Baseline Sleep Efficiency Research Articles

The influence of baseline sleep on exercise‐induced cognitive change in older adults: A randomised clinical trial

AbstractBackgroundObservational studies consistently demonstrate that physical activity is associated with enhanced cognitive function and reduced risk for dementia. However, there remains significant heterogeneity in study findings regarding the effect of exercise interventions on cognitive function. Individual variation in sleep behaviours are hypothesized to be a source of this variability in the effectiveness of exercise to influence cognition, however this has not yet been investigated. Thus, the current study aimed to 1) investigate the influence of a 6‐month exercise intervention on sleep pre‐ and post‐intervention and 2) investigate whether baseline sleep measures moderate exercise‐induced cognitive changes.MethodWe utilised data from the Intense Physical Activity and Cognition (IPAC) study (n = 89), a 6‐month moderate intensity and high intensity exercise intervention, in cognitively normal community‐dwelling older adults aged 60‐80 years (68.76 ± 5.32). Exercise was supervised and completed on a stationary exercise bicycle, and cognitive function was measured using a comprehensive neuropsychological battery administered pre‐ and post‐intervention. Sleep was measured using the Pittsburgh sleep quality index (PSQI) to yield measures of sleep duration, efficiency, and sleep latency.ResultThere was no effect of the exercise intervention on any sleep outcomes from pre‐ to post‐intervention. There was a significant moderating effect of baseline sleep efficiency on both episodic memory and global cognition within the moderate intensity exercise group (β = ‐0.024, SE = 0.008, p = .004; β = ‐0.011, SE = 0.005, p = .036), such that those with poorer sleep efficiency at baseline showed greater exercise‐induced cognitive improvements.ConclusionThese results indicate that those with poorer sleep may have the greatest exercise‐induced cognitive benefits and that baseline sleep behaviours may be an important source of heterogeneity in previous exercise interventions targeting cognitive outcomes.

P058 Dissecting Sleep Restriction: Defining and Empirically testing a two-stage Build-Maintain model of Sleep Restriction Therapy for Insomnia

Abstract Introduction Sleep Restriction Therapy (SRT) is one of the core components of CBT for Insomnia (CBT-I). However, there is little empirical evidence regarding how SRT implementation evolves over the course of therapy. Here, we propose a conceptual model for defining stages of SRT and assess the applicability of the model in a recently completed clinical trial. Methods Our proposed two-stage Build-Maintain model of SRT is: 1) The Build stage starts with SRT implementation. The primary goal is building homeostatic pressure until average weekly sleep efficiency (SE) is high enough to increase time-in-bed (e.g., 85% or 90%). 2) The Maintain stage starts with the first increase of time-in-bed after the target SE is reached. The goal is to maintain sleep pressure sufficiently high that one can maintain SE in the desired range. We assessed the model in 83 adults (age=48.3±14.8 years; 50F) undergoing CBT-I in a RCT. SRT was introduced in week 2. We explored the extent to which age, sex, psychiatric comorbidities, use of hypnotics, and baseline insomnia severity predicted progression through the SRT stages. Results Participants were in the Build stage 2.1±1.3 weeks (41.8% were in Build for only one week; 84% for ≤3 weeks). Higher baseline ISI (r=.238,p=.036) and lower baseline SE (r=-.365,p=.001) predicted spending more weeks in the Build stage before transitioning to the Maintain stage. Discussion The two-stage Build-Maintain model of SRT may inform: a) setting empirically-based expectations for client progress; b) examining adherence to CBT-I; c) evaluating shortened versions of CBT-I.

Effectiveness of internet-based CBT-I for the treatment of chronic subthreshold to moderate insomnia.

To study the effectiveness of the first internet-based cognitive behavioral therapy for insomnia (CBT-i) in Thailand, using the Nitra application, for chronic subthreshold to moderate insomnia treatment. An interventional study without a control group was conducted between January and June 2022. Participants were adults aged 18 years old and older with subthreshold to moderate severity of chronic insomnia (insomnia severity index (ISI) of 8-21) and had mean sleep efficiency <85% from baseline sleep diaries. Baseline sleep characteristics were obtained from questionnaires and sleep diaries from the Nitra application for 2 weeks. Eligible participants continued using the Nitra application for 4 weeks during the intervention period. Interventions including sleep restriction, stimulus control, cognitive restructuring, relaxation techniques, and sleep hygiene education were implemented via the pre-programmed Nitra application. Post-intervention sleep characteristics were also obtained from questionnaires and sleep diaries from the Nitra application for another 1 week. A total of 40 participants completed the study. All participants had a baseline sleep efficiency of less than 85% with the majority of the participants having a sleep-onset insomnia problem (98%). For the primary outcome, sleep efficiency was significantly improved after using the Nitra application (p < 0.001). Self-reported total sleep time, sleep onset latency, wake after sleep onset, early morning awakening, ISI, Pittsburgh Sleep Quality Index (PSQI), and average subjective sleep quality were also significantly improved (p < 0.001 for all parameters except p = 0.017 for total sleep time and p = 0.018 for wake after sleep onset). Participants who had a low baseline ISI and went to bed and woke up within 30 minutes of a designated bedtime and wake-up time recommended by the Nitra application for ≥70% of all nights demonstrated an increased chance of achieving normal sleep efficiency after using the Nitra application. This first internet-based CBT-i in Thailand, using the Nitra application, effectively improved sleep efficiency and other sleep parameters in chronic subthreshold to moderate insomnia.

Daily Sleep-Stress Reactivity and Functional Impairment in World Trade Center Responders.

How sleep is impacted by stress ("sleep reactivity to stress") and how stress is impacted by sleep ("stress reactivity to sleep") are trait-like characteristics of individuals that predict depression, anxiety, and insomnia. However, pathways between reactivity and functional impairment (e.g., impairment in social relationships and interpersonal functioning) have not been explored, which may be a critical pathway in understanding the link between reactivity and the development of psychological disorders. We examined associations between reactivity and changes in functional impairment among a cohort of 9/11 World Trade Center responders. Data from 452 responders (Mage = 55.22 years; 89.4% male) were collected between 2014 and 2016. Four baseline sleep and stress reactivity indices (i.e., sleep duration and efficiency reactivity to stress; stress reactivity to sleep duration and efficiency) were calculated from 14 days of sleep and stress data using random slopes from multilevel models. Functional impairment was assessed approximately 1 year and 2 years after baseline via semi-structured interviews. Latent change score analyses examined associations between baseline reactivity indices and changes in functional impairment. Greater baseline sleep efficiency reactivity to stress was associated with decreases in functioning (β = -0.05, p = .039). In addition, greater stress reactivity to sleep duration (β = -0.08, p = .017) and sleep efficiency (β = -0.22, p < .001) was associated with lower functioning at timepoint one. People who are more reactive to daily fluctuations in stress and sleep have poorer interpersonal relationships and social functioning. Identifying individuals with high reactivity who could benefit from preventative treatment may foster better social integration.

Neural mechanism of the relationship between sleep efficiency and clinical improvement in major depressive disorder: A longitudinal functional magnetic resonance imaging study.

BackgroundAntidepressants represent the most common treatment of choice for major depressive disorder (MDD). In this study, we aimed to explore the status-related changes (acute vs. remitted status) in brain function in patients with MDD.MethodsRegular antidepressant medications (an average of 7 months after the initial visit, remitted status) were received by 48 patients with MDD. All the patients underwent MRI and polysomnography examinations as well as clinical assessment at each visit.ResultsWe found that baseline fractional amplitude of low-frequency fluctuations (fALFF) of right superior parietal gyrus (SPG) and middle frontal gyrus could predict depression and anxiety symptoms improvement from acute to remitted status in patients with MDD, respectively. Moreover, we found a significant positive correlation between the fALFF of right SPG and baseline sleep efficiency (SE) in patients with MDD. Further mediation analysis revealed that the fALFF of right SPG mediated the relationship between baseline SE and depressive symptom improvement.ConclusionApart from highlighting the fALFF as a potential prognostic indicator to predict and track disease progression in patients with MDD, these findings might provide a neural mechanism basis for improving sleep quality of patients with MDD and thus promoting the recovery of clinical symptoms, as well as provide a practical basis for clinical interventions in patients with MDD with sleep disorders.

0388 Predictors of Incident Reduced Sleep Efficiency in Community-Dwelling Older Women

Abstract Introduction There is a paucity of longitudinal studies with sleep efficiency (SE) as an outcome measure. Our objective was to examine potential risk factors for incident reduced SE among community-dwelling women in late life. Methods We studied 700 women (mean age 82.5 [SD=3.0] years) with a SE ≥70% at the Year 16 (2002-04) visit of the Study of Osteoporotic Fractures with a follow-up measure of SE at the Year 20 (2006-08) visit. SE (percentage of time sleeping while in bed) at both visits was measured using a wrist actigraph with data collected for an average of four 24-hour periods. Women were classified as having incident reduced SE if they had SE &amp;lt;70% at Year 20. Logistic regression was used to estimate the associations between potential risk factors (demographics, lifestyle, use of medications, self-reported medical conditions, functional impairment, frailty, mental and physical health) at Year 16 and reduced SE at Year 20. The association of each candidate risk factor with reduced SE at Year 20 was examined in models adjusted for age, clinical site and continuous SE at Year 16. Candidate risk factors with Benjamin Hochberg false-discovery rate q-values &amp;lt;0.10 were included in a final multivariate model. Results Among the 700 eligible women, 62 (8.9%) developed incident reduced SE between the Year 16 and Year 20 visits. After adjusting for age, site and baseline SE, antidepressant use [OR=3.06; 95% CI: 1.50-6.25], benzodiazepine use [OR=2.97; 95% CI: 1.30-6.80] and the presence of hypertension [OR=2.83; 95% CI: 1.47-5.45] at Year 16 were independently associated with a higher odds of having reduced SE at follow-up. Conclusion These findings suggest that antidepressant use, benzodiazepine use and hypertension are risk factors or markers for the development of reduced sleep efficiency in older women. Future studies are warranted to examine the underlying mechanisms for these associations. Support The Study of Osteoporotic Fractures (SOF) is supported by National Institutes of Health funding. The National Institute on Aging (NIA) provides support under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576.

Efficacy of a sleep health intervention to optimize standard smoking cessation treatment response: results from a pilot randomized controlled trial

AbstractBackgroundWe tested if an adjunctive sleep health (SH) intervention improved smoking cessation treatment response by increasing quit rates. We also examined if baseline sleep, and improvements in sleep in the first weeks of quitting, were associated with quitting at the end of treatment.MethodsTreatment-seeking smokers (N = 29) aged 21–65 years were randomized to a SH intervention (n = 16), or general health (GH) control (n = 13) condition. Participants received six counseling sessions across 15-weeks: SH received smoking cessation + SH counseling; GH received smoking cessation + GH counseling. Counseling began 4-weeks before the target quit date (TQD), and varenicline treatment began 1-week prior to TQD. Smoking status and SH were assessed at baseline (week 1), TQD (week 4), 3 weeks after cessation (week 7), week 12, and at the end of treatment (EOT; week 15).ResultsSH versus GH participants had higher Carbon Monoxide (CO) -verified, 7-day point prevalence abstinence at EOT (69% vs. 54%, respectively; adjusted odds ratio (aOR) = 2.10, 95% confidence interval (CI) = 0.40–10.69, P = 0.77). Higher baseline sleep efficiency (aOR = 1.42, 95% CI = 1.03–1.96, P = 0.03), predicted higher EOT cessation. Models were adjusted for age, sex, education, and baseline nicotine dependence.ConclusionsImproving SH in treatment-seeking smokers prior to cessation warrants further examination as a viable strategy to promote cessation.

Digital Cognitive Behavioral Therapy for Insomnia for Adolescents With Mental Health Problems: Feasibility Open Trial.

BackgroundInsomnia in adolescents is common, persistent, and associated with poor mental health including anxiety and depression. Insomnia in adolescents attending child mental health services is seldom directly treated, and the effects of digital cognitive behavioral therapy (CBT) for insomnia (CBTi) on the mental health of adolescents with significant mental health problems are unknown.ObjectiveThis open study aimed to assess the feasibility of adding supported Web-based CBT for insomnia to the usual care of young people aged 14 to 17 years attending specialist child and adolescent mental health services (CAMHS).MethodsA total of 39 adolescents with insomnia aged 14 to 17 years attending specialist CAMHS were assessed and offered digital CBTi. The digital intervention was Sleepio, an evidence-based, self-directed, fully automated CBTi that has proven effective in multiple randomized controlled trials with adults. Self-report assessments of sleep (Sleep Condition Indicator [SCI], Insomnia Severity Scale, and Web- or app-based sleep diaries), anxiety (Revised Child Anxiety and Depression Scale [RCADS]), and depression (Mood and Feelings Questionnaire [MFQ]) were completed at baseline and post intervention. Postuse interviews assessed satisfaction with digital CBTi.ResultsAverage baseline sleep efficiency was very poor (53%), with participants spending an average of 9.6 hours in bed but only 5.1 hours asleep. All participants scored less than 17 on the SCI, with 92% (36/39) participants scoring 15 or greater on the Insomnia Severity Scale, suggesting clinical insomnia. Of the 39 participants, 36 (92%) scored 27 or greater on the MFQ for major depression and 20 (51%) had clinically elevated symptoms of anxiety. The majority of participants (38/49, 78%) were not having any treatment for their insomnia, with the remaining 25% (12/49) receiving medication. Sleepio was acceptable, with 77% (30/39) of the participants activating their account and 54% (21/39) completing the program. Satisfaction was high, with 84% (16/19) of the participants finding Sleepio helpful, 95% (18/19) indicating that they would recommend it to a friend, and 37% (7/19) expressing a definite preference for a digital intervention. Statistically significant pre-post improvements were found in weekly diaries of sleep efficiency (P=.005) and sleep quality (P=.001) and on measures of sleep (SCI: P=.001 and Insomnia Severity Index: P=.001), low mood (MFQ: P=.03), and anxiety (RCADS: P=.005).ConclusionsOur study has a number of methodological limitations, particularly the small sample size, absence of a comparison group and no follow-up assessment. Nonetheless, our findings are encouraging and suggest that digital CBTi for young people with mental health problems might offer an acceptable and an effective way to improve both sleep and mental health.International Registered Report Identifier (IRRID)RR2-10.2196/11324

Acute effects of 3,4-methylenedioxymethamphetamine (MDMA) and R(-) MDMA on actigraphy-based daytime activity and sleep parameters in rhesus monkeys.

3,4-Methylenedioxymethamphetamine (MDMA) affects monoaminergic pathways that play a critical role in sleep-wake cycles. Dopaminergic mechanisms are thought to mediate the sleep-disrupting effects of stimulant drugs. However, the mechanisms underlying the effects of MDMA on sleep-wake cycles and the effects of R(-) MDMA, a stereoisomer that lacks dopaminergic activity, on sleep remain unknown. The aim of the present study was to investigate the effects of racemic MDMA and R(-) MDMA on daytime activity and sleep-like parameters evaluated with actigraphy in adult rhesus macaques (Macaca mulatta, n = 6). Actiwatch monitors were attached to the monkeys' collars and actigraphy recording was conducted during baseline conditions and after the administration of acute intramuscular injections of saline (vehicle), racemic MDMA (0.3, 1.0, or 1.7 mg/kg), or R(-) MDMA (0.3, 1.0, or 1.7 mg/kg) at 9 or 16 h (3 h before "lights off"). Morning treatments had no effects on sleep-like parameters. Racemic MDMA decreased general daytime activity during the first hour after injection and increased daytime activity at 3 hr posttreatment. Although afternoon administration of racemic MDMA increased sleep latency, it improved other sleep parameters, decreasing wake time after sleep onset (WASO) and increasing sleep efficiency for subjects with low baseline sleep efficiency. Afternoon treatment with R(-) MDMA improved sleep measures, increasing sleep efficiency and decreasing sleep latency and WASO, while having no effects on daytime activity. The stimulant and sleep-disrupting effects of racemic MDMA are likely mediated by dopaminergic and noradrenergic mechanisms, while serotonergic pathways appear to be involved in the sleep-promoting effects of MDMA. (PsycINFO Database Record

Baseline Sleep Efficiency and Arousal Index Do Not Predict Who Will Benefit From Sedatives in Improving Positive Airway Pressure Adherence in Sleep Apnea to 90.

Positive airway pressure (PAP) is the preferred treatment for obstructive sleep apnea (OSA), but adherence is low. Educational or ongoing supportive intervention improves the number of PAP adherent patients from the 50% to the 70% range. A common side effect of PAP is increased awakenings. This prospective trial examined baseline polysomnographically derived sleep efficiency and arousal index in PAP adherent and nonadherent patients, and in patients needing sedating medicines to attain PAP adherence versus those who did not need such medicines. Patients with OSA were titrated on PAP during a polysomnography or treated with autotitrating PAP, followed by educational and supportive interventions. Patients with PAP related awakenings (patients describing waking up and taking PAP off in the middle of the night) or difficulty tolerating PAP were additionally treated with medicines that suppress arousals/awakenings (trazodone, mirtazapine, doxepin). A total of 120 of 151 (79%) new patients were ≥70% PAP adherent over a continuous 30-day period, typically within the first 90 days of starting PAP, without sedating medicines. Nineteen of the remaining patients were treated with medicines that suppress arousals and awakenings, and 16 became adherent, resulting in 136 (90%) of 151 new patients achieving adherence. There were no differences in baseline sleep efficiency or arousal index, between adherent and nonadherent patients, as well as between patients who needed sedating medicines for PAP adherence and those who did not. Adding medicines that suppress arousals and awakenings for patients having trouble tolerating PAP, increases the number of patients who are PAP adherent. The need for such medicines seems to be related to the PAP side effect of increased awakenings rather than baseline impaired sleep.

Chronotype and Improved Sleep Efficiency Independently Predict Depressive Symptom Reduction after Group Cognitive Behavioral Therapy for Insomnia.

Cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve both sleep and depressive symptoms, but predictors of depression outcome following CBT-I have not been well examined. This study investigated how chronotype (i.e., morningness-eveningness trait) and changes in sleep efficiency (SE) were related to changes in depressive symptoms among recipients of CBT-I. Included were 419 adult insomnia outpatients from a sleep disorders clinic (43.20% males, age mean ± standard deviation = 48.14 ± 14.02). All participants completed the Composite Scale of Morningness and attended at least 4 sessions of a 6-session group CBT-I. SE was extracted from sleep diary; depressive symptoms were assessed using the Beck Depression Inventory (BDI) prior to (Baseline), and at the end (End) of intervention. Multilevel structural equation modeling revealed that from Baseline to End, SE increased and BDI decreased significantly. Controlling for age, sex, BDI, and SE at Baseline, stronger evening chronotype and less improvement in SE significantly and uniquely predicted less reduction in BDI from Baseline to End. Chronotype did not predict improvement in SE. In an insomnia outpatient sample, SE and depressive symptoms improved significantly after a CBT-I group intervention. All chronotypes benefited from sleep improvement, but those with greater eveningness and/or less sleep improvement experienced less reduction in depressive symptom severity. This suggests that evening preference and insomnia symptoms may have distinct relationships with mood, raising the possibility that the effect of CBT-I on depressive symptoms could be enhanced by assessing and addressing circadian factors.

Clinical Field Testing of an Enhanced-Activity Intervention in Hospitalized Children with Cancer

This prospective, two-site, randomized, controlled pilot study assessed the feasibility of an enhanced physical activity (EPA) intervention in hospitalized children and adolescents receiving treatment for a solid tumor or for acute myeloid leukemia (AML), and assessed different statistical techniques to detect the intervention's sleep and fatigue outcomes. Twenty-nine patients (25 with a solid tumor and 4 with AML) participated. Data were collected from actigraph; patient, parent, and staff nurse reports of patient fatigue; parent sleep diaries; and patient charts. The intervention was successfully implemented 85.4% of the scheduled times. We used two different statistical methods to analyze the longitudinal data. Using an ANOVA model, sleep was significantly more efficient in the experimental arm than in the control arm when daily differences from baseline sleep efficiency values were averaged and compared ( F = 4.17, P = 0.053). However, in a mixed model (repeated measures) analysis, sleep duration ( F = 0.54, P = 0.47) and sleep efficiency ( F = 0.04, P = 0.85) were not seen to differ between study arms. We conclude that an inpatient intervention of EPA can be delivered to children and adolescents receiving chemotherapy. Our findings identify design and statistical considerations for a future effectiveness study of the EPA intervention in hospitalized pediatric oncology patients.

Medium-term open label trial of L-carnitine in Rett syndrome

Treatment strategies in Rett syndrome so far have been essentially symptomatic and supportive. In order to establish the medium-term effects of L-carnitine, an open label trial was performed in a cohort of 21 Rett syndrome females, with a control group of 62 Rett syndrome females of a similar age, for a 6-month period. Compared with the Rett syndrome controls, treatment with L-carnitine led to significant improvements in sleep efficiency ( P=0.027), especially in the subjects with a baseline sleep efficiency less than 90%, energy level ( P<0.005) and communication skills ( P=0.004). There was no significant difference in the subject's level of physical activity, hand function or in the quality of life of the subject's parents. In addition, before and after comparisons of the treatment group showed improvements in expressive speech ( P=0.011). Treatment with L-carnitine seems to be of significant benefit in a subgroup of girls with Rett syndrome. In these girls, small but discernible improvements may be of considerable importance to their parents and carers.