Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

Sleep disruptions and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a daily basis. However, most of the previous research has focused on subjective sleep measures only. In this study, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective sleep measures (actigraphy) in 41 non-treatment seeking, trauma-exposed young adults (age M=24.68, SD=8.15) with a range of PTSD symptom severities (PTSS, 0-53 on PCL-5). Participants reported daily PTSS and number of intrusions as well as nightly sleep, while wearing an actigraphy watch over four weeks. Linear mixed models showed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and more intrusions both within and between participants. Similar effects were found for PTSD symptoms influencing subsequent subjective sleep. However, these associations were not found in the objective sleep data. Exploratory moderator analyses including sex (male vs. female) suggested sex-specificity in these associations. While subjective sleep results were in line with previous research, objective sleep results differed. Several factors may underly the divergent findings, such as the COVID-19 pandemic and/ or sleep-wake state discrepancy. Although further research is required, these data suggest the relationship between sleep and PTSD symptoms differs between objective and subjective sleep measures and depending on sex.

This study examined the extent to which self-reported exposure to blast during deployment to Iraq and Afghanistan affects subjective and objective sleep measures in service members and veterans with and without posttraumatic stress disorder (PTSD). Seventy-one medication-free service members and veterans (mean age = 29.47 ± 5.76 years old; 85% men) completed self-report sleep measures and overnight polysomnographic studies. Four multivariate analyses of variance (MANOVAs) were conducted to examine the impact of blast exposure and PTSD on subjective sleep measures, measures of sleep continuity, non-rapid eye movement (NREM) sleep parameters, and rapid eye movement (REM) sleep parameters. There was no significant Blast × PTSD interaction on subjective sleep measures. Rather, PTSD had a main effect on insomnia severity, sleep quality, and disruptive nocturnal behaviors. There was no significant Blast × PTSD interaction, nor were there main effects of PTSD or Blast on measures of sleep continuity and NREM sleep. A significant PTSD × Blast interaction effect was found for REM fragmentation. The results suggest that, although persistent concussive symptoms following blast exposure are associated with sleep disturbances, self-reported blast exposure without concurrent symptoms does not appear to contribute to poor sleep quality, insomnia, and disruptive nocturnal disturbances beyond the effects of PTSD. Reduced REM sleep fragmentation may be a sensitive index of the synergetic effects of both psychological and physical insults.

Childhood trauma and gender: Synergistic and additive effects on sleep in healthy young adults

Sleep disturbance is associated with persistence and exacerbation of chronic pain. As this relationship seems to be bidirectional, factors underpinning sleep disturbance may prove important in multimodal rehabilitation approaches. The aim of this cross-sectional study was to examine the impact of psychological symptoms on subjective and objective sleep measures in patients with chronic musculoskeletal pain (CMP), as compared with pain-free controls. Sleep was assessed by self-report questionnaires, actigraphy, and polysomnography recordings in 56 patients (75.0% female; M age=41.7 y, SD=10.8 y) with CMP and compared with 53 matched pain-free controls (71.7% female; M age=41.8 y, SD=10.7). Mental distress (Hopkins Symptoms Checklist [HSCL]) and Pain Catastrophizing Scale (PCS) were tested as predictors of objective and subjective sleep measures in multiple regression models, and their indirect effects were tested in bootstrapped mediation models. The sleep data revealed substantially more subjective sleep disturbance (Hedge g: 1.32 to 1.47, P<0.001), moderately worse sleep efficiency in the actigraphy measures (Hedges g: 0.5 to 0.6, P<0.01), and less polysomnography measured slow wave sleep (Hedges g: 0.43, P<0.05) in patients, as compared with controls. HSCL was strongly associated with the self-reported measures Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI). HSCL also partially explained the association between pain and sleep, but HSCL was not associated with any of the objective sleep measures. More pain catastrophizing was related to less slow wave sleep. The differences in subjective and objective sleep measures indicate that they probe different aspects of sleep functioning in patients with musculoskeletal pain, and their combined application may be valuable in clinical practice. Self-reported sleep disturbance seems to overlap with affective dimensions reflected by the HSCL questionnaire.

ABSTRACTObjectives: This study compared subjective (questionnaire) and objective (actigraphy) sleep assessments, and examined agreement between these methods, in vulnerable older adults participating in a Veterans Administration Adult Day Health Care (ADHC) program.Methods: 59 ADHC participants (95% male, mean age = 78 years) completed sleep questionnaires and 72 continuous hours of wrist actigraphy. Linear regression was used to examine agreement between methods and explore discrepancies in subjective/objective measures.Results: Disturbed sleep was common, yet there was no agreement between subjective and objective sleep assessment methods. Compared with objective measures, one-half of participants reported worse sleep efficiency (SE) on questionnaires while one-quarter over-estimated SE. Participants reporting worse pain had a greater discrepancy between subjective and objective SE.Conclusions: Vulnerable older adults demonstrated unique patterns of reporting sleep quality when comparing subjective and objective methods. Additional research is needed to better understand how vulnerable older adults evaluate sleep problems.Clinical Implications: Objective and subjective sleep measures may represent unique and equally important constructs in this population. Clinicians should consider utilizing both objective and subjective sleep measures to identify individuals who may benefit from behavioral sleep treatments, and future research is needed to develop and validate appropriate sleep assessments for vulnerable older adults.

Objective and subjective measurement of sleep disturbance in female trauma survivors with posttraumatic stress disorder

Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition

Anxiety and depression are one of the most distressing symptoms for the family caregivers. Little is known about the relationship between sleep impairments and anxiety/depression in this population and how objective and subjective sleep measures differ in relation to anxiety. This study was designed to examine the relationship between sleep impairments and anxiety/depression in people with dementia, using both subjective and objective sleep measures. Among the 170 study participants, 50% (n=85) reported to have anxiety/depression. In univariate logistic regression analyses on anxiety/depression, adjusting for dementia stage, people with more subjective sleep impairment had higher odds of having anxiety/depression (OR=1.111; 95% CI: 1.020-1.211, p=0.016) and people with poorer subjective sleep quality had higher odds of having anxiety/depression (OR=1.702; 95% CI: 1.046-2.769, p=0.032). Objective sleep measures from actigraphy did not show any significant relationships to anxiety/depression. The results suggest that subjective sleep measures are closely related to anxiety/depression in this population.

The purpose of this study was to correlate subjective sleep characteristics based on questionnaire response, and objective sleep EEG features based on polysomnography, in 52 patients with major depressive disorders (MDD) and 49 healthy controls. With the exception of the number of awakenings, subjective and objective sleep measures were strongly correlated in both groups. Patients and controls were able to accurately judge time in bed, total sleep time and sleep latency. However, sleep quality, depth, and how rested participants felt upon awakening were not strongly correlated with objective sleep characteristics, particularly in those with MDD. The findings suggest that estimates such as total sleep time and sleep latency, obtained from questionnaire data, bear a strong resemblance to objective polysomnographic characteristics in both those with MDD and healthy controls. Patients with MDD do not show sleep-state misperceptions although depressed women are more accurate in estimating sleep characteristics than depressed men.

Subjective measures may offer practitioners a relatively simple method to monitor recruit responses to basic military training (BMT). Yet, a lack of agreement between subjective and objective measures may presents a problem to practitioners wishing to implement subjective monitoring strategies. This study therefore aims to examine associations between subjective and objective measures of workload and sleep in Australian Army recruits. Thirty recruits provided daily rating of perceived exertion (RPE) and differential RPE (d-RPE) for breathlessness and leg muscle exertion each evening. Daily internal workloads determined via heart rate monitors were expressed as Edwards training impulse (TRIMP) and average heart rate. External workloads were determined via global positioning system (PlayerLoadTM) and activity monitors (step count). Subjective sleep quality and duration was monitored in 29 different recruits via a customized questionnaire. Activity monitors assessed objective sleep measures. Linear mixed-models assessed associations between objective and subjective measures. Akaike Information Criterion assessed if the inclusion of d-RPE measures resulted in a more parsimonious model. Mean bias, typical error of the estimate (TEE) and within-subject repeated measures correlations examined agreement between subjective and objective sleep duration. Conditional R2 for associations between objective and subjective workloads ranged from 0.18 to 0.78, P < 0.01, with strong associations between subjective measures of workload and TRIMP (0.65-0.78), average heart rate (0.57-0.73), and PlayerLoadTM (0.54-0.68). Including d-RPE lowered Akaike Information Criterion. The slope estimate between objective and subjective measures of sleep quality was not significant. A trivial relationship (r = 0.12; CI -0.03, 0.27) was observed between objective and subjective sleep duration with subjective measures overestimating (mean bias 25 min) sleep duration (TEE 41 min). Daily RPE offers a proxy measure of internal workload in Australian Army recruits; however, the current subjective sleep questionnaire should not be considered a proxy measure of objective sleep measures.

To determine whether bright light can improve sleep in older individuals with insomnia. Single-blind, placebo-controlled, 12-week, parallel-group randomized design comparing four treatment groups representing a factorial combination of two lighting conditions and two times of light administration. At-home light treatment; eight office therapy sessions. Thirty-six women and fifteen men (aged 63.6+/-7.1) meeting primary insomnia criteria recruited from the community. A 12-week program of sleep hygiene and exposure to bright ( approximately 4,000 lux) or dim light ( approximately 65 lux) scheduled daily in the morning or evening for 45 minutes. Within-group changes were observed for subjective (sleep logs, questionnaires) and objective (actigraphy, polysomnography) sleep measures after morning or evening bright light. Within-group changes for subjective sleep measures after morning or evening bright light were not significantly different from those observed after exposure to scheduled dim light. Objective sleep changes (actigraphy, polysomnography) after treatment were not significantly different between the bright and dim light groups. Scheduled light exposure was able to shift the circadian phase predictably but was unrelated to changes in objective or subjective sleep measures. A polymorphism in CLOCK predicted morningness but did not moderate the effects of light on sleep. The phase angle between the circadian system (melatonin midpoint) and sleep (darkness) predicted the magnitude of phase delays, but not phase advances, engendered by bright light. Except for one subjective measure, scheduled morning or evening bright light effects were not different from those of scheduled dim light. Thus, support was not found for bright light treatment of older individuals with primary insomnia.

BackgroundSleep has been linked cognitive function among older adults, and acts as a meaningful predictor of future Alzheimer's Disease and Related Dementias (AD/ADRD); however, there are diverse types of sleep metrics, including daily self‐reports, retrospective surveys, and subjective and objective measures of clinical sleep, which can contribute to inconsistencies across study findings. Examining the associations between different measures of sleep may provide insights to better understand the role of sleep in AD/ADRD risk and prevention. Also, older adults in rural areas who have higher risk of cognitive decline and AD/ADRD have not received much attention in previous sleep literature. Therefore, this study aimed to explore the associations between objective measures of sleep measured via a sleep profiler assessment and self‐reported daily sleep and between subjective, survey‐based Pittsburgh Sleep Quality Index (PSQI) and objective sleep among rural older adults.MethodWe used baseline data from the Everyday Function Intervention Trial (NCT04651582). Sample included participants who completed all three measures of sleep (N = 28). Fourteen days of smartphone‐based self‐reported sleep measures included overall means and day‐to‐day variations in sleep quality, difficulty falling asleep, difficulty staying asleep, and feeling refreshed after wake. PSQI included sleep quality, latency, disturbance, duration, efficiency, medication, and daytime dysfunction. Wireless sleep electroencephalography (EEG) monitor (Sleep Profiler™) was used to measure REM percent, NREM Stage 1‐3 percentage, REM latency, and NREM 3 latency.ResultLinear regression models showed that higher NREM Stage 3 percentage (i.e., longer deep sleep) was associated with better daily sleep quality and feeling more refreshed after waking up every morning. In addition, higher PSQI total score (i.e., worse sleep) was related to longer NREM 3 latency (i.e., longer time until deep sleep stage).ConclusionResults suggest that objective measures of NREM sleep were largely in concordance with subjective measures of sleep (i.e., daily reports of sleep and survey‐based PSQI) and that PSQI could be used as a time and cost‐effective measure of sleep quality with similar accuracy to objective measures of sleep among rural older adults who may lack access to sleep study diagnostics, providing opportunities for ADRD prevention through early sleep interventions.

Subjective and objective sleep discrepancy in symptomatic bipolar disorder compared to healthy controls

Objective: Poor sleep quality is related to worse neurocognition in older adults and in people with HIV (PWH); however, many previous studies have relied only on self-report sleep questionnaires, which are inconsistently correlated with objective sleep measures. We examined relationships between objective and subjective sleep quality and neurocognition in persons with and without HIV, aged 50 and older. Method: Eighty-five adults (PWH n = 52, HIV-negative n = 32) completed comprehensive neuropsychological testing to assess global and domain-specific neurocognition. Objective sleep quality was assessed with wrist actigraphy (total sleep time, efficiency, sleep fragmentation) for five to 14 nights. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index. Results: Objective and subjective sleep measures were unrelated (p’s > 0.30). Compared to HIV-negative participants, PWH had greater sleep efficiency (80% vs. 75%, p = 0.05) and were more likely to be using prescription and/or over the counter sleep medication (p = 0.04). In the whole sample, better sleep efficiency (p < 0.01) and greater total sleep time (p = 0.05) were associated with better learning. Less sleep fragmentation was associated with better learning (p < 0.01) and recall (p = 0.04). While PWH had slightly stronger relationships between total sleep time and sleep fragmentation, it is not clear if these differences are clinically meaningful. Better subjective sleep quality was associated with better executive function (p < 0.01) and working memory (p = 0.05); this relationship was primarily driven by the HIV-negative group. Conclusions: Objective sleep quality was associated with learning and recall whereas subjective sleep quality was associated with executive function and working memory. Therefore, assessing objective and subjective sleep quality could be clinically useful, as they are both related to important domains of cognition frequently impacted in HIV-associated neurocognitive disorders as well as neurodegenerative disorders associated with aging. Future studies should evaluate if behavioral sleep interventions can improve neurocognition.

Introduction Impaired sleep during the menopausal transition reduces quality of life and increases risk of multiple diseases. The changing hormonal milieu during midlife is associated with impaired sleep. Endocrine disrupting chemicals, such as phthalates, may also contribute to the increased prevalence of sleep disturbances in midlife women. Phthalates are known to impact the endogenous hormones associated with sleep. However, the link between phthalate exposure and sleep quality remains unexplored. Methods We recruited 26 midlife women (median age 50 years) through the Carle Regional Sleep Disorders Center in Urbana, Illinois. Subjective sleep was assessed through the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and self-reported frequency of sleep disturbances, insomnia, and restless sleep. Objective sleep was measured using actigraphy and manual sleep logs (7-day average). Serum levels of follicle-stimulating hormone, estradiol, progesterone, testosterone, free estradiol, and free testosterone were quantified using ELISAs from a single sample from each participant. Phthalate metabolites were quantified from urine using high performance liquid chromatography-mass spectrometry (HPLC-MS). Covariates, including depression, hot flashes, quality of life, demographics, and lifestyle factors, were measured via surveys. Results Preliminary unadjusted logistic regression was used to determine the association between hormone values and subjective sleep quality binomial variables, including daytime sleepiness, sleep efficiency, sleep onset latency, sleep duration, number of sleep disturbances, and frequency of sleep disturbances. Each of these subjective sleep measures is significantly associated with one or more hormones. Conclusion Our results are consistent with literature identifying associations between hormones and subjective sleep in midlife women. Additional analyses will determine associations between hormones and objective sleep, and phthalates with both subjective and objective sleep measures. Excitingly, our study will be among the first to investigate the association between endocrine disruption and sleep quality in this population. Support Carle Illinois Seed Grant Program