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Showing papers in "Sleep in 2011"


Journal ArticleDOI
01 May 2011-Sleep
TL;DR: Findings provide further evidence that the Insomnia Severity Index is a reliable and valid instrument to detect cases of insomnia in the population and is sensitive to treatment response in clinical patients.
Abstract: Background Although insomnia is a prevalent complaint with significant morbidity, it often remains unrecognized and untreated. Brief and valid instruments are needed both for screening and outcome assessment. This study examined psychometric indices of the Insomnia Severity Index (ISI) to detect cases of insomnia in a population-based sample and to evaluate treatment response in a clinical sample. Methods Participants were 959 individuals selected from the community for an epidemiological study of insomnia (Community sample) and 183 individuals evaluated for insomnia treatment and 62 controls without insomnia (Clinical sample). They completed the ISI and several measures of sleep quality, fatigue, psychological symptoms, and quality of life; those in the Clinical sample also completed sleep diaries, polysomnography, and interviews to validate their insomnia/good sleep status and assess treatment response. In addition to standard psychometric indices of reliability and validity, item response theory analyses were computed to examine ISI item response patterns. Receiver operating curves were used to derive optimal cutoff scores for case identification and to quantify the minimally important changes in relation to global improvement ratings obtained by an independent assessor. Results ISI internal consistency was excellent for both samples (Cronbach α of 0.90 and 0.91). Item response analyses revealed adequate discriminatory capacity for 5 of the 7 items. Convergent validity was supported by significant correlations between total ISI score and measures of fatigue, quality of life, anxiety, and depression. A cutoff score of 10 was optimal (86.1% sensitivity and 87.7% specificity) for detecting insomnia cases in the community sample. In the clinical sample, a change score of -8.4 points (95% CI: -7.1, -9.4) was associated with moderate improvement as rated by an independent assessor after treatment. Conclusion These findings provide further evidence that the ISI is a reliable and valid instrument to detect cases of insomnia in the population and is sensitive to treatment response in clinical patients.

2,651 citations


Journal ArticleDOI
01 May 2011-Sleep
TL;DR: Using both sensitive PVT metrics and optimal test durations maximizes the sensitivity of the PVT to sleep loss and therefore potentially decreases the sample size needed to detect the same neurobehavioral deficit and proposes criteria to better standardize the 10-min PVT.
Abstract: STUDY OBJECTIVES The psychomotor vigilance test (PVT) is among the most widely used measures of behavioral alertness, but there is large variation among published studies in PVT performance outcomes and test durations. To promote standardization of the PVT and increase its sensitivity and specificity to sleep loss, we determined PVT metrics and task durations that optimally discriminated sleep deprived subjects from alert subjects. DESIGN Repeated-measures experiments involving 10-min PVT assessments every 2 h across both acute total sleep deprivation (TSD) and 5 days of chronic partial sleep deprivation (PSD). SETTING Controlled laboratory environment. PARTICIPANTS 74 healthy subjects (34 female), aged 22-45 years. INTERVENTIONS TSD experiment involving 33 h awake (N = 31 subjects) and a PSD experiment involving 5 nights of 4 h time in bed (N = 43 subjects). MEASUREMENTS AND RESULTS In a paired t-test paradigm and for both TSD and PSD, effect sizes of 10 different PVT performance outcomes were calculated. Effect sizes were high for both TSD (1.59-1.94) and PSD (0.88-1.21) for PVT metrics related to lapses and to measures of psychomotor speed, i.e., mean 1/RT (response time) and mean slowest 10% 1/RT. In contrast, PVT mean and median RT outcomes scored low to moderate effect sizes influenced by extreme values. Analyses facilitating only portions of the full 10-min PVT indicated that for some outcomes, high effect sizes could be achieved with PVT durations considerably shorter than 10 min, although metrics involving lapses seemed to profit from longer test durations in TSD. CONCLUSIONS Due to their superior conceptual and statistical properties and high sensitivity to sleep deprivation, metrics involving response speed and lapses should be considered primary outcomes for the 10-min PVT. In contrast, PVT mean and median metrics, which are among the most widely used outcomes, should be avoided as primary measures of alertness. Our analyses also suggest that some shorter-duration PVT versions may be sensitive to sleep loss, depending on the outcome variable selected, although this will need to be confirmed in comparative analyses of separate duration versions of the PVT. Using both sensitive PVT metrics and optimal test durations maximizes the sensitivity of the PVT to sleep loss and therefore potentially decreases the sample size needed to detect the same neurobehavioral deficit. We propose criteria to better standardize the 10-min PVT and facilitate between-study comparisons and meta-analyses.

674 citations


Journal ArticleDOI
01 Oct 2011-Sleep
TL;DR: The reported temporal relationships during SO sequences suggest that fast spindles, driven by the SO up-state feed back to enhance the likelihood of succeeding SOs together with slow spindle, possibly play a key role in sleep-dependent memory processing.
Abstract: STUDY OBJECTIVES Thalamo-cortical spindles driven by the up-state of neocortical slow (< 1 Hz) oscillations (SOs) represent a candidate mechanism of memory consolidation during sleep. We examined interactions between SOs and spindles in human slow wave sleep, focusing on the presumed existence of 2 kinds of spindles, i.e., slow frontocortical and fast centro-parietal spindles. DESIGN Two experiments were performed in healthy humans (24.5 ± 0.9 y) investigating undisturbed sleep (Experiment I) and the effects of prior learning (word paired associates) vs. non-learning (Experiment II) on multichannel EEG recordings during sleep. MEASUREMENTS AND RESULTS Only fast spindles (12-15 Hz) were synchronized to the depolarizing SO up-state. Slow spindles (9-12 Hz) occurred preferentially at the transition into the SO down-state, i.e., during waning depolarization. Slow spindles also revealed a higher probability to follow rather than precede fast spindles. For sequences of individual SOs, fast spindle activity was largest for "initial" SOs, whereas SO amplitude and slow spindle activity were largest for succeeding SOs. Prior learning enhanced this pattern. CONCLUSIONS The finding that fast and slow spindles occur at different times of the SO cycle points to disparate generating mechanisms for the 2 kinds of spindles. The reported temporal relationships during SO sequences suggest that fast spindles, driven by the SO up-state feed back to enhance the likelihood of succeeding SOs together with slow spindles. By enforcing such SO-spindle cycles, particularly after prior learning, fast spindles possibly play a key role in sleep-dependent memory processing.

446 citations


Journal ArticleDOI
01 Nov 2011-Sleep
TL;DR: Short sleepers, especially those with poor sleep quality, have an increased risk of total CVD and CHD incidence and future investigations should not only focus on sleep duration, but should also take sleep quality into account.
Abstract: Study Objectives: We studied sleep duration and sleep quality in relation to cardiovascular disease (CVD) incidence. Design/Setting: Dutch population-based cohort study. Participants: 20,432 men and women aged 20-65 y with no history of CVD. Interventions: N/A Measurements: Sleep duration and sleep quality were assessed by a self-administered questionnaire. Morbidity data, vital status, and causes of death were obtained through linkage with several national registries. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards models. Results: During 10-15 years of follow-up, 1,486 CVD and 1,148 coronary heart disease (CHD) events occurred. Short sleepers (= 6 h) had a 15% higher risk of total CVD (HR: 1.15; 95%CI: 1.00-1.32) and a 23% higher risk of CHD (HR: 1.23 [1.04-1.45]) compared to normal sleepers (7 h) after adjustment for all confounders. Additional adjustment for intermediate biological risk factors attenuated these relative risks to 1.11 (0.97-1.27) for total CVD and to 1.19 (1.00-1.40) for CHD. Short sleepers with poor sleep quality had a 63% higher risk of CVD (HR: 1.63 [1.21-2.19]) and a 79% higher risk of CHD incidence (HR: 1.79 [1.24-2.58]) compared to normal sleepers with good sleep quality, after adjustments for all confounders. We observed no associations between long sleep duration (= 9 h) and CVD or CHD incidence. Conclusions: Short sleepers, especially those with poor sleep quality, have an increased risk of total CVD and CHD incidence. Future investigations should not only focus on sleep duration, but should also take sleep quality into account.

443 citations


Journal ArticleDOI
01 Jul 2011-Sleep
TL;DR: Improvements in specific measures of basketball performance after sleep extension indicate that optimal sleep is likely beneficial in reaching peak athletic performance.
Abstract: STUDY OBJECTIVES To investigate the effects of sleep extension over multiple weeks on specific measures of athletic performance as well as reaction time, mood, and daytime sleepiness. SETTING Stanford Sleep Disorders Clinic and Research Laboratory and Maples Pavilion, Stanford University, Stanford, CA. PARTICIPANTS Eleven healthy students on the Stanford University men's varsity basketball team (mean age 19.4 ± 1.4 years). INTERVENTIONS Subjects maintained their habitual sleep-wake schedule for a 2-4 week baseline followed by a 5-7 week sleep extension period. Subjects obtained as much nocturnal sleep as possible during sleep extension with a minimum goal of 10 h in bed each night. Measures of athletic performance specific to basketball were recorded after every practice including a timed sprint and shooting accuracy. Reaction time, levels of daytime sleepiness, and mood were monitored via the Psychomotor Vigilance Task (PVT), Epworth Sleepiness Scale (ESS), and Profile of Mood States (POMS), respectively. RESULTS Total objective nightly sleep time increased during sleep extension compared to baseline by 110.9 ± 79.7 min (P < 0.001). Subjects demonstrated a faster timed sprint following sleep extension (16.2 ± 0.61 sec at baseline vs. 15.5 ± 0.54 sec at end of sleep extension, P < 0.001). Shooting accuracy improved, with free throw percentage increasing by 9% and 3-point field goal percentage increasing by 9.2% (P < 0.001). Mean PVT reaction time and Epworth Sleepiness Scale scores decreased following sleep extension (P < 0.01). POMS scores improved with increased vigor and decreased fatigue subscales (P < 0.001). Subjects also reported improved overall ratings of physical and mental well-being during practices and games. CONCLUSIONS Improvements in specific measures of basketball performance after sleep extension indicate that optimal sleep is likely beneficial in reaching peak athletic performance.

440 citations


Journal ArticleDOI
01 Jan 2011-Sleep
TL;DR: This study suggests that a greater percentage of patients achieve normal functioning with longer nightly CPAP duration of use, but a substantial proportion of patients will not normalize neurobehavioral responses despite seemingly adequate CPAP use.
Abstract: CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) HAS BEEN SHOWN TO REDUCE DAYTIME SLEEPINESS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA (OSA) and is widely accepted as the most efficacious therapy for OSA. Patel and colleagues performed a meta-analysis showing that CPAP reduced the Epworth Sleepiness Scale (ESS) score an average of 2.9 points more than did placebo (P < 0.001) in patients with OSA. Patients with moderate to severe OSA had a greater fall in ESS than did those with mild OSA. 1

420 citations


Journal ArticleDOI
01 Sep 2011-Sleep
TL;DR: Insomnia is associated with substantial workplace costs and although experimental studies suggest some of these costs could be recovered with insomnia disease management programs, effectiveness trials are needed to obtain precise estimates of return-on-investment of such interventions from the employer perspective.
Abstract: 2 1 = 39.5, P < 0.001) but not absenteeism (χ 2 1 = 3.2, P = 0.07), with an annualized individual-level association of insomnia with presenteeism equivalent to 11.3 days of lost work performance. This estimate decreased to 7.8 days when controls were introduced for comorbid conditions. The individual-level human capital value of this net estimate was $2,280. If we provision - ally assume these estimates generalize to the total Us workforce, they are equivalent to annualized population-level estimates of 252.7 days and $63.2 billion. Conclusions: Insomnia is associated with substantial workplace costs. Although experimental studies suggest some of these costs could be re- covered with insomnia disease management programs, effectiveness trials are needed to obtain precise estimates of return-on-investment of such

415 citations


Journal ArticleDOI
01 Mar 2011-Sleep
TL;DR: This paper addresses indications for polysomnography in children with suspected sleep related breathing disorders and recommends practices in accordance with the AASM Manual for the Scoring of Sleep and Associated Events.
Abstract: Background There has been marked expansion in the literature and practice of pediatric sleep medicine; however, no recent evidence-based practice parameters have been reported. These practice parameters are the first of 2 papers that assess indications for polysomnography in children. This paper addresses indications for polysomnography in children with suspected sleep related breathing disorders. These recommendations were reviewed and approved by the Board of Directors of the American Academy of Sleep Medicine. Methods A systematic review of the literature was performed, and the American Academy of Neurology grading system was used to assess the quality of evidence. RECOMMENDATIONS FOR PSG USE: 1. Polysomnography in children should be performed and interpreted in accordance with the recommendations of the AASM Manual for the Scoring of Sleep and Associated Events. (Standard) 2. Polysomnography is indicated when the clinical assessment suggests the diagnosis of obstructive sleep apnea syndrome (OSAS) in children. (Standard) 3. Children with mild OSAS preoperatively should have clinical evaluation following adenotonsillectomy to assess for residual symptoms. If there are residual symptoms of OSAS, polysomnography should be performed. (Standard) 4. Polysomnography is indicated following adenotonsillectomy to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway, and neurologic disorders (e.g., Down syndrome, Prader-Willi syndrome, and myelomeningocele). (Standard) 5. Polysomnography is indicated for positive airway pressure (PAP) titration in children with obstructive sleep apnea syndrome. (Standard) 6. Polysomnography is indicated when the clinical assessment suggests the diagnosis of congenital central alveolar hypoventilation syndrome or sleep related hypoventilation due to neuromuscular disorders or chest wall deformities. It is indicated in selected cases of primary sleep apnea of infancy. (Guideline) 7. Polysomnography is indicated when there is clinical evidence of a sleep related breathing disorder in infants who have experienced an apparent life-threatening event (ALTE). (Guideline) 8. Polysomnography is indicated in children being considered for adenotonsillectomy to treat obstructive sleep apnea syndrome. (Guideline) 9. Follow-up PSG in children on chronic PAP support is indicated to determine whether pressure requirements have changed as a result of the child's growth and development, if symptoms recur while on PAP, or if additional or alternate treatment is instituted. (Guideline) 10. Polysomnography is indicated after treatment of children for OSAS with rapid maxillary expansion to assess for the level of residual disease and to determine whether additional treatment is necessary. (Option) 11. Children with OSAS treated with an oral appliance should have clinical follow-up and polysomnography to assess response to treatment. (Option) 12. Polysomnography is indicated for noninvasive positive pressure ventilation (NIPPV) titration in children with other sleep related breathing disorders. (Option) 13. Children treated with mechanical ventilation may benefit from periodic evaluation with polysomnography to adjust ventilator settings. (Option) 14. Children treated with tracheostomy for sleep related breathing disorders benefit from polysomnography as part of the evaluation prior to decannulation. These children should be followed clinically after decannulation to assess for recurrence of symptoms of sleep related breathing disorders. (Option) 15. Polysomnography is indicated in the following respiratory disorders only if there is a clinical suspicion for an accompanying sleep related breathing disorder: chronic asthma, cystic fibrosis, pulmonary hypertension, bronchopulmonary dysplasia, or chest wall abnormality such as kyphoscoliosis. (Option) RECOMMENDATIONS AGAINST PSG USE: 16. Nap (abbreviated) polysomnography is not recommended for the evaluation of obstructive sleep apnea syndrome in children. (Option) 17. Children considered for treatment with supplemental oxygen do not routinely require polysomnography for management of oxygen therapy. (Option) Conclusions Current evidence in the field of pediatric sleep medicine indicates that PSG has clinical utility in the diagnosis and management of sleep related breathing disorders. The accurate diagnosis of SRBD in the pediatric population is best accomplished by integration of polysomnographic findings with clinical evaluation.

335 citations


Journal ArticleDOI
01 Mar 2011-Sleep
TL;DR: Propofol anesthesia is a sleep-like state and slow waves are associated with diminished consciousness even in the presence of high gamma activity.
Abstract: 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.

334 citations


Journal ArticleDOI
01 Dec 2011-Sleep
TL;DR: Exercise training had moderate treatment efficacy for the reduction of AHI in sedentary overweight/obese adults, which suggests that exercise may be beneficial for the management of OSA beyond simply facilitating weight loss.
Abstract: STUDY OBJECTIVES To evaluate the efficacy of a 12-week exercise training program for reducing obstructive sleep apnea (OSA) severity and improving sleep quality, and to explore possible mechanisms by which exercise may reduce OSA severity. DESIGN Randomized controlled trial. SETTING Clinical exercise physiology center, sleep laboratory. PARTICIPANTS Forty-three sedentary and overweight/obese adults aged 18-55 years with at least moderate-severity untreated OSA (screening apnea-hypopnea index [AHI] ≥ 15). INTERVENTIONS Participants randomized to exercise training (n = 27) met 4 times/week for 12 weeks and performed 150 min/week of moderate-intensity aerobic activity, followed by resistance training twice/week. Participants randomized to a stretching control (n = 16) met twice weekly for 12 weeks to perform low-intensity exercises designed to increase whole-body flexibility. MEASUREMENTS AND RESULTS OSA severity was assessed with one night of laboratory polysomnography (PSG) before and following the 12-week intervention. Measures of sleep quality included PSG, actigraphy (7-10 days), and the Pittsburgh Sleep Quality Index. Compared with stretching, exercise resulted in a significant AHI reduction (exercise: 32.2 ± 5.6 to 24.6 ± 4.4, stretching: 24.4 ± 5.6 to 28.9 ± 6.4; P < 0.01) as well as significant changes in oxygen desaturation index (ODI; P = 0.03) and stage N3 sleep (P = 0.03). Reductions in AHI and ODI were achieved without a significant decrease in body weight. Improvements in actigraphic sleep and subjective sleep quality were also noted following exercise compared with stretching. CONCLUSIONS Exercise training had moderate treatment efficacy for the reduction of AHI in sedentary overweight/obese adults, which suggests that exercise may be beneficial for the management of OSA beyond simply facilitating weight loss. TRIAL REGISTRATION Clinicaltrials.gov identification number NCT00956423.

273 citations


Journal ArticleDOI
01 Aug 2011-Sleep
TL;DR: It was 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.
Abstract: 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.

Journal ArticleDOI
01 Jan 2011-Sleep
TL;DR: Nightmares may be more than a marker of PTSD and hence may be important in the identification of suicidal ideation.
Abstract: Study objectives The purpose of this study was to investigate whether insomnia symptoms and nightmares are related to suicidal ideation independent of one another and independent of the symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) Design The study consisted of questionnaires examining insomnia symptoms and nightmares, and symptoms of depression, anxiety, and PTSD The questionnaires were administered online Setting University Patients or participants 583 undergraduate students at a large, public university in southeastern United States Interventions N/A Measurements and results Results indicated that both nightmares and insomnia symptoms were related to suicidal ideation, independent of one another Nightmares, but not insomnia symptoms, were related to suicidal ideation after controlling for the symptoms of anxiety, depression, and PTSD Conclusions Nightmares may be more than a marker of PTSD and hence may be important in the identification of suicidal ideation

Journal ArticleDOI
01 Nov 2011-Sleep
TL;DR: HGNS demonstrated favorable safety, efficacy, and compliance in treating obstructive sleep apnea and participants experienced a significant decrease in OSA severity and OSA-associated symptoms.
Abstract: Background: Reduced upper airway muscle activity during sleep is fundamental to obstructive sleep apnea (OSA) pathogenesis. Hypoglossal nerve stimulation (HGNS) counteracts this problem, with potential to reduce OSA severity. Study objectives: To examine safety and efficacy of a novel HGNS system (HGNS, Apnex Medical, Inc.) in treating OSA. Participants: Twenty-one patients, 67% male, age (mean ± SD) 53.6 ± 9.2 years, with moderate to severe OSA and unable to tolerate continuous positive airway pressure (CPAP). Design: Each participant underwent surgical implantation of the HGNS system in a prospective single-arm interventional trial. OSA severity was defined by apnea-hypopnea index (AHI) during in-laboratory polysomnography (PSG) at baseline and 3 and 6 months post-implant. Therapy compliance was assessed by nightly hours of use. Symptoms were assessed using the Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Calgary Sleep Apnea Quality of Life Index (SAQLI), and the Beck Depression Inventory (BDI). Results: HGNS was used on 89% ± 15% of nights (n = 21). On these nights, it was used for 5.8 ± 1.6 h per night. Nineteen of 21 participants had baseline and 6-month PSGs. There was a significant improvement (all P < 0.05) from baseline to 6 months in: AHI (43.1 ± 17.5 to 19.5 ± 16.7), ESS (12.1 ± 4.7 to 8.1 ± 4.4), FOSQ (14.4 ± 2.0 to 16.7 ± 2.2), SAQLI (3.2 ± 1.0 to 4.9 ± 1.3), and BDI (15.8 ± 9.0 to 9.7 ± 7.6). Two serious device-related adverse events occurred: an infection requiring device removal and a stimulation lead cuff dislodgement requiring replacement. Conclusions: HGNS demonstrated favorable safety, efficacy, and compliance. Participants experienced a significant decrease in OSA severity and OSA-associated symptoms. Clinical trial information: NAME: Australian Clinical Study of the Apnex Medical HGNS System to Treat Obstructive Sleep Apnea. Registration number: NCT01186926. URL: http://clinicaltrials.gov/ct2/show/NCT01186926.

Journal ArticleDOI
01 Jan 2011-Sleep
TL;DR: In this article, the effects of air, road and rail traffic noise on sleep and recuperation were investigated for 11 consecutive nights, which included eight noise exposure nights and one noise-free control night.
Abstract: Study Objectives: 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 Measurements and Results: Subjects were investigated for 11 consecutive nights, which included eight 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 due to 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 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.

Journal ArticleDOI
01 Jul 2011-Sleep
TL;DR: An up-to-date review of neurochemical systems interact to generate wakefulness and sleep should allow clinicians and researchers to better understand the effects of drugs, lesions, and neurologic disease on sleep and wakefulness.
Abstract: Many neurochemical systems interact to generate wakefulness and sleep. Wakefulness is promoted by neurons in the pons, midbrain, and posterior hypothalamus that produce acetylcholine, norepinephrine, dopamine, serotonin, histamine, and orexin/hypocretin. Most of these ascending arousal systems diffusely activate the cortex and other forebrain targets. NREM sleep is mainly driven by neurons in the preoptic area that inhibit the ascending arousal systems, while REM sleep is regulated primarily by neurons in the pons, with additional influence arising in the hypothalamus. Mutual inhibition between these wake- and sleep-regulating regions likely helps generate full wakefulness and sleep with rapid transitions between states. This up-to-date review of these systems should allow clinicians and researchers to better understand the effects of drugs, lesions, and neurologic disease on sleep and wakefulness.

Journal ArticleDOI
01 May 2011-Sleep
TL;DR: Adverse changes in sleep duration are associated with poorer cognitive function in the middle-aged, according to the results of the Whitehall II study.
Abstract: STUDY OBJECTIVES: Evidence from cross-sectional studies shows that sleep is associated with cognitive function This study examines change in sleep duration as a determinant of cognitive function DESIGN: Prospective cohort SETTING: The Whitehall II study PARTICIPANTS: 1459 women and 3972 men aged 45-69 at baseline INTERVENTIONS: None MEASUREMENTS AND RESULTS: Sleep duration (≤ 5, 6, 7, 8, ≥ 9 h on an average week night) was assessed once between 1997-1999, baseline for the present study, and once between 2002-2004, average follow-up 54 years Cognitive function was measured (2002-2004) using 6 tests: verbal memory, inductive reasoning (Alice Heim 4-I), verbal meaning (Mill Hill), phonemic and semantic fluency, and the Mini Mental State Examination (MMSE) In analyses adjusted for age, sex, and education, and corrected for multiple testing, adverse changes in sleep between baseline and follow-up (decrease from 6, 7, or 8 h, increase from 7 or 8 h) were associated with lower scores on most cognitive function tests Exceptions were memory, and, for a decrease from 6-8 h only, phonemic fluency Further adjustment for occupational position attenuated the associations slightly However, firm evidence remained for an association between an increase from 7 or 8 h sleep and lower cognitive function for all tests, except memory, and between a decrease from 6-8 h sleep and poorer reasoning, vocabulary, and the MMSE The magnitude of these effects was equivalent to a 4-7 year increase in age CONCLUSIONS: These results suggest that adverse changes in sleep duration are associated with poorer cognitive function in the middle-aged CITATION: Ferrie JE; Shipley MJ; Akbaraly TN; Marmot MG; Kivimaki M; Singh-Manoux A Change in sleep duration and cognitive function: findings from the Whitehall II study SLEEP 2011;34(5):565-573

Journal ArticleDOI
01 Oct 2011-Sleep
TL;DR: Late bedtimes and late wake up times are associated with an unfavorable activity and weight status profile, independent of age, sex, household income, geographical remoteness, and sleep duration.
Abstract: STUDY OBJECTIVES To assess the effects of early and late bedtimes and wake up times on use of time and weight status in Australian school-aged children. DESIGN Observational cross-sectional study involving use of time interviews and pedometers. SETTING Free-living Australian adolescents. PARTICIPANTS 2200 9- to 16-year-olds from all states of Australia INTERVENTIONS NA. MEASUREMENTS AND RESULTS Bedtimes and wake times were adjusted for age and sex and classified as early or late using median splits. Adolescents were allocated into 4 sleep-wake pattern groups: Early-bed/Early-rise; Early-bed/Late-rise; Late-bed/Early-rise; Late-bed/Late-rise. The groups were compared for use of time (screen time, physical activity, and study-related time), sociodemographic characteristics, and weight status. Adolescents in the Late-bed/Late-rise category experienced 48 min/d more screen time and 27 min less moderate-to-vigorous physical activity (MVPA) (P<0.0001) than adolescents in the Early-bed/Early-rise category, in spite of similar sleep durations. Late-bed/Late-rise adolescents had a higher BMI z-score (0.66 vs. 0.45, P=0.0015). Late-bed/Late-rise adolescents were 1.47 times more likely to be overweight or obese than Early-bed/Early-rise adolescents, 2.16 times more likely to be obese, 1.77 times more likely to have low MVPA, and 2.92 times more likely to have high screen time. Late-bed/Late-rise adolescents were more likely to come from poorer households, to live in major cities, and have fewer siblings. CONCLUSIONS Late bedtimes and late wake up times are associated with an unfavorable activity and weight status profile, independent of age, sex, household income, geographical remoteness, and sleep duration.

Journal ArticleDOI
01 Aug 2011-Sleep
TL;DR: Insomnia symptoms, EDS, and the use of medication independently increase the risk of subsequent depression in the elderly, and disturbed sleep and prolonged use of sleep medication may be early indicators or potentially reversible risk factors for depression.
Abstract: STUDY OBJECTIVES: Previous studies have reported that insomnia and excessive daytime sleepiness (EDS) may predict depression in adults However, these associations have not been investigated in community-dwelling elderly taking into account insomnia symptoms, EDS, and sleep medication DESIGN: Four-year longitudinal study SETTING: The French Three-City Study PARTICIPANTS: 3824 subjects aged ≥ 65 years and free of depressive symptoms at baseline MEASUREMENTS AND RESULTS: Questionnaires were used to evaluate "insomnia symptoms", EDS, and sleep medication at baseline Depressive symptoms (DEP-s) were assessed using the Center for Epidemiologic Studies-Depression scale at baseline, and at 2-year and 4-year follow-up Logistic regression models controlling for potential confounders were generated to determine whether sleep disturbances were associated with incident DEP-s and to determine the effect of individual insomnia symptoms Insomnia symptoms and EDS independently increased the risk of incident DEP-s (OR=123, 95% CI=101-149 and OR=205, 95% CI=130-323, respectively) Poor sleep quality and difficulty in initiating and in maintaining sleep-but not early morning awakening-were identified as risk factors of DEP-s, with risk increasing with the frequency of insomnia symptoms Sleep medication was not only a risk factor for DEP-s independent of insomnia symptoms (OR=162, 95% CI=126-209), but also independent of EDS (OR=171 95%=133-220) CONCLUSIONS: Insomnia symptoms, EDS, and the use of medication independently increase the risk of subsequent depression in the elderly In clinical practice, disturbed sleep and prolonged use of sleep medication may be early indicators or potentially reversible risk factors for depression, suggesting the need for further clinical interventional research

Journal ArticleDOI
01 Sep 2011-Sleep
TL;DR: After controlling for combat exposure, short sleep duration (SSD) was associated with symptoms of depression, posttraumatic stress disorder, panic syndrome, and with high-risk health behaviors such as abuse of tobacco and alcohol products, and suicide attempts.
Abstract: STUDY OBJECTIVES: Short sleep duration (SSD) is common among deployed soldiers. The prevalence of SSD during redeployment, however, is unknown. DESIGN: Cross-sectional study of a brigade combat team (n = 3152 US Army soldiers) surveyed 90-180 days after completing a 6-15 month deployment to Iraq as part of Operation Iraqi Freedom (OIF). Survey items targeted sleep habits and comorbid medical conditions. Multivariate logistic regression analyses were performed to calculate adjusted odds ratios of medical comorbidities associated with SSD. SETTING: US Army Infantry Post. SUBJECTS: All soldiers from a redeploying brigade combat team participated in a health assessment between 90 and 180 days upon return to Ft. Lewis from Iraq. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: A total of 2738 (86.9%) soldiers answered questions regarding self-perceived sleep and were included in the analysis. Mean sleep duration was 5.8 ± 1.2 hours. Nineteen hundred fifty-nine (72%) slept ≤ 6 h, but only 16% reported a daytime nap or felt their job performance was affected due to lack of sleep. Short sleep was more common among soldiers who reported combat exposure. After controlling for combat exposure, short sleep duration (SSD) was associated with symptoms of depression, posttraumatic stress disorder, panic syndrome, and with high-risk health behaviors such as abuse of tobacco and alcohol products, and suicide attempts. CONCLUSIONS: SSD is common among redeployed soldiers. Soldiers who experienced combat are at increased risk for persistent SSD and comorbidities associated with SSD. Efforts to reestablish good sleep habits and aggressive evaluation of soldiers with persistent SSD following deployment may aid in the prevention and management of associated medical conditions. CITATION: Luxton DD; Greenburg D; Ryan J; Niven A; Wheeler G; Mysliwiec V. Prevalence and impact of short sleep duration in redeployed OIF soldiers. SLEEP 2011;34(9):1189-1195. Language: en

Journal ArticleDOI
01 Jun 2011-Sleep
TL;DR: Those with parent-set bedtimes had earlier bedtimes, obtained more sleep, and experienced improved daytime wakefulness and less fatigue, compared to adolescents without parent- set bedtimes.
Abstract: Study objectives To determine the proportion of adolescents whose bedtime is set by their parents and to evaluate whether parent-set bedtimes are associated with earlier bedtimes, more sleep, and better daytime functioning. Participants 385 adolescents aged 13-18 years (mean = 15.6, SD = 0.95; 60% male) from 8 socioeconomically diverse schools in South Australia. Measurements and methods Adolescents completed the School Sleep Habits Survey during class time and then completed an 8-day Sleep Diary. The Flinders Fatigue Scale was completed on the final day of the study. Results 17.5% of adolescents reported a parent-set bedtime as the main factor determining their bedtime on school nights. Compared to adolescents without parent-set bedtimes, those with parent-set bedtimes had earlier bedtimes, obtained more sleep, and experienced improved daytime wakefulness and less fatigue. They did not differ significantly in terms of time taken to fall asleep. When parent-set bedtimes were removed on weekends, sleep patterns did not significantly differ between groups. Conclusions Significant personal and public health issues, such as depression and accidental injury and mortality, are associated with insufficient sleep. Converging biological and psychosocial factors mean that adolescence is a period of heightened risk. Parent-set bedtimes offer promise as a simple and easily translatable means for parents to improve the sleep and daytime functioning of their teens.

Journal ArticleDOI
01 Jul 2011-Sleep
TL;DR: This large population-based study suggests that insomnia is highly prevalent in diverse chronic medical disorders, however, polysomnographic evidence of disturbed sleep is present in only a subset of comorbid insomnia populations.
Abstract: Study Objectives: To determine the prevalence and polysomnographic correlates of insomnia in subjects with self-reported medical disorders. Design: Prospective cross-sectional study. Participants: Community-based sample of 3282 men and women aged 18 to 65 years old, with a subset who underwent polysomnography. Measurements: Self-reported measures of sleep habits and current health, and polysomnographic sleep variables. Results: The prevalence of insomnia was 21.4%. The adjusted odds of insomnia were 2.2 times as high in persons with any medical disorders as in those without medical disorders. Specifically, odds of insomnia were higher in people with heart disease (OR = 1.6 [95% CI: 1.2-23], P = 0.004), hypertension (1.5 [12-18], P < 0.001), diabetes (1.4 [105-20], P = 0.04), stomach ulcers (2.1 [1.6-2.7], P < 0.001), arthritis (1.8 [1.52.2], P < 0.001), migraine (1.8 [1.5-2.1], P < 0.001), asthma (1.6 [1.3-2.0], P = 0.04), COPD (1.9 [1.5-2.5], P < 0.001), neurological problems (2.0 [1.5-2.7], P < 0.001), and menstrual problems (1.7 [1.3-2.1], P < 0.001) than in people without these disorders. Prevalence of insomnia increased with increasing number of medical disorders. However, polysomnographic sleep was not significantly different in persons with or without medical disorders for most disorders assessed. Conclusion: This large population-based study suggests that insomnia is highly prevalent in diverse chronic medical disorders. However, polysomnographic evidence of disturbed sleep is present in only a subset of comorbid insomnia populations.

Journal ArticleDOI
01 Nov 2011-Sleep
TL;DR: It is suggested that poor sleep may contribute to increased risk for PTB both independently, as well as in conjunction with other established risk factors, such as stress.
Abstract: Study objectives Preterm birth (PTB) is a major public health priority and the most common adverse pregnancy outcome. Several risk factors have been identified, but a gap in the understanding of the underlying etiology of PTB persists. Poor sleep quality is a correlate of adverse health outcomes. Therefore, we evaluated whether sleep quality during pregnancy was a clinically relevant risk factor for PTB. Design Observational. Measurements and results Participants included 166 pregnant women (mean age = 28.6 ± 5.5 years). Self-report questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), were administered at 14-16, 24-26, and 30-32 weeks gestation. Logistic regression models were used to evaluate whether sleep quality was associated with preterm delivery. Poor sleep quality was a predictor of preterm birth, with the largest effects in early pregnancy (14-16 weeks) (OR: 1.25 95% CI [1.04-1.50], P = 0.02) and more modest effects in later pregnancy (30-32 weeks) (OR: 1.18 95% CI [0.98-1.42], P = 0.07). With every one-point increase on the PSQI, the odds of preterm birth increase 25% in early pregnancy and 18% in later pregnancy. Conclusions Poor sleep quality, in both early and late pregnancy, is associated with an increased risk of delivering preterm. Currently the specific pathway(s) through which disturbed sleep contributes to PTB are unknown. We suggest that poor sleep may contribute to increased risk for PTB both independently, as well as in conjunction with other established risk factors, such as stress.

Journal ArticleDOI
01 Oct 2011-Sleep
TL;DR: There were modest cross-sectional associations of WASO and self-reported long sleep with cognition among older community-dwelling men and EDS and PSQI were not related to cognition.
Abstract: STUDY OBJECTIVES To examine the association of objectively and subjectively measured sleep characteristics with cognition in older men. DESIGN A population-based cross-sectional study. SETTING 6 centers in the United States. PARTICIPANTS 3,132 community-dwelling older men (mean age 76.4 ± 5.6 years). INTERVENTIONS None. MEASUREMENTS AND RESULTS Objectively measured sleep predictors from wrist actigraphy were total sleep time (TST), sleep efficiency (SE), and wake after sleep onset (WASO). Subjective sleep predictors were self-reported poor sleep (Pittsburgh Sleep Quality Index [PSQI] > 5), excessive daytime sleepiness (EDS, Epworth Sleepiness Scale Score > 10), and TST. Cognitive outcomes were measured with the Modified Mini-Mental State examination (3MS), the Trails B test, and the Digit Vigilance Test (DVT). After adjustment for multiple potential confounders, WASO was modestly related to poorer cognition. Compared to those with WASO 8 h) on average took 8.6 sec more to complete the Trails B test, had a 0.6-point worse 3MS score, and took 46 sec longer to complete the DVT (P<0.05). PSQI and EDS were not independently related to cognitive outcomes. CONCLUSIONS There were modest cross-sectional associations of WASO and self-reported long sleep with cognition among older community-dwelling men. EDS and PSQI were not related to cognition.

Journal ArticleDOI
01 Dec 2011-Sleep
TL;DR: CBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term, and studies evaluating the treatment effectiveness of each treatment component are needed.
Abstract: Objective: To evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD). Design: Randomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only. Setting: Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia. Patients: 49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs WL: N = 17). Interventions: CBT plus BLT consisted of 6 individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene. Measurements and Results: DSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P < 0.0001), yet 13% still met DSPD criteria at the 6-month follow-up. Conclusions: CBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed. Clinical Trial Information: Australia & New Zealand Trials Registry Number: ACTRN12610001041044.

Journal ArticleDOI
01 Mar 2011-Sleep
TL;DR: The impact of OSA on neurocognitive performance is small for many individuals with this condition and is most related to the severity of hypoxemia.
Abstract: Study objectives To determine associations between obstructive sleep apnea (OSA) and neurocognitive performance in a large cohort of adults. Study design Cross-sectional analyses of polysomnographic and neurocognitive data from 1204 adult participants with a clinical diagnosis of obstructive sleep apnea (OSA) in the Apnea Positive Pressure Long-term Efficacy Study (APPLES), assessed at baseline before randomization to either continuous positive airway pressure (CPAP) or sham CPAP. Measurements Sleep and respiratory indices obtained by laboratory polysomnography and several measures of neurocognitive performance. Results Weak correlations were found for both the apnea hypopnea index (AHI) and several indices of oxygen desaturation and neurocognitive performance in unadjusted analyses. After adjustment for level of education, ethnicity, and gender, there was no association between the AHI and neurocognitive performance. However, severity of oxygen desaturation was weakly associated with worse neurocognitive performance on some measures of intelligence, attention, and processing speed. Conclusions The impact of OSA on neurocognitive performance is small for many individuals with this condition and is most related to the severity of hypoxemia.

Journal ArticleDOI
01 Nov 2011-Sleep
TL;DR: Key elements in the design and implementation of a controlled trial for a widely used "standard practice" surgical intervention in a pediatric population are addressed, that include establishment of standardized data collection procedures across sites for a wide variety of data types, establishment of equipoise, and approaches for minimizing unblinding of selected key personnel.
Abstract: Each year, over 500,000 adenotonsillectomies (AT), mostly for the treatment of pediatric obstructive sleep apnea (OSA) are performed in the US in children under 15 years of age. No definitive study, however, has been yet conducted that has rigorously evaluated the effectiveness of AT for not only improving sleep disordered breathing, but also for improving clinically relevant outcomes, such as neurocognitive function, behavior, and quality of life. The Childhood Adenotonsillectomy Trial (CHAT) was designed to assess neuropsychological and health outcomes in children randomized to receive early AT (eAT) as compared to Watchful Waiting with Supportive Care (WWSC). Important secondary goals of the study are to evaluate outcomes in subgroups defined by obesity and race. This paper addresses key elements in the design and implementation of a controlled trial for a widely used "standard practice" surgical intervention in a pediatric population, that include establishment of standardized data collection procedures across sites for a wide variety of data types, establishment of equipoise, and approaches for minimizing unblinding of selected key personnel. The study framework that was established should provide a useful template for other pediatric controlled studies or other studies that evaluate surgical interventions.

Journal ArticleDOI
01 Nov 2011-Sleep
TL;DR: Loneliness was a significant predictor of sleep fragmentation, suggesting that Humans' social nature may partly be manifest through the authors' dependence on feeling secure in their social environment to sleep well.
Abstract: STUDY OBJECTIVE Loneliness has been shown to predict poor health. One hypothesized mechanism is that lonely individuals do not sleep as well as individuals who feel more connected to others. Our goal was to test whether loneliness is associated with sleep fragmentation or sleep duration. DESIGN Cross-sectional study. SETTING Members of a traditional, communal, agrarian society living in South Dakota. PARTICIPANTS Ninety-five participants (mean age 39.8 years, 55% female) who were ≥ 19 years of age at the study's inception. INTERVENTIONS Not applicable. MEASUREMENTS AND RESULTS We conducted interviews querying loneliness, depression, anxiety, and stress, as well as subjective sleep quality and daytime sleepiness. Study participants wore a wrist actigraph for one week to measure objective sleep properties; the two studied here were sleep fragmentation and sleep duration. Higher loneliness scores were associated with significantly higher levels of sleep fragmentation (β = 0.073, t = 2.55, P = 0.01), controlling for age, sex, body mass index, risk of sleep apnea, and negative affect (a factor comprising symptoms of depression and anxiety, and perceived stress). Loneliness was not associated with sleep duration or with either subjective sleep measure. CONCLUSIONS Loneliness was a significant predictor of sleep fragmentation. Humans' social nature may partly be manifest through our dependence on feeling secure in our social environment to sleep well.

Journal ArticleDOI
01 Mar 2011-Sleep
TL;DR: Pediatric polysomnography shows validity, reliability, and clinical utility that is commensurate with most other routinely employed diagnostic clinical tools or procedures and indicates that the "gold standard" for diagnosis of sleep related breathing disorders in children is rather the skillful integration of clinical and polygraphic findings by a knowledgeable sleep specialist.
Abstract: Objective This comprehensive, evidence-based review provides a systematic analysis of the literature regarding the validity, reliability, and clinical utility of polysomnography for characterizing breathing during sleep in children. Findings serve as the foundation of practice parameters regarding respiratory indications for polysomnography in children. Methods A task force of content experts performed a systematic review of the relevant literature and graded the evidence using a standardized grading system. Two hundred forty-three evidentiary papers were reviewed, summarized, and graded. The analysis addressed the operating characteristics of polysomnography as a diagnostic procedure in children and identified strengths and limitations of polysomnography for evaluation of respiratory function during sleep. Results The analysis documents strong face validity and content validity, moderately strong convergent validity when comparing respiratory findings with a variety of relevant independent measures, moderate-to-strong test-retest validity, and limited data supporting discriminant validity for characterizing breathing during sleep in children. The analysis documents moderate-to-strong test-retest reliability and interscorer reliability based on limited data. The data indicate particularly strong clinical utility in children with suspected sleep related breathing disorders and obesity, evolving metabolic syndrome, neurological, neurodevelopmental, or genetic disorders, and children with craniofacial syndromes. Specific consideration was given to clinical utility of polysomnography prior to adenotonsillectomy (AT) for confirmation of obstructive sleep apnea syndrome. The most relevant findings include: (1) recognition that clinical history and examination are often poor predictors of respiratory polygraphic findings, (2) preoperative polysomnography is helpful in predicting risk for perioperative complications, and (3) preoperative polysomnography is often helpful in predicting persistence of obstructive sleep apnea syndrome in patients after AT. No prospective studies were identified that address whether clinical outcome following AT for treatment of obstructive sleep apnea is improved in association with routine performance of polysomnography before surgery in otherwise healthy children. A small group of papers confirm the clinical utility of polysomnography for initiation and titration of positive airway pressure support. Conclusions Pediatric polysomnography shows validity, reliability, and clinical utility that is commensurate with most other routinely employed diagnostic clinical tools or procedures. Findings indicate that the "gold standard" for diagnosis of sleep related breathing disorders in children is not polysomnography alone, but rather the skillful integration of clinical and polygraphic findings by a knowledgeable sleep specialist. Future developments will provide more sophisticated methods for data collection and analysis, but integration of polysomnographic findings with the clinical evaluation will represent the fundamental diagnostic challenge for the sleep specialist.

Journal ArticleDOI
01 Dec 2011-Sleep
TL;DR: Black race and lower socioeconomic residential areas are associated with poorer adherence to CPAP in subjects with standardized access to care and treatment in a multi-center randomized trial of home vs. laboratory-based evaluation and treatment of OSA.
Abstract: Study objectives There are few established predictors of CPAP adherence; poor adherence limits its effectiveness We investigated whether race, education level, and residential economic status predict CPAP adherence in participants enrolled in a trial with standard access to treatment Design A multi-center randomized trial of home vs lab-based evaluation and treatment of OSA assessing adherence to CPAP at 1 and 3 months Setting Seven AASM-accredited sleep centers in 5 US cities Participants Subjects with moderate to severe OSA (AHI ≥ 15 and Epworth Sleepiness Scale score > 12) who completed follow-up at 1 and/or 3 months (n = 135) Measurements and results Subjects' demographic data were collected upon enrollment; CPAP use at 1 and 3 months was assessed at clinic follow-up In unadjusted analyses, CPAP adherence (average minutes per night of CPAP use) at 3 months was lower in black subjects and in subjects from lower socioeconomic status ZIP codes In adjusted analyses using multivariate linear regression, black race was predictive of CPAP adherence at one month (P = 003) At 3 months, black race was predictive in analyses only when ZIP code SES was not adjusted for Conclusion Black race and lower socioeconomic residential areas are associated with poorer adherence to CPAP in subjects with standardized access to care and treatment Disparities remain despite provision of standardized care in a clinical trial setting Future research is needed to identify barriers to adherence and to develop interventions tailored to improve CPAP adherence in at risk populations Portable Monitoring for Diagnosis and Management of Sleep Apnea (HomePAP) CLINICAL TRIAL INFORMATION: NIH CLINICAL TRIALS REGISTRY NUMBER: NCT00642486 URL: http://clinicaltrialsgov/show/NCT00642486

Journal ArticleDOI
01 Aug 2011-Sleep
TL;DR: The results suggest that core nighttime symptoms of insomnia are associated with different patterns of risk and perceived health and that symptom-based subtyping might have value.
Abstract: Study objectives To explore the distribution of the 4 cardinal nighttime symptoms of insomnia-difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), and nonrestorative sleep (NRS)-in a national sample of health plan members and the associations of these nighttime symptoms with sociodemographics, comorbidity, and perceived health. Design/setting/participants Cross-sectional telephone survey of 6,791 adult respondents. Intervention None. Measurements/results Current insomnia was assessed using the Brief Insomnia Questionnaire (BIQ)-a fully structured validated scale generating diagnoses of insomnia using DSM-IV-TR, ICD-10, and RDC/ICSD-2 inclusion criteria. DMS (61.0%) and EMA (52.2%) were more prevalent than DIS (37.7%) and NRS (25.2%) among respondents with insomnia. Sociodemographic correlates varied significantly across the 4 symptoms. All 4 nighttime symptoms were significantly related to a wide range of comorbid physical and mental conditions. All 4 also significantly predicted decrements in perceived health both in the total sample and among respondents with insomnia after adjusting for comorbid physical and mental conditions. Joint associations of the 4 symptoms predicting perceived health were additive and related to daytime distress/impairment. Individual-level associations were strongest for NRS. At the societal level, though, where both prevalence and strength of individual-level associations were taken into consideration, DMS had the strongest associations. Conclusions The extent to which nighttime insomnia symptoms are stable over time requires future long-term longitudinal study. Within the context of this limitation, the results suggest that core nighttime symptoms are associated with different patterns of risk and perceived health and that symptom-based subtyping might have value.