 6.8% (95% CL, 34.1% over to 20.5% under), overestimated sleep onset latency by 2.6 min (95% CL, 63.3 over to 58.2 under) and underestimated wake after sleep onset by 50.7 min (95% CL, 162.5 under to 61.2 over). Jawbone overestimated total sleep time by 59.1 min (95% CL, 208.6 min over to 90.5 under) and overestimated sleep efficiency by 14.9% (95% CL, 52.6% over to 22.7% under). In multivariate models, age, sleep onset latency, wake after sleep onset, % N1 and apnea-hypopnea index explained only some of the variance in device performance. Gender also affected performance. Actiwatch and Jawbone mis-estimate sleep measures with very wide confidence limits and accuracy varies with multiple patient-level characteristics. Given these large individual inaccuracies, data from these devices must be applied only with extreme caution in clinical practice.

Carbonic anhydrase, obstructive sleep apnea and hypertension: Effects of intervention.

Abstract: Whole blood carbonic anhydrase activity (CAa) is increased in patients with obstructive sleep apnea (OSA). Our study investigated the influence of positive airway pressure (PAP) or CA inhibitor acetazolamide (ACT) therapy on CAa, OSA and blood pressure. Thirty-three OSA patients (21 hypertensive, body mass index (BMI) 37 ± 7 kg/m2 and apnea-hypopnea index (AHI) of 47 ± 31 events/hr) were followed-up after PAP treatment (compliance, 4.7 ± 1.5 hr/day; duration, median 6 [IQR 6,6] months) (Cohort A). A second OSA Cohort (B) contained nine hypertensive patients (BMI, 29 ± 4 kg/m2 ; AHI, 39 ± 20 events/hr) with 2-week treatment of ACT, PAP or ACT + PAP in an open crossover study. CAa was assessed at baseline and at the end of each treatment period. In Cohort A, baseline CAa was higher in hypertensive, compared with normotensive, patients (1,033 ± 204 versus 861 ± 201 units, p = .028). PAP treatment reduced systolic/diastolic blood pressure but not CAa (-9 ± 11/-5 ± 7 mmHg and -20 ± 289 units, p < .001, <.001 and .70). In Cohort B, blood pressure was reduced in both ACT-treated groups (-10 ± 10/-5 ± 7 mmHg, p = .043 and .019; and -5 ± 5/-13 ± 13 mmHg, p < .001 and .009). AHI was reduced in both groups: ACT only, -17 ± 9 events/hr p = .001; and ACT + PAP, -39 ± 19 events/hr, p < .001. PAP did not change CAa (p = .98) but activity tended to decrease after ACT with or without PAP (p = .081 and .056). CAa is elevated in hypertensive OSA patients. Long-term PAP reduced blood pressure without affecting CAa. ACT reduced blood pressure and CAa. Increased CAa may constitute a physiological characteristic in OSA, contributing to comorbid hypertension.

Validity, potential clinical utility and comparison of a consumer activity tracker and a research-grade activity tracker in insomnia disorder II: Outside the laboratory.

Abstract: Accurate assessment of sleep can be fundamental for monitoring, managing and evaluating treatment outcomes within diseases. A proliferation of consumer activity trackers gives easy access to objective sleep. We evaluated the performance of a commercial device (Fitbit Alta HR) relative to a research-grade actigraph (Actiwatch Spectrum Pro) in measuring sleep before and after a cognitive behavioural intervention in insomnia disorder. Twenty-five individuals with DSM-5 insomnia disorder (M = 50.6 ± 15.9 years) wore Fitbit and Actiwatch and completed a sleep diary during an in-laboratory polysomnogram, and for 1 week preceding and following seven weekly sessions of cognitive-behavioural intervention for insomnia. Device performance was compared for sleep outcomes (total sleep time, sleep latency, sleep efficiency and wake after sleep onset). The analyses assessed (a) agreement between devices across days and pre- to post-treatment, and (b) whether pre- to post-treatment changes in sleep assessed by devices correlated with clinical measures of change. Devices generally did not significantly differ from each other on sleep variable estimates, either night to night, in response to sleep manipulation (pre- to post-treatment) or in response to changes in environment (in the laboratory versus at home). Change in sleep measures across time from each device showed some correlation with common clinical measures of change in insomnia, but not insomnia diagnosis as a categorical variable. Overall, the Fitbit provides similar estimates of sleep outside the laboratory to a research grade actigraph. Despite the similarity between Fitbit and Actiwatch performance, the use of consumer technology is still in its infancy and caution should be taken in its interpretation.

Sleep structure in sleep bruxism: A polysomnographic study including bruxism activity phenotypes across sleep stages.

Abstract: The aim of the study was to assess sleep structure, phenotypes related to bruxism activity and basic respiratory parameters among a large group of participants with sleep bruxism and without obstructive sleep apnea. Adult participants with clinical suspicion of sleep bruxism and with no other significant medical history were recruited. Video-polysomnography was performed to detect masseter muscles activity. Polysomnographic scoring was performed according to the American Academy of Sleep Medicine Criteria. Finally, 146 participants were included. The participants were divided into three subgroups: severe, mild and no sleep bruxism. There were no differences in total sleep time, sleep latency, sleep efficiency, wake duration after sleep onset, rapid eye movement, and measured respiratory parameters. The severity of sleep bruxism contributed to the increased intensity of all sleep bruxism phenotypes in almost all sleep stages, apart from tonic and mixed activity in non-rapid eye movement stage 3 sleep (slow-wave sleep). Those with bruxism spent more time in rapid eye movement sleep compared to controls; there were no differences in non-rapid eye movement sleep stages. The results confirmed that sleep bruxism does not significantly affect sleep duration, efficiency and continuity (in terms of sleep-wake cycles). Sleep bruxism contributes to a higher percentage of rapid eye movement sleep in the total sleep time. Those with bruxism present more frequent episodes during all stages of sleep; however, in the case of slow-wave sleep, tonic and mixed activity observed in participants with sleep bruxism are comparable to those of healthy people.

A brief period of sleep deprivation leads to subtle changes in mouse gut microbiota

Abstract: Not getting enough sleep is a common problem in our society and contributes to numerous health problems, including high blood pressure, diabetes and obesity. Related to these observations, a wealth of studies has underscored the negative impact of both acute and chronic sleep deprivation on cognitive function. More recently it has become apparent that the gut microbiota composition can be rapidly altered, modulates brain function and is affected by the aforementioned health problems. As such, changes in the microbiota composition may contribute to the behavioural and physiological phenotypes associated with sleep deprivation. It is unclear, however, whether a brief period of sleep deprivation can also negatively impact the gut microbiota. Here, we examined the impact of 5 hr of sleep deprivation on gut microbiota composition of male C57Bl6/J mice. Despite the fact that the overall microbial composition did not change between the control- and sleep-deprived groups, the relative abundance of the Clostridiaceae and Lachnospiraceae were slightly altered in sleep-deprived animals compared to controls. Together, these data suggest that depriving mice of sleep for 5 hr leads to subtle changes in the gut microbiota composition.

Prevalence of shift work disorder among hospital personnel: A cross-sectional study using objective working hour data.

Abstract: The prevalence of shift work disorder (SWD) has been studied using self-reported data and the International Classification of Sleep Disorders, Second Edition (ICSD-2) criteria. We examined the prevalence in relation to ICSD-2 and ICSD-3 criteria, work schedules and the number of non-day shifts (work outside 06:00-18:00 hours) using objective working-hours data. Secondly, we explored a minimum cut-off for the occurrence of SWD symptoms. Hospital shift workers without (n = 1,813) and with night shifts (n = 2,917) and permanent night workers (n = 84) answered a survey (response rate 69%) on SWD and fatigue on days off. The prevalence of SWD was calculated for groups with ≥1, ≥3, ≥5 and ≥7 monthly non-day shifts utilizing the working hours registry. ICSD-3-based SWD prevalence was 2.5%-3.7% (shift workers without nights), 2.6%-9.5% (shift workers with nights) and 6.0% (permanent night workers), depending on the cut-off of non-day shifts (≥7-1/month, respectively). The ICSD-2-based prevalence was higher: 7.1%-9.2%, 5.6%-33.5% and 16.7%, respectively. The prevalence was significantly higher among shift workers with than those without nights (p-values <.001) when using the cut-offs of ≥1-3 non-day shifts. Shift workers with nights who had ≥3 days with ICSD-3-based SWD symptoms/month more commonly had fatigue on days off (49.3%) than those below the cut-off (35.8%, p < .05). The ICSD-3 criteria provided lower estimates for SWD prevalence than ISCD-2 criteria, similarly to exclusion of employees with the fewest non-day shifts. The results suggest that a plausible cut-off for days with ICSD-3-based SWD symptoms is ≥3/month, resulting in 3%-6% prevalence of SWD.

Influence of one-night CPAP therapy on the changes of HIF-1α protein in OSA patients: A pilot study.

Abstract: Obstructive sleep apnea (OSA) is a chronic condition that is characterized by recurrent pauses in breathing during sleep, caused by collapse of the upper airway. One of the typical complications of OSA is recurrent intermittent hypoxia. The main factor responsible for oxygen metabolism homeostasis is hypoxia-inducible factor 1 (HIF-1), comprised of two subunits: α and β. Subunit HIF-1α is oxygen sensitive and in normoxia, it is subject to degradation, whereas it stabilizes in hypoxic conditions (Semenza, 2011). Data regarding HIF-1 in OSA are limited and in the vast majority of studies are based on animal models of the disorder (He et al., 2014), suggesting HIF-1α protein level is increased in OSA patients compared to healthy control (Gabryelska et al., 2019). Therefore, the aim of the study was to evaluate the evening‒morning changes in the HIF-1α protein level before and after 1 night of continuous positive airway pressure (CPAP) intervention. This pilot study included 16 consecutive individuals diagnosed with severe OSA (AHI ≥ 30) and 10 healthy individuals (AHI < 5), with excluded chronic respiratory diseases, cardiovascular disorders and cancer. All participants underwent diagnostic polysomnography (PSG), with the OSA group undergoing a follow-up 1-night trial of CPAP treatment with PSG monitoring. Peripheral blood was collected (for clot) in the evening (21:00–22:00 hours) before and in the morning (06:00–07:00 hours, within 10 min from awakening) after both examinations. HIF-1α serum protein level was measured using ELISA immunoenzyme assay. The study was approved by the Ethical Committee of the Medical University of Lodz (RNN/77/18/ KE); all patients provided written informed consent to participate in the study. Median HIF-1α serum protein concentration was significantly higher in OSA patients compared to the control group, both in the evening (2,172.7 pg/ml [IQR, 1997.2–3,520.2] vs. 654.4 pg/ ml [IQR, 431.6–838.5]; p < .001) and in the morning (2014.6 pg/ ml [IQR, 1813.0–2427.8] vs. 524.8 pg/ml [IQR, 451.9–869.4]; p < .001) blood samples. There was no difference between evening and morning HIF-1α serum protein level. Additionally, no differences were observed between evening and morning HIF-1α serum protein level after 1 night of CPAP treatment (986.6 pg/ ml [IQR, 539.6–2,323.2] vs. 1,151.8 pg/ml [IQR, 631.1–2,129.1]; p = .352) (Figure 1). These results suggest that changes in HIF-1α protein concentration are chronically increased and are not reverted by 1 night of CPAP treatment. This is in contrast to clinical hypoxaemia assessed by pulseoxymetry, which is intermittent, only present during night and withdrawn during the day. Only one study assessed the influence of CPAP therapy on HIF-1α protein. Lu et al. (Lu, Li, Yao, & Zhou, 2017) assessed the effect of 2-month CPAP treatment on the change in serum HIF-1α protein concentration. The study observed the significant decrease in the concentration of HIF-1α protein in patients who regularly used CPAP treatment for 2 months; at the same time no similar change in the control group was observed. These results suggest that continuous long-term CPAP treatment is necessary to revert changes in serum HIF-1α protein in OSA patients, as one night of intervention does not affect this variable.

Obstructive sleep apnea and hypertriglyceridaemia share common genetic background: Results of a twin study.

Abstract: Obstructive sleep apnea is associated with an increased risk of hypertension, diabetes and dyslipidaemia. Both obstructive sleep apnea and its comorbidities are at least partly heritable, suggesting a common genetic background. Our aim was to analyse the heritability of the relationship between obstructive sleep apnea and its comorbidities using a twin study. Forty-seven monozygotic and 22 dizygotic adult twin pairs recruited from the Hungarian Twin Registry (mean age 51 ± 15 years) attended an overnight diagnostic sleep study. A medical history was taken, blood pressure was measured, and blood samples were taken for fasting glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and lipoprotein (a). To evaluate the heritability of obstructive sleep apnea and its comorbidities bivariate analysis was performed with an adjustment for age, gender, body mass index (BMI) and smoking after false discovery rate correction and following exclusion of patients on lipid-lowering and antidiabetic medications. There was a significant correlation between indices of obstructive sleep apnea severity, such as the apnea-hypopnea index, oxygen desaturation index and percentage of sleep time spent with oxygen saturation below 90%, as well as blood pressure, serum triglyceride, lipoprotein (a) and glucose levels (all p < .05). The bivariate analysis revealed a common genetic background for the correlations between serum triglyceride and the oxygen desaturation index (r = .63, p = .03), as well as percentage of sleep time spent with oxygen saturation below 90% (r = .58, p = .03). None of the other correlations were significantly genetically or environmentally determined. This twin study demonstrates that the co-occurrence of obstructive sleep apnea with hypertriglyceridaemia has a genetic influence and heritable factors play an important role in the pathogenesis of dyslipidaemia in obstructive sleep apnea.

Racial/ethnic disparities in sleep duration and sleep disturbances among pregnant and non‐pregnant women in the United States

Abstract: Sleep disturbances among pregnant women are increasingly linked to suboptimal maternal/birth outcomes. Few studies in the USA investigating sleep by pregnancy status have included racially/ethnically diverse populations, despite worsening disparities in adverse birth outcomes. Using a nationally representative sample of 71,644 (2,349 pregnant) women from the National Health Interview Survey (2004-2017), we investigated relationships between self-reported pregnancy and six sleep characteristics stratified by race/ethnicity. We also examined associations between race/ethnicity and sleep stratified by pregnancy status. We used average marginal predictions from fitted logistic regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for each sleep dimension, adjusting for sociodemographic and health characteristics. Pregnant women were less likely than non-pregnant women to report short sleep (PROverall = 0.75; 95% CI, 0.68-0.82) and more likely to report long sleep (PROverall = 2.06; 95% CI, 1.74-2.43) and trouble staying asleep (PROverall = 1.34; 95% CI, 1.25-1.44). The association between pregnancy and sleep duration was less pronounced among women aged 35-49 years compared to those <35 years. Among white women, sleep medication use was less prevalent among pregnant compared to non-pregnant women (PRWhite = 0.45; 95% CI, 0.31-0.64), but this association was not observed among black women (PRBlack = 0.98; 95% CI, 0.46-2.09) and was less pronounced among Hispanic/Latina women (PRHispanic/Latina = 0.82; 95% CI, 0.38-1.77). Compared to pregnant white women, pregnant black women had a higher short sleep prevalence (PRBlack = 1.35; 95% CI, 1.08-1.67). Given disparities in maternal/birth outcomes and sleep, expectant mothers (particularly racial/ethnic minorities) may need screening followed by treatment for sleep disturbances. Our findings should be interpreted in the historical and sociocultural context of the USA.

Electronic cigarette use and sleep health in young adults

Abstract: Poor sleep health is associated with numerous health concerns, and sleep problems are exacerbated by cigarette smoking. Although rates of traditional tobacco use are declining, rates of electronic cigarette (e-cigarette) use are comparatively high and growing. Given that nicotine is a primary mechanism by which smoking negatively impacts sleep health, e-cigarette use may also be linked to poor sleep health; however, no research has investigated this association. Participants were 1,664 college students, 40.9% of whom reported ever trying or currently using an e-cigarette. Questionnaires assessed demographic information, sleep health and e-cigarette use status and patterns. All measures were completed remotely via a secure online survey. Analysis of covariance was used to compare the sleep health of daily/non-daily e-cigarette users to (a) non-users and (b) users of combustible cigarettes. Gender and drinks per week were included as covariates in analyses. Current combustible and e-cigarette users reported significantly more sleep difficulties than never users. Users of e-cigarettes reported greater use of sleep medication than combustible cigarette users. Similar to combustible cigarette smoking, e-cigarette use (vs. non-use) was associated with worse sleep health, even among non-daily e-cigarette users. These findings may indicate a need for assessment of and education on the role of e-cigarette use in sleep health among individuals who report experimentation with or current use of e-cigarettes. Future research should examine these relationships prospectively.

Reduced structural connectivity in Insomnia Disorder.

Abstract: Insomnia Disorder is the most prevalent sleep disorder, and it involves both sleep difficulties and daytime complaints. The neural underpinnings of Insomnia Disorder are poorly understood. Several existing neuroimaging studies focused on local measures and specific regions of interests, which makes it difficult to judge their whole-brain significance. We therefore here applied a data-driven approach to assess differences in whole-brain structural connectivity between adults with Insomnia Disorder and matched controls without sleep complaints. We used diffusion tensor imaging and probabilistic tractography to assess whole-brain structural connectivity, and examined group differences using network-based statistics. The results revealed a significant difference in the structural connectivity of the two groups (p = .014). Participants with Insomnia Disorder showed reduced connectivity in a sub-network that included mainly fronto-subcortical connections with the insula as a key region. By taking a whole-brain network perspective, our study enables the integration of previous inconsistent findings. Our results reveal that reduced structural connectivity of the left insula and the connections between frontal and subcortical regions are central neurobiological features of Insomnia Disorder. The importance of these areas for interoception, emotional processing, stress responses and the generation of slow-wave sleep may help guide the development of neurobiology-based models of the prevalent condition of Insomnia Disorder.

Effects of continuous positive airway pressure on blood pressure in obstructive sleep apnea patients: The Apnea Positive Pressure Long-term Efficacy Study (APPLES).

Abstract: Obstructive sleep apnea is associated with hypertension, and short-term studies have demonstrated a modest reduction in blood pressure with continuous positive airway pressure therapy. We evaluated the effects of continuous positive airway pressure versus sham continuous positive airway pressure on blood pressure in 1,101 participants with obstructive sleep apnea from the Apnea Positive Pressure Long-term Efficacy Study, a randomized, sham-controlled double-blinded study designed to assess the impact of continuous positive airway pressure on neurocognition. Participants with apnea-hypopnea index ≥ 10 were randomly assigned to continuous positive airway pressure or sham continuous positive airway pressure. Blood pressures measured in the morning and evening at baseline, 2 months and 6 months were analysed post hoc using a mixed-model repeated-measures analysis of variance. The largest magnitude reduction was approximately 2.4 mmHg in morning systolic pressure that occurred at 2 months in the continuous positive airway pressure arm as compared with an approximate 0.5 mmHg reduction in the sham group (continuous positive airway pressure effect -1.9 mmHg, p = .008). At 6 months, the difference between groups was diminished and no longer statistically significant (continuous positive airway pressure effect -0.9 mmHg, p = .12). Sensitivity analysis with use of multiple imputation approaches to account for missing data did not change the results. Treatment with continuous positive airway pressure for obstructive sleep apnea reduces morning but not evening blood pressure in a population with well-controlled blood pressure. The effect was greater after 2 than after 6 months of treatment.

Exploring scoring methods for research studies: Accuracy and variability of visual and automated sleep scoring.

Abstract: Sleep studies face new challenges in terms of data, objectives and metrics. This requires reappraising the adequacy of existing analysis methods, including scoring methods. Visual and automatic sleep scoring of healthy individuals were compared in terms of reliability (i.e., accuracy and stability) to find a scoring method capable of giving access to the actual data variability without adding exogenous variability. A first dataset (DS1, four recordings) scored by six experts plus an autoscoring algorithm was used to characterize inter-scoring variability. A second dataset (DS2, 88 recordings) scored a few weeks later was used to explore intra-expert variability. Percentage agreements and Conger's kappa were derived from epoch-by-epoch comparisons on pairwise and consensus scorings. On DS1 the number of epochs of agreement decreased when the number of experts increased, ranging from 86% (pairwise) to 69% (all experts). Adding autoscoring to visual scorings changed the kappa value from 0.81 to 0.79. Agreement between expert consensus and autoscoring was 93%. On DS2 the hypothesis of intra-expert variability was supported by a systematic decrease in kappa scores between autoscoring used as reference and each single expert between datasets (.75-.70). Although visual scoring induces inter- and intra-expert variability, autoscoring methods can cope with intra-scorer variability, making them a sensible option to reduce exogenous variability and give access to the endogenous variability in the data.

Yawning while scrolling? Examining gender differences in the association between smartphone use and sleep quality

Abstract: The negative consequences of deteriorated sleep have been widely acknowledged. Therefore, research on the determinants of poor sleep is crucial. A factor potentially contributing to poor sleep is the use of a smartphone. This study aims to measure the association between overall daily smartphone use and both sleep quality and sleep duration. To this end, we exploit data on 1,889 first-year university students. Compared with previous research we control for a large set of observed confounding factors. Higher overall smartphone use is associated with lower odds of experiencing a good sleep. In addition, we explore heterogeneous differences by socioeconomic factors not yet investigated. We find that the negative association between smartphone use and sleep quality is mainly driven by female participants.

(Not so) Smart sleep tracking through the phone: Findings from a polysomnography study testing the reliability of four sleep applications

Abstract: An increasing number of sleep applications are currently available and are being widely used for in-home sleep tracking. The present study assessed four smartphone applications (Sleep Cycle-Accelerometer, SCa; Sleep Cycle-Microphone, SCm; Sense, Se; Smart Alarm, SA) designed for sleep-wake detection through sound and movement sensors, by comparing their performance with polysomnography. Twenty-one healthy participants (six males, 15 females) used the four sleep applications running on iPhone (provided by the experimenter) simultaneously with portable polysomnography recording at home, while sleeping alone for two consecutive nights. Whereas all apps showed a significant correlation with polysomnography-time in bed, only SA offered significant correlations for sleep efficacy. Furthermore, SA seemed to be quite effective in reliable detection of total sleep time and also light sleep; however, it underestimated wake and partially overestimated deep sleep. None of the apps resulted capable of detecting and scoring rapid eye movement sleep. To sum up, SC (functioning through both accelerometer and microphone) and Se did not result sufficiently reliable in sleep-wake detection compared with polysomnography. SA, the only application offering the possibility of an epoch-by-epoch analysis, showed higher accuracy than the other apps in comparison with polysomnography, but it still shows some limitations, particularly regarding wake and deep sleep detection. Developing scoring algorithms specific for smartphone sleep detection and adding external sensors to record other physiological parameters may overcome the present limits of sleep tracking through smart phone apps.

Evening circadian preference is associated with sleep problems and daytime sleepiness in adolescents with ADHD.

Abstract: Adolescence is a developmental period characterized by disruptions in sleep and changes in circadian preferences. Although adolescents with attention-deficit/hyperactivity disorder (ADHD) are at even higher risk of sleep disruption than their peers, no study has examined whether circadian preference is associated with sleep problems and daytime sleepiness in adolescents with ADHD. This study provides an initial test of the hypothesis that greater evening preference would be associated with more sleep problems and daytime sleepiness in adolescents diagnosed with ADHD. Participants were 80 adolescents (69% male), aged 13-17 years, with ADHD. Adolescents completed measures assessing circadian preference, pubertal development, anxiety/depressive symptoms and weeknight sleep duration. Both adolescents and parents completed measures of sleep problems and daytime sleepiness. In regression analyses controlling for a number of other variables (i.e., age, sex, pubertal development, ADHD medication use, and ADHD, oppositional defiant disorder and internalizing symptom severity), greater evening preference was associated with both adolescent- and parent-reported sleep problems and daytime sleepiness. Greater evening preference remained significantly associated with each of these sleep problems and daytime sleepiness when also controlling for weeknight sleep duration. This is the first study to demonstrate that evening circadian preference is associated with both sleep problems and daytime sleepiness in adolescents with ADHD. The results indicate that it is important to consider circadian function as research examining sleep in adolescents with ADHD continues to advance.

Association between sleep quality and physical activity according to gender and shift work

Abstract: Shift work directly causes circadian disruption and reduces sleep quality. Physical activity is also associated with sleep quality. However, no study has reported the relationship between a specific level of physical activity and sleep quality. This study aimed to investigate the relationship between sleep quality and the amount of physical activity by stratifying subjects into gender and shift-work subgroups. Among those who participated in the Kangbuk Samsung Health Study in 2016-2017, data from 185,958 full-time workers were analysed. We evaluated their physical activity by metabolic equivalents (METs-min/week), sleep quality and shift work. A chi-squared test, a t test and logistic regression analysis were performed. An increase in sleep quality was found for the group with physical activity of 600-9,000 METs-min/week compared to that in the sedentary group among all subjects. In female day workers, the sleep quality of the group with 600-6,000 METs-min/week was significantly higher (odds ratio [OR], 0.760; 95% confidence interval [CI], 0.673-857) than that in the sedentary group. In male day workers, sleep quality increased when physical activity was increased up to 6,000-9,000 METs-min/week (OR, 0.760; 95% CI, 0.673-857). In female shift workers, there was no significant difference in sleep quality according to physical activity level. In male shift workers, sleep quality was better in the group with physical activity of 1,800-3,000 METs-min/week (OR, 0.826; 95% CI, 0.692-0.986) or 3,000-6,000 METs-min/week (OR, 0.771; 95% CI, 0.642-0.926). Optimal physical activity is good for sleep quality. The sleep quality of females is significantly worse than that of males in both day and shift workers.