Consensus Sleep Diary Research Articles

The evaluation of the consensus sleep diary in patients with post-concussion insomnia

The evaluation of the consensus sleep diary in patients with post-concussion insomnia

Measurements and status of sleep quality in patients with cancers.

Sleep disturbance is identified as a prominent concern in cancer patients with detrimental effect on health outcome, which accompanies a decline in functional status, reduces quality of life, and even accelerates deterioration of disease. Therefore, in order to design safe and effective therapy, and improve the quality of life in cancer patients, it is necessary to seek the optimal measures of sleep quality evaluation, which include the objective assessments (e.g., polysomnography [PSG], the bispectral index [BIS], actigraphy) and subjective assessments (e.g., Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], Epworth Sleepiness Scale [ESS], Consensus Sleep Diary [CSD]) and understand the status of sleep quality in cancer patients, especially patients with cancers in the breast, lung, head and neck, ovaries, and uterus. This review summarizes the common methods used to measure sleep quality and compares the sensitivity, specificity, and practicability of these methods. In addition, the status of sleep disturbance in patients with cancer is analyzed.

Sleep Characteristics in Mothers of Children With Developmental Disabilities

Impaired sleep can contribute to conditions such as cardiometabolic disorders, depression, and decreased immune function. Mothers of children with developmental disabilities (DDs) may be at greater risk for impaired sleep due to the sleep problems of their children. This cross-sectional study described the self-reported sleep characteristics of mothers of children (ages 6-12) with DDs by using a sleep diary and the Pittsburgh Sleep Quality Index (PSQI) as quantitative and qualitative measures of sleep in these mothers. The Consensus Sleep Diary was modified to ascertain how the child's sleep and needs for care during the night impacted the mother's sleep. The results showed that mothers had short sleep duration (nearly 40% slept <7 hours per night), woke up an average of 2.2 times per night (most commonly due to caregiving needs of children), and had poor sleep quality (mean PSQI global score of 7.9 [SD=4.8]). The sleep problems of children with DDs may influence mothers’ sleep.

Characterization of Patients Who Present With Insomnia: Is There Room for a Symptom Cluster-Based Approach?

This study examined empirically derived symptom cluster profiles among patients who present with insomnia using clinical data and polysomnography. Latent profile analysis was used to identify symptom cluster profiles of 175 individuals (63% female) with insomnia disorder based on total scores on validated self-report instruments of daytime and nighttime symptoms (Insomnia Severity Index, Glasgow Sleep Effort Scale, Fatigue Severity Scale, Beliefs and Attitudes about Sleep, Epworth Sleepiness Scale, Pre-Sleep Arousal Scale), mean values from a 7-day sleep diary (sleep onset latency, wake after sleep onset, and sleep efficiency), and total sleep time derived from an in-laboratory PSG. The best-fitting model had three symptom cluster profiles: "High Subjective Wakefulness" (HSW), "Mild Insomnia" (MI) and "Insomnia-Related Distress" (IRD). The HSW symptom cluster profile (26.3% of the sample) reported high wake after sleep onset, high sleep onset latency, and low sleep efficiency. Despite relatively comparable PSG-derived total sleep time, they reported greater levels of daytime sleepiness. The MI symptom cluster profile (45.1%) reported the least disturbance in the sleep diary and questionnaires and had the highest sleep efficiency. The IRD symptom cluster profile (28.6%) reported the highest mean scores on the insomnia-related distress measures (eg, sleep effort and arousal) and waking correlates (fatigue). Covariates associated with symptom cluster membership were older age for the HSW profile, greater obstructive sleep apnea severity for the MI profile, and, when adjusting for obstructive sleep apnea severity, being overweight/obese for the IRD profile. The heterogeneous nature of insomnia disorder is captured by this data-driven approach to identify symptom cluster profiles. The adaptation of a symptom cluster-based approach could guide tailored patient-centered management of patients presenting with insomnia, and enhance patient care.

061 Premature aging in Cockayne syndrome due to a failure in ribosomal biogenesis?

061 Premature aging in Cockayne syndrome due to a failure in ribosomal biogenesis? M Alupei, P esser, K Scharffetter-Kochanek and S Iben 1 University of Ulm, Ulm, Germany and 2 University of freiburg, Freiburg, Germany Cockayne syndrome (CS) is a progeroid disease characterized by growth failure, neurological degeneration, loss of subcutaneous fat and cachexia. The mutations of this polygenic disease inactivate a subbranch of the DNA-repair pathway nucleotide excision repair (NER), thus Cockayne syndrome is regarded as a DNA-repair disease. As the total loss of DNA repair by the NER in xeroderma pigmentosum does not lead to childhood degeneration, alternative functions of the CS proteins might account for the disease. One common alternative function of the Cockayne syndrome proteins is the key step in ribosomal biogenesis, transcription by RNA polymerase I in the nucleolus. We investigated the cellular consequences of a failure of RNA polymerase I transcription in CS-cells and discovered a circulus vitiosus repressing ribosomal biogenesis. A disturbed RNA polymerase I transcription gives rise to ribosomes with a low translational fidelity that produce misfolded proteins. Misfolded proteins provoke endoplasmic reticulum stress and an unfolded protein response that represses RNA polymerase I transcription. The oxidative hypersensitivity of Cockayne syndrome cells might be due to oxidation of misfolded proteins. The elevated apoptosis rate of CS cells after oxidative challenge can be overcome by pharmacological chaperones that dampen endoplasmic reticulum stress and the unfolded protein response. Pharmacological chaperones are restoring proper RNA polymerase I transcription by de-repression thus breaking the circulus vitiosus. This might be a treatment opportunity for children suffering from premature aging. Moreover, loss of proteostasis due to a reduced translational fidelity of ribosomes might be a mechanism contributing to aging and aging associated diseases in humans. 062 Stress perception impacts on clinical signs of skin ageing and modifies the epigenome R Pattinson, C Bundy, L Cordingley, S Kyle, W Yeung, G Beauchef, A Nkengne, A O’Callaghan, CE Griffiths and RE Watson 1 University of Manchester, Manchester, United Kingdom, 2 Laboratoire CLARINS, Pontoise, France and 3 Fios Genomics Ltd., Edinburgh, United Kingdom In this study we tested the commonly held assumption that stress affects the appearance of skin through the premature occurrence of clinical features of skin ageing (lines, wrinkles and dark under-eye circles). We recruited 84 healthy adult female volunteers (age range, 24 e 40 years; mean 30.7 4.7 years); each volunteer completed a comprehensive battery of psychological and sleep questionnaires (State-Trait Anxiety Inventory, Perceived Stress Score, Hospital Anxiety and Depression Scale, Pittsburgh sleep quality index [PSQI], Ford insomnia response to stress test [FIRST] and consensus sleep diary), clinical photography (VISIA-CR ) and provided a sample of whole blood for epigenetic analysis. Image analysis of clinical photographs allowed the objective quantification of wrinkles around the eye (eye bag and crow’s feet), the nasolabial fold and deep mid-forehead frown lines. Initial analysis correlated perceived stress with worse sleep patterns; those volunteers who perceived stress more keenly had significantly disturbed sleep as measured by PSQI and FIRST with reduced sleep efficiency (r1⁄4-0.22; P<0.05) and increased wakefulness after sleep onset (r1⁄40.32; P<0.01). In addition, sleep onset latency positively correlated with increased measures for nasolabial folds, frown lines and crow’s feet wrinkles (r1⁄4-0.47; p<0.01). We next stratified the volunteers on the basis of their stress perception response to identify extreme groups (high stress response, n1⁄412; low stress response, n1⁄412) for epigenetic analysis of whole blood. Using Infinium HumanMethylation450BeadChip, principal component analysis identified significant clustering of methylation signatures between the two groups, with 484 differentially methylated regions observed (P<0.001). Hence, how an individual perceives psychological stress appears to impact on physical signs of skin ageing although the precise mechanism remains unclear.

062 Stress perception impacts on clinical signs of skin ageing and modifies the epigenome

061 Premature aging in Cockayne syndrome due to a failure in ribosomal biogenesis? M Alupei, P esser, K Scharffetter-Kochanek and S Iben 1 University of Ulm, Ulm, Germany and 2 University of freiburg, Freiburg, Germany Cockayne syndrome (CS) is a progeroid disease characterized by growth failure, neurological degeneration, loss of subcutaneous fat and cachexia. The mutations of this polygenic disease inactivate a subbranch of the DNA-repair pathway nucleotide excision repair (NER), thus Cockayne syndrome is regarded as a DNA-repair disease. As the total loss of DNA repair by the NER in xeroderma pigmentosum does not lead to childhood degeneration, alternative functions of the CS proteins might account for the disease. One common alternative function of the Cockayne syndrome proteins is the key step in ribosomal biogenesis, transcription by RNA polymerase I in the nucleolus. We investigated the cellular consequences of a failure of RNA polymerase I transcription in CS-cells and discovered a circulus vitiosus repressing ribosomal biogenesis. A disturbed RNA polymerase I transcription gives rise to ribosomes with a low translational fidelity that produce misfolded proteins. Misfolded proteins provoke endoplasmic reticulum stress and an unfolded protein response that represses RNA polymerase I transcription. The oxidative hypersensitivity of Cockayne syndrome cells might be due to oxidation of misfolded proteins. The elevated apoptosis rate of CS cells after oxidative challenge can be overcome by pharmacological chaperones that dampen endoplasmic reticulum stress and the unfolded protein response. Pharmacological chaperones are restoring proper RNA polymerase I transcription by de-repression thus breaking the circulus vitiosus. This might be a treatment opportunity for children suffering from premature aging. Moreover, loss of proteostasis due to a reduced translational fidelity of ribosomes might be a mechanism contributing to aging and aging associated diseases in humans. 062 Stress perception impacts on clinical signs of skin ageing and modifies the epigenome R Pattinson, C Bundy, L Cordingley, S Kyle, W Yeung, G Beauchef, A Nkengne, A O’Callaghan, CE Griffiths and RE Watson 1 University of Manchester, Manchester, United Kingdom, 2 Laboratoire CLARINS, Pontoise, France and 3 Fios Genomics Ltd., Edinburgh, United Kingdom In this study we tested the commonly held assumption that stress affects the appearance of skin through the premature occurrence of clinical features of skin ageing (lines, wrinkles and dark under-eye circles). We recruited 84 healthy adult female volunteers (age range, 24 e 40 years; mean 30.7 4.7 years); each volunteer completed a comprehensive battery of psychological and sleep questionnaires (State-Trait Anxiety Inventory, Perceived Stress Score, Hospital Anxiety and Depression Scale, Pittsburgh sleep quality index [PSQI], Ford insomnia response to stress test [FIRST] and consensus sleep diary), clinical photography (VISIA-CR ) and provided a sample of whole blood for epigenetic analysis. Image analysis of clinical photographs allowed the objective quantification of wrinkles around the eye (eye bag and crow’s feet), the nasolabial fold and deep mid-forehead frown lines. Initial analysis correlated perceived stress with worse sleep patterns; those volunteers who perceived stress more keenly had significantly disturbed sleep as measured by PSQI and FIRST with reduced sleep efficiency (r1⁄4-0.22; P<0.05) and increased wakefulness after sleep onset (r1⁄40.32; P<0.01). In addition, sleep onset latency positively correlated with increased measures for nasolabial folds, frown lines and crow’s feet wrinkles (r1⁄4-0.47; p<0.01). We next stratified the volunteers on the basis of their stress perception response to identify extreme groups (high stress response, n1⁄412; low stress response, n1⁄412) for epigenetic analysis of whole blood. Using Infinium HumanMethylation450BeadChip, principal component analysis identified significant clustering of methylation signatures between the two groups, with 484 differentially methylated regions observed (P<0.001). Hence, how an individual perceives psychological stress appears to impact on physical signs of skin ageing although the precise mechanism remains unclear.

The Cortisol Awakening Response and Depressive Symptomatology: The Moderating Role of Sleep and Gender.

The association between depression and the cortisol awakening response (CAR) has been widely examined, yet the results are mixed and factors responsible for such inconsistencies are poorly understood. The current study investigated whether the link between depressive symptomatology and CAR varied as a function of two such factors: sleep and gender. The sample included 58 young adults (30 females; Mage = 18.7; SDage = 0.91). Participants completed the Beck Depression Inventory as well as the Consensus Sleep Diary to assess depressive symptomatology and daily sleep patterns, respectively. Participants also provided four salivary cortisol samples (0, 30, 45 and 60 min after awakening) during two consecutive weekdays. Results demonstrated that greater depressive symptoms were associated with a greater CAR but only when depressive symptoms were linked to a shorter sleep time. In addition, gender significantly moderated the association between depressive symptoms and CAR. While greater depressive symptoms were associated with an elevated CAR among females, they were associated with a blunted CAR among males. These findings provide some insight into potential mechanisms linking depressive symptomatology and CAR, and suggest that future studies examining CAR as a biomarker of depression should account for differences in sleep and gender. Copyright © 2016 John Wiley & Sons, Ltd.

Effect of Micronutrients on Insomnia in Adults

Insomnia is a debilitating condition causing psychological distress and frequently comorbid with other mental health conditions. This study examined the effect of 8 weeks of treatment by broad spectrum micronutrients (vitamins and minerals) on insomnia using a multiple-baseline-across-participants open-label trial design. Seventeen adults were randomized to 1-, 2-, or 3-week baseline periods (14 completed). Self-report measures were the Consensus Sleep Diary–Morning (CSD-M), the Pittsburgh Insomnia Rating Scale (PIRS), and the Depression, Anxiety, Stress Scale (DASS). Baselines were generally stable. Treatment completers reported reliable and clinically significant change in insomnia severity (PIRS), in depression, stress, and anxiety (DASS), and on at least two aspects of sleep measured by the CDS-M. All completers were treatment-compliant, and side effects were minimal. Nutritional supplementation is shown to be a novel, beneficial treatment for insomnia in adults. Follow-up research using placebo-controlled designs as well as comparisons to cognitive-behavioral and other treatments is recommended.

Comparison between paper and electronic sleep diary

This study aimed to test the concurrent validity of an electronic version (to run on tablet) of a sleep diary derived from the core Consensus Sleep Diary compared with the traditional paper and pencil version. To this end, 15 healthy volunteers (6 males; mean age 37.20 ± 17.55 years) every morning, for at least 7 consecutive days, filled both paper and electronic sleep diary. Furthermore, sleep was objectively assessed through actigraphy. With reference to all sleep parameters examined, no significant differences were observed between paper and electronic sleep diary. As expected, paper and electronic sleep diary showed the same poor agreement with actigraphic estimates of sleep quantity and sleep quality. On the basis of the present data, we can conclude that electronic sleep diary performs like paper sleep diary. Bearing in mind that electronic sleep diary presents several benefits in comparison to the paper sleep diary (e.g. avoiding of the “parking lot syndrome”, in which patient retrospectively completes more days at the same time; reducing the time for data entry and scoring), we suggest that, if the present findings will be confirmed also in clinical populations, electronic sleep diary should replace paper sleep diary in both research and clinical settings.

Correlates and prognostic relevance of sleep irregularity in inter-episode bipolar disorder

ObjectivesSleep–wake disturbances, such as sleep irregularity, are common in bipolar disorder. Early studies suggest that sleep irregularity is associated with mood symptoms in bipolar disorder, but little research has been conducted to identify other correlates of sleep irregularity. We investigated the relationship between sleep irregularity and sleep quality, social rhythms, eveningness, sleep-related cognitions and behaviors, and past and future mood episodes in 84 patients with inter-episode bipolar I or II disorder. MethodsThis is a retrospective and prospective, naturalistic follow-up study. The Expanded Consensus Sleep Diary, Pittsburgh Sleep Quality Index (PSQI), Social Rhythm Metric (SRM-II-5), Composite Scale of Morningness (CSM), Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS-16), and Sleep Hygiene Practice Scale (SHPS) were administered. The Square Successive Difference (SSD), derived from a week-long sleep diary, was used as an index of sleep irregularity. Multilevel modeling analysis, which adjusts for biases in parameter estimates, was used to minimize the impact of missing data. Bonferroni correction was performed to account for multiple testing. ResultsHigher SSD scores of sleep diary variables were significantly associated with higher PSQI, SRM-II-5, DBAS-16, and SHPS scores. Irregularity in total sleep time was related to more depressive episodes in the past 5years (p=.002), while irregularity in wake after sleep onset predicted the onset of depressive episodes over the next 2years (p=.002). ConclusionSleep irregularity was associated with poor sleep quality, irregular social rhythms, dysfunctional sleep-related cognitions and behaviors, and greater number of depressive episodes in bipolar disorder.

Psychometric Properties of the Consensus Sleep Diary in Those With Insomnia Disorder

The Consensus Sleep Diary (CSD) is a standardized, prospective tool for tracking nightly subjective sleep. The current study evaluated the validity and utility of the CSD, with consideration for challenges inherent to psychometric evaluation of diary measures. Results showed that the CSD indices differentiated good sleepers from those with insomnia and were associated with similar objective indices and a subjective insomnia severity measure. The ability to detect treatment improvements after cognitive behavior therapy for insomnia (CBT-I) was tested by comparing pre- and post-CBT-I CSD indices with a subjective rating of insomnia symptom severity. Improvement in insomnia symptom severity was significantly related to improvement on the CSD indices. Completion rate of the CSD amongst participants across all 14 days was 99.8%. These findings provide support for the validity, clinical utility, and usability of the CSD.

Measuring Sleep Efficiency: What Should the Denominator Be?

Inconsistency in operationally defining sleep efficiency (SE) creates confusion with regard to the conceptualization and use of the construct by researchers and clinicians. The source of the inconsistency is the denominator of the widely published operational definition of SE: ratio of total sleep time (TST) to time in bed (TIB) (multiplied by 100 to yield a percentage). When taken literally, TIB includes non-sleep-related activity (e.g., reading, texting, conversing with a partner, watching television) both prior to initiating sleep and after the final awakening. However, the construct of SE refers to TST compared to the amount of time spent attempting to initially fall asleep and sleep discontinuity. Non-sleep related activities in bed do not reflect that construct. Also, time out of bed during nighttime awakenings, a manifestation of sleep discontinuity, should be included in the SE denominator. Using TIB as the denominator can also create a methodological problem when SE is an outcome measure in sleep intervention research. It is proposed that research and practice would benefit by clarifying and adopting a consistent operational definition that more accurately captures the construct of SE. An alternate denominator, duration of the sleep episode (DSE), is suggested, where DSE = sleep onset latency (SOL) + TST + time awake after initial sleep onset but before the final awakening (WASO) + time attempting to sleep after final awakening (TASAFA). The proposed formula for SE would be: SE = TST / DSE (× 100). DSE can be easily calculated using standard sleep diary entries along with one item from the Expanded Consensus Sleep Diary. Implications for insomnia research and practice are discussed.

The Effect of Low-Dose Dexmedetomidine as an Adjuvant to Levobupivacaine in Patients Undergoing Vitreoretinal Surgery Under Sub-Tenon's Block Anesthesia.

This study evaluated the motor and sensory block durations and the postoperative analgesic effects of adding dexmedetomidine to levobupivacaine for sub-Tenon's block anesthesia in patients undergoing vitreoretinal surgery. Motor and sensory block durations were considered as a primary end point. Sixty ASA physical status I to III patients subjected to vitreoretinal surgery under sub-Tenon's block anesthesia were randomly divided equally into 2 groups, depending on the local anesthesia solution used, to receive 4 mL of 0.75% levobupivacaine plus 15 IU hyaluronidase diluted with 1 mL normal saline (group L) or 4 mL of 0.75% levobupivacaine plus 15 IU hyaluronidase and 20 μg dexmedetomidine diluted with 1 mL normal saline (group LD). The total volume of the local anesthesia solution used was 5 mL. Motor block and sensory block durations were evaluated until the return of normal motor and sensory functions. The sedation level was assessed during the surgery period and 24 hours postoperatively, together with the degree of postoperative pain. The total diclofenac consumption (milligrams) and the number of patients (%) who required tramadol were recorded. The sleep quality of the first postoperative night was assessed using the Consensus Sleep Diary. Dexmedetomidine provided significantly longer motor block duration (371.90 ± 48.10 vs 264.13 ± 41.48 minutes, P = 0.001) and significantly longer sensory block duration (499.10 ± 51.76 vs 344.33 ± 45.46 minutes, P = 0.001) compared with levobupivacaine alone. Furthermore, the patients in the dexmedetomidine group achieved significantly (P < 0.0001) greater levels of sedation during the surgery period and for 12 hours postoperatively together with significantly (P < 0.0001) lower values of verbal numeric rating scale of pain between the periods from 4 to 12 hours postoperatively compared with the patients in the levobupivacaine group. There was significantly (P = 0.001) less diclofenac consumed (mg) in the dexmedetomidine group. The patients in the dexmedetomidine group reported significantly higher rates of good sleep quality on the first postoperative night (70%) compared with those in the levobupivacaine group (30%; P < 0.0001). For patients undergoing vitreoretinal surgery, adding 20 μg of dexmedetomidine to levobupivacaine for sub-Tenon's block anesthesia in vitreoretinal surgery extended the motor and sensory block durations and provided more effective postoperative analgesia with improvement in the sleep quality in the first postoperative night compared with levobupivacaine alone.

Measuring sleep quality in older adults: a comparison using subjective and objective methods

Sleep quality decreases with aging and thus sleep complaints are prevalent in older adults, particularly for those with cognitive impairment and dementia. For older adults, emerging evidence suggests poor sleep quality increases risk of developing cognitive impairment and dementia. Given the aging population—and the impending economic burden associated with increasing numbers of dementia patients—there is pressing need to improve sleep quality among older adults. As such, research efforts have increased focus on investigating the association between age-related sleep changes and cognitive decline in older adults. Sleep quality is a complex construct to evaluate empirically, and yet the Pittsburg Sleep Quality Index (PSQI) is commonly used in studies as their only measure of sleep quality. Furthermore, the PSQI may not be the best sleep quality measure for older adults, due to its reliance on the cognitive capacity to reflect on the past month. Further study is needed to determine the PSQI's validity among older adults. Thus, the current study examined sleep quality for 78 community dwelling adults 55+ to determine the PSQI's predictive validity for objective sleep quality (as measured by actigraphy). We compared two subjective measures of sleep quality—the PSQI and Consensus Sleep Diary (CSD)—with actigraphy (MotionWatch 8©; camntech). Our results suggest perceived sleep quality is quite different from objective reality, at least for adults 55+. Importantly, we show this difference is unrelated to age, gender, education, or cognitive status (assessed using standard screens). Previous studies have shown the PSQI to be a valuable tool for assessing subjective sleep quality; however, our findings indicate for older adults the PSQI should not be used as a substitute for actigraphy, or vice versa. Hence, we conclude best practice is to include both subjective and objective measures when examining sleep quality in older adults (i.e., the PSQI, CSD, and actigraphy).

The consensus sleep diary: quantitative criteria for primary insomnia diagnosis.

The aim of the study was to put forward quantitative criteria for the Consensus Sleep Diary, to differentiate people with insomnia from normal sleepers. In this retrospective study, we analyzed 295 sleep diaries of patients with primary insomnia (43% were male, ages ranging between 17 and 76 years) collected in two clinical centers for insomnia and 536 sleep diaries of normal sleepers (47% were male, ages ranging between 15 and 82 years). We considered the following sleep parameters: time in bed, sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, number of awakenings, terminal wakefulness, and subjective feeling of rest. Using the Youden index, we calculated the quantitative criteria that performed best for each sleep parameter. Finally, we created receiver operating characteristic curves to test the accuracy of each identified criterion. Individuals with insomnia significantly differed from controls on all sleep indices (p < .001). Differentiation between individuals with insomnia from controls was optimal for terminal wakefulness (>15 minutes, area under the curve [AUC] = 0.83), wake after sleep onset (cutoff >20 minutes, AUC = 0.81), total sleep time (<390 minutes, AUC = 0.80), and particularly sleep efficiency (<87.5%, AUC = 0.92, sensitivity = 0.80, specificity = 0.90). Time in bed was the least differentiating variable (<500 minutes, AUC = 0.57). The quantitative criteria of the sleep diary in this study agree with the few available data in the literature. This confirms that the sleep diary could be a useful screening tool for assessing patients with primary insomnia.

Sleep-wake time perception varies by direct or indirect query.

The diagnosis of insomnia rests on self-report of difficulty initiating or maintaining sleep. However, subjective reports may be unreliable, and possibly may vary by the method of inquiry. We investigated this possibility by comparing within-individual response to direct versus indirect time queries after overnight polysomnography. We obtained self-reported sleep-wake times via morning questionnaires in 879 consecutive adult diagnostic polysomnograms. Responses were compared within subjects (direct versus indirect query) and across groups defined by apnea-hypopnea index and by self-reported insomnia symptoms in pre-sleep questionnaires. Direct queries required a time duration response, while indirect queries required clock times from which we calculated time durations. Direct and indirect queries of sleep latency were the same in only 41% of cases, and total sleep time queries matched in only 5.4%. For both latency and total sleep, the most common discrepancy involved the indirect value being larger than the direct response. The discrepancy between direct and indirect queries was not related to objective sleep metrics. The degree of discrepancy was not related to the presence of insomnia symptoms, although patients reporting insomnia symptoms showed underestimation of total sleep duration by direct response. Self-reported sleep latency and total sleep time are often internally inconsistent when comparing direct and indirect survey queries of each measure. These discrepancies represent substantive challenges to effective clinical practice, particularly when diagnosis and management depends on self-reported sleep patterns, as with insomnia. Although self-reported sleep-wake times remains fundamental to clinical practice, objective measures provide clinically relevant adjunctive information.

The sleep registry. An international online survey and cognitive test assessment tool and database for multivariate sleep and insomnia phenotyping

Introduction Insomnia as a complaint is a complex, heterogeneous condition. It can be a symptom of medical, psychiatric, or substance abuse disorders or it can be a condition on its own. Even in the latter case, there appears to be considerable variability in complaints and patient characteristics. This heterogeneity makes progress in our understanding of insomnia difficult. A first logical step would be to determine well-defined insomnia subtypes and subsequently unravel the brain mechanisms underlying insomnia complaints in these homogenous subtypes. The need to determine these subtypes, and obtain a large sample to be able to do so, has been recognized by several researchers before (e.g. Edinger et al., 1996; Van Someren et al., 2009; Vgontzas et al., 2012; Roenneberg, 2013). Materials and methods Internet technology has profoundly changed survey methodology and moreover makes web-based cognitive performance testing possible. Freeware implementations of these technologies have been combined in the Sleep Registry (www.sleepregistry.org) to obtain multiple descriptive, subjective and performance parameters in a huge sample of individuals and families. The multidimensional variable space can be subjected to latent class analysis in order to yield homogeneous subgroups. Given the large amount of measurements that will be done in the Sleep Registry, participants are given the opportunity to fill out their set of questionnaires and computer-based tests voluntarily at their own pace. Feedback on performance is given as reward to promote adherence. The setup of the Sleep Registry site is very modular making it possible for individual labs to add questionnaires and tests, or to initiate parallel sampling using different languages. Results Currently, around 14.000 people signed up for the Sleep Registry in the Netherlands and filled out between one and 28 modules, where each module contains one or more validated questionnaires. In addition, modules are available to assess the Consensus Sleep Diary (Carney et al., 2012), as well as common tasks including overnight word pair learning, the psychomotor vigilance test (Dinges and Powell, 1985; Basner and Dinges, 2011) and the digit span. Two modules are available for extensive structured diagnosis of sleep disorders as well as somatic, psychiatric and neurological disorders and medication use. The Sleep Registry is now available in Dutch, English, Spanish, Portugese, German, French, Italian and Polish. Labs can identify their own URL to make sure that they can own the data of their recruited participants, and are free to pool data with colleagues. Conclusion The Sleep Registry thus provides a useful tool for efficiently and flexibly acquiring large samples of descriptive, subjective and performance measurements to facilitate sleep research and truly start a cooperative Human Sleep Project (Roenneberg, 2013). Labs interested to run their own Sleep Registry and cooperate are welcome: e.van.someren@nin.knaw.nl Dinges DF and Powell JW (1985) Microcomputer analyses of performance on a portable, simple visual RT task during sustained attention. Behav Res Meth Instr Comp 17:652–655. Edinger JD, Fins AI, Goeke JM, McMillan DK, Gersh TL, Krystal AD and McCall WV (1996) The empirical identification of insomnia subtypes: a cluster analytic approach. Sleep 19:398–411. Van Someren EJW, Pollmacher T, Leger D, Espie C, Bassetti C and Riemann D (2009) The European Insomnia Network. Front Neurosci 3:436. Basner M and Dinges DF (2011) Maximizing Sensitivity of the Psychomotor Vigilance Test (PVT) to Sleep Loss. Sleep 34:581–591. Carney CE, Buysse DJ, Ancoli-Israel S, Edinger JD, Krystal AD, Lichstein KL and Morin CM (2012) The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep 35:287–302. Vgontzas AN, Fernandez-Mendoza J, Bixler EO, Singareddy R, Shaffer ML, Calhoun SL, Liao D, Basta M and Chrousos GP (2012) Persistent insomnia: the role of objective short sleep duration and mental health. Sleep 35:61–68. Roenneberg T (2013) Chronobiology: the human sleep project. Nature 498:427–428. Acknowledgements Supported by the VICI Innovation Grant 453-07-001 of the Netherlands Organization of Scientific Research (NWO); The Hague, the Netherlands; co-funding of the Polish translation by an ENSRL travel grant of the ESRS to Michal Jarkiewicz; co-funding of the English translatop by Kevin Morgan, Sleep Research Centre, School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK.

Sleep diaries for shift workers

Introduction Sleep diaries have long been the preferred method for collecting data on self-reported sleep over time in insomnia research. Only a few studies were dedicated to daily self-reports of sleep difficulties associated with shift work. The aim of this study is to qualitatively document the use of sleep diaries in the context of shift work and to present a diary template that reflects the reality of shift work. Materials and methods The sample included 46 shift workers (86.9% women; mean age = 35.4 years old) taking part in a study on bio-psychosocial factors involved in the evolution of shift work sleep disorder. Among them the first 10 were given a sleep diary used in previous insomnia studies. This sleep diary consisted of 7-day report presented on a single page with a column for each day of the week. This format is similar to the one proposed recently as a consensus sleep diary by a committee of experts. The other 36 participants received a diary with a 24-h scale on each page. Both sleep diaries included 6 questions on sleep and wake time, and a question on medication, alcohol and caffeine use. Both formats used a sleepiness rating scale (Likert scale from “1” to “7”) to be completed after each sleeping period. Results 55.5% of the total sample (26 out of 46 participants) reported at least 3 sleep periods per day when working at night, 41.3% reported 2 sleep periods per day and only 1 participant reported 1 sleep period per day. The first 10 participants were unable to comply with the 7 columns for each day of the week diary. All of them reported that this version did not reflect the reality of their sleep schedules. A few added an extra column in order to report transitions before and after night shift. Most of them did not report napping periods as they consider that they had more than one sleep period per day rather than a nap. Most of them wanted to comment on their sleep difficulties occurring at different time point. The 36 participants using the second sleep diary format did not report any of these difficulties. Conclusion Qualitative reports suggest that within the context of shift work, sleep diaries need to be adjusted in order to capture the sleep patterns over 24 h. Moreover, this tool will help clinicians to better investigate difficulties with sleep in the shift work population and to develop a treatment plan that better suits the reality of shift work sleep disorder. Acknowledgement Supported by the Canadian Institutes of Health Research (#197171).

The Consensus Sleep Diary: Standardizing Prospective Sleep Self-Monitoring

To present an expert consensus, standardized, patient-informed sleep diary. Sleep diaries from the original expert panel of 25 attendees of the Pittsburgh Assessment Conference(1) were collected and reviewed. A smaller subset of experts formed a committee and reviewed the compiled diaries. Items deemed essential were included in a Core sleep diary, and those deemed optional were retained for an expanded diary. Secondly, optional items would be available in other versions. A draft of the Core and optional versions along with a feedback questionnaire were sent to members of the Pittsburgh Assessment Conference. The feedback from the group was integrated and the diary drafts were subjected to 6 focus groups composed of good sleepers, people with insomnia, and people with sleep apnea. The data were summarized into themes and changes to the drafts were made in response to the focus groups. The resultant draft was evaluated by another focus group and subjected to lexile analyses. The lexile analyses suggested that the Core diary instructions are at a sixth-grade reading level and the Core diary was written at a third-grade reading level. The Consensus Sleep Diary was the result of collaborations with insomnia experts and potential users. The adoption of a standard sleep diary for insomnia will facilitate comparisons across studies and advance the field. The proposed diary is intended as a living document which still needs to be tested, refined, and validated.