Lower Sleep Efficiency Research Articles

Sleep Trajectory of Hospitalized Medically Ill Older Adults: Do Sleep Medications Make a Difference?

Sleep disturbances are prevalent during acute hospitalization in medically ill older patients, with undesirable outcomes. Sleep medication use is common, but its effectiveness is questionable. This study explored the trajectory of sleep parameters from home to hospital and assessed the impact of sleep medication use, considering covariates such as physical symptom burden. A prospective multicenter study was conducted in four Israeli hospitals. Cognitively intact older patients (n=683), with an admission interview and at least one follow-up, were recruited. Total sleep time (TST), sleep efficiency (SE), sleep quality (SQ), number of awakenings (NOA), sleep medication use, sleep medication burden (quantity and dosage), and physical symptom burden were recorded daily. Personal and illness-related covariates were included in a repeated-measures mixed model design. Participants (male: 54%, aged 77.31±6.60) showed shorter TST (329.73±111.94 vs. 377.03±101.06 minutes), lower SE (71.49±19.28% vs. 76.14±15.53%), and higher probability for lower SQ, in the hospital compared to home. Sleep medication use was not correlated with any sleep parameters; sleep medication burden was associated with NOA. Physical symptom burden showed significant main effects on SE, SQ, and NOA, and a significant interaction was found with time-points on TST, such that higher burden was more strongly associated with shorter TST at first in-hospital follow-up than at admission, with no differences between all subsequent in-hospital time points. Conclusions: Sleep declined during acute hospitalization compared to the home, with sleep medications showing minimal effect. Managing symptom burden should be prioritized when addressing sleep disturbances in older patients during hospitalization.

Multidimensional Sleep Health, Glycemic Control, and Self-Reported Outcomes in Type 1 Diabetes: A Cross-Sectional Study.

Sleep health is multidimensional. While studies have shown associations between certain sleep dimensions and health in type 1 diabetes (T1D), global sleep health has rarely been considered. To examine the associations between individual sleep dimensions and multidimensional sleep health (MSH) on glycemic control and self-reported outcomes in T1D. Data from 116 adults with T1D participating in a sleep study (NCT04506151) were analyzed. Sleep satisfaction and alertness were assessed by questionnaires. Sleep timing, efficiency, duration, and regularity were derived from 7-day actigraphy. A composite MSH score was created by counting "healthy sleep" across these six measures. Glycemic control was assessed by 7-day continuous glucose monitoring and A1C. Self-reported outcomes were collected through questionnaires. After adjusting for covariates, greater sleep irregularity was associated with higher glycemic variability (b=5.048, p<0.01), less time in range (TIR) (b=-10.806, p<0.01), higher time above range (TAR) (b=7.40, p<0.05), and higher A1C (b=0.365, p<0.05)]. Poor sleep satisfaction was associated with higher diabetes distress and depression (b=0.29, p<0.05, b=3.59, p<0.05), respectively. Later sleep timing was associated with higher depression (b=1.545, p<0.05), while lower sleep efficiency was associated with higher depression (b=1.545, p<0.01). Worse MSH was significantly associated with lower TIR (b=2.376, p<0.05), higher TAR, A1C, and depression (b=-2.38, p<0.05; b=-0.177, p<0.01; b=-1.275, p<0.05, respectively). Sleep irregularity likely drives the association between MSH and glycemic control, while poor sleep satisfaction, lower efficiency, and later timing contribute to the association between MSH and depression. These results highlight the importance of comprehensive sleep health evaluation in T1D.

Polysomnographic findings and psychiatric symptoms in patients with comorbid insomnia and sleep apnea: a retrospective study focusing on sex differences.

Comorbid insomnia and obstructive sleep apnea (COMISA) present significant clinical challenges, given their overlapping symptoms and detrimental effects on health. Only a few studies have explored sex differences in patients with obstructive sleep apnea (OSA) and COMISA. This retrospective study investigated sex differences in psychiatric symptoms and polysomnographic findings between patients with COMISA and those with OSA alone. Patients who underwent polysomnography (PSG) and completed questionnaires at a single tertiary hospital sleep center were enrolled. Patients diagnosed with OSA using PSG (apnea-hypopnea index ≥ 5) were categorized based on the Insomnia Severity Index-Korean version (ISI) into OSA without insomnia (OSA-only group; ISI < 15) and OSA with insomnia (COMISA group; ISI ≥ 15). This study included 1,096 adult patients diagnosed with OSA, of whom 426 (38.9%) were in the COMISA group. COMISA was more common in women than in men (50.7% vs. 34.5%, p < 0.001). The COMISA group reported more severe subjective psychiatric symptoms, including depression, anxiety, and daytime sleepiness in both men and women. The male COMISA group had lower sleep efficiency (p = 0.02) and longer sleep latency (p = 0.002) than those had by the OSA-only group. The male COMISA group had a higher apnea-hypopnea index (p = 0.04) and a lower mean oxygen saturation (p = 0.004) than those had by the OSA-only group. These findings highlight the importance of considering sex-specific clinical and polysomnographic characteristics when managing patients with COMISA.

Bidirectional links between sleep and pain among heavy-drinking Veterans with insomnia

Abstract Study Objectives Military veterans often suffer from chronic pain and sleep issues at a greater frequency than the general population, leading some to self-medicate with alcohol. While research shows a connection between sleep and pain, few studies have examined bidirectional links between sleep and pain at the daily level–or the extent to which alcohol use may moderate these associations. Methods Heavy-drinking veterans seeking treatment for insomnia (N=109, 82.5% male, mean age 38.9y) completed 14 days of morning diaries documenting sleep patterns, pain intensity, and alcohol consumption. Multilevel modeling examined within- and between-person associations between sleep (quality, duration, and efficiency) and next-day pain as well as pain and same-night sleep. Results Individuals with longer sleep duration, better sleep quality, and higher sleep efficiency reported lower pain levels compared to those with shorter sleep, poorer sleep quality, and lower sleep efficiency (p-values &amp;lt;.001 to .01). Additionally, on days when individuals experienced better sleep quality compared to their own average, they reported lower pain levels the following day (p=.01). In contrast to hypotheses, daily pain levels did not predict sleep outcomes at the daily within-person level, although significant between-person correlations were noted. Daily alcohol intake did not affect these relationships. Conclusions Sleep quality is associated with the daily experience of pain among heavy-drinking veterans with insomnia. Daily variations in sleep quality significantly impact pain, irrespective of alcohol consumption, highlighting a predominantly unidirectional influence from sleep to pain. These findings underscore the importance of optimizing sleep to mitigate pain in this population.

Within- and Between-Person Correlates of Affect and Sleep Health Among Health Science Students.

To examine the relationships between state affect and sleep health at within- and between-person levels among health science students. A correlational design was used and 54 health science students were included. The participants completed baseline and 7-day ambulatory assessments in a free-living setting. Daily sleep and affect were measured using the Consensus Sleep Diary and Positive and Negative Affect Schedule. Mixed-effect models were used to examine the effects of affect on sleep health. The participants were 19.8 (SD, 0.6) years and 92.6% were females. Approximately 40% had poor sleep quality. Controlling for the potential confounders (e.g., age, sex, and bedtime procrastination), higher within-person negative affect predicted shorter sleep duration, lower sleep efficiency, longer sleep onset latency, and less feeling rested. Higher between-person negative affect predicted shorter sleep duration. Higher within-person positive affect predicted longer sleep onset latency. Higher within- and between-person positive affect predicted more feeling rested. Negative affect was most consistently associated with sleep health at the individual level. Affect regulation should be considered when delivering personalized interventions targeting sleep health among health science students.

A cross-sectional study on the relationship between infant sleep, temperament, and bedtime practices.

We explored the interplay between infant temperament, sleep characteristics, and bedtime practices. We conducted a cross-sectional study involving a large sample of infants 9-13 months of age (n = 623). Sleep data were collected through auto-videosomnography, allowing for objective, noninvasive assessment of sleep in an infant's ecological environment. Infant temperament and bedtime practices were assessed with questionnaires completed by parents. Results revealed significant correlations between negative affectivity and disrupted sleep patterns, including shorter sleep duration, more night awakenings, and increased parental interventions. Infants falling asleep while being breast/bottle feeding or while being held/rocked had shorter nocturnal sleep duration, lower sleep efficiency, later bedtime, earlier wake-up time, and more parental interventions. Regression analyses indicated that bedtime practices accounted for a substantial portion of variance in sleep metrics, emphasizing their role in influencing infants' sleep. The study highlights the intricate interconnections between infants' temperament, sleep, and caregiving practices, emphasizing the need for a nuanced understanding of individual differences to tailor effective parenting strategies for promoting healthy sleep in infants. Breda M, Lucchini M, Barnett N, Bruni O. A cross-sectional study on the relationship between infant sleep, temperament, and bedtime practices. J Clin Sleep Med. 2024;20(12):1965-1974.

Sleep Fragmentation Despite Intact Rest-Activity Patterns in Premanifest Huntington's disease: An Actigraphy Study

ObjectiveSleep research in Huntington’s disease (HD) has primarily focused on manifest HD, with significantly less attention given to premanifest HD (Pre-HD). Therefore, we investigated sleep and rest-activity patterns in people with Pre-HD versus healthy controls (HC). MethodsWe conducted a cross-sectional study including 36 Pre-HD and 48 HC participants. Pre-HD participants were stratified into three groups according to their proximity to estimated diagnosis, using a cytosine-adenine-guanine (CAG) and current age-based predictive model: NEAR (<9 years to diagnosis), MID (9-15 years to diagnosis) and FAR (>15 years to diagnosis). Sleep and rest-activity patterns were assessed using wrist-worn actigraphy, a sleep diary, and sleep questionnaires. ResultsNEAR and MID groups experienced higher fragmentation index than HC and FAR groups. NEAR and MID groups also exhibited greater WASO than the FAR group. NEAR and MID groups showed lower intra-daily variability (IV) than HC and FAR groups, with the NEAR group also being more active in the most active 10 hours (M10). Groups did not differ on subjective sleep measures, inter-daily stability (IS), sleep regularity index, relative amplitude, or amount of activity in the least active five hours (L5). Considering all Pre-HD participants, fewer years to diagnosis, higher CAG-age-product (CAP) scores (a measure of cumulative exposure to the HD-causing gene mutation) and larger CAG repeat lengths correlated with higher WASO, fragmentation index, L5, IS, and lower sleep efficiency and IV. Higher CAP score correlated with higher M10. ConclusionsDespite intact rest-activity patterns and similar subjective sleep quality to HC, greater sleep fragmentation is a prominent and early feature in Pre-HD. Therefore, reducing sleep fragmentation may be a potential target for sleep intervention in HD. Longitudinal studies using larger samples are needed to assess sleep across the disease spectrum and its impact on clinical outcomes, like cognition.

Relationship between actigraphy-derived physical activity, sedentary behaviours and sleep parameters in preschool girls and boys: A cross-sectional study.

The aim of the study was to examine associations between moderate-to-vigorous physical activity and sedentary time with sleep quality and quantity among preschool girls and boys using objective methods. Children (5-6 years old) attending kindergarten were recruited (n = 676). Measures included accelerometer-derived 24-hr activity and sleep for seven consecutive days. Longer time spent in moderate-to-vigorous physical activity was associated with higher sleep efficiency both in boys (p < 0.0001) and girls (p = 0447), and with lower Sleep Fragmentation Index in boys (p = 0.0042) and girls (p = 0.0494). Moreover, among boys, moderate-to-vigorous physical activity was inversely associated with wakefulness after sleep onset (p = 0.0006), number of awakenings (p = 0.0081) and Fragmentation Index (p = 0.0041), while in girls with sleep duration (p = 0.0405), Movement Index (p = 0.0128) and Sleep Fragmentation Index (p = 0.0494). Longer time spent sedentary was associated with lower sleep efficiency, and higher wakefulness after sleep onset, number of awakenings, Movement Index and Sleep Fragmentation Index-all with p < 0.0001. Furthermore, sedentary time was inversely associated with sleep duration both in boys (p < 0.0001) and girls (p = 0.0006), and directly associated with Fragmentation Index but only in boys (p = 0.0069). Meeting the recommended level of moderate-to-vigorous physical activity was associated with better sleep efficiency, lower wakefulness after sleep onset and number of awakenings among boys. All sleep-related variables showed significant differences between quartile groups according to sedentary time (p < 0.05) in both the total group and the boys. The sedentary time had the strongest, negative effect on sleep-related parameters in preschool children, therefore sedentary time reduction may contribute more to improving sleep quality than increasing moderate-to-vigorous physical activity.

P046 Towards defining the sleep phenotype of children with neurofibromatosis type 1

Abstract Introduction Research involving drosophila highlight the role of the NF1 gene in regulating the sleep-wake cycle. Despite this, there remains limited knowledge about sleep in people who carry a mutation in the NF1 gene, also known as Neurofibromatosis type 1 (NF1). Methods The study aimed to characterise sleep disturbance and its impact in children with NF1. The sleep patterns of children with NF1 (n=93) and TD children (n=45) were compared using actigraphy, sleep diary, the Sleep Disturbance Scale (SDSC), Paediatric Sleep Questionnaire (PSQ) and neuropsychological assessment. Results SDSC indicated 59% of parents of children with NF1 and 32% of parents of controls reported sleep disturbances. The PSQ-derived PLMD and SDB scales identified suspected cases, with 5-6% of TD children and 38% and 30% of children with NF1 meeting the clinical thresholds for SDB and PLMD, respectively. Actigraphy showed children with NF1 had significantly longer sleep onset latency (p=.001), lower sleep efficiency (p=.002), and less total sleep time (p&amp;lt;.05). Correlation analysis in children with NF1 revealed significant links between SDB scores and sleep efficiency, reading, executive functions, depression, adaptive functioning, fatigue, and QoL (p&amp;lt;.01). PLMD scores were significantly correlated with pain, executive functioning, and QoL. Conclusion This study is the first to document abnormal sleep patterns in children with NF1 using actigraphy. Results highlight the significant sleep problems these children face and the need for clinicians to routinely screen for the presence of sleep disorders such as SDB or PLMD. Early intervention to improve sleep may improve sleep problems and functioning.

Phenotypes of sleep health among adults with chronic heart failure in a randomized controlled trial of cognitive behavioral therapy for insomnia

BackgroundPoor sleep contributes to adverse health in heart failure. However, studies are limited to isolated sleep characteristics. PurposesTo evaluate changes in sleep health phenotypes after cognitive behavioral therapy for insomnia or attention control and associations between sleep health phenotypes, symptoms, stress, functional performance, and emergency department visits and hospitalizations. MethodsSecondary analysis of a randomized controlled trial of cognitive behavioral therapy for insomnia among adults with heart failure. We measured sleep (rest-activity rhythms, sleep duration, quality, and efficiency, insomnia severity, daytime sleepiness), symptoms, cognitive ability, vigilance, and 6-minute walk distance at baseline and 3-, 6-, and 12-month postintervention and collected hospitalizations and emergency department visits. We used K-means cluster analysis and generalized linear mixed models, generalized estimating equations, and Cox proportional hazard models. ResultsAmong 166 participants (M age=63.2 (SD=12.6) years; 57% male; 23% New York Heart Association Class III/IV), there were four sleep health phenotypes (“Unstable Sleep” (15%); “Short Sleep” (39%); “Low Sleep Efficiency” (25%); and “Good Sleep” (21%)) at baseline. The healthiest phenotype was associated with the lowest fatigue. The proportions of participants in the healthiest sleep group increased from pre- to post-treatment. Low sleepiness (p = .0188) and a robust circadian quotient (p = .007) predicted transition to the healthiest phenotype. The poorest sleep phenotype at baseline predicted time to hospitalizations and emergency department visits (hazard ratios 0.35-0.60) after adjusting for covariates. ConclusionSleep phenotypes predict heart failure outcomes. Tailored interventions targeting phenotypes may be more effective than approaches that focus on single sleep characteristics.

Sleep-wake cycle and 24-h motor activity in early-mid Huntington's disease patients: An actigraphy-based study

Background: Disrupted 24-h sleep-wake and rest-activity cycles are known common features in Huntington's disease (HD) patients; however, critical periods during the 24-h cycle have been less studied. Objective: To analyze the differences between early-mid stage HD patients and healthy controls (HC) in sleep patterns and 24-h motor activity by using actigraphic monitoring. Methods: Twenty HD patients (13 females; mean age ± SD 56.45 ± 16.94) at early-mid stage of the disease and 20 HC were actigraphically monitored for a week. We applied the Functional Linear Modeling (FLM) to analyze motor activity from the actigraphic data. We analyzed parameters regarding both the time spent in bed and out of bed; get-up time (GUT); time in bed (TIB); midpoint of sleep (MS); sleep motor activity (SMA); sleep onset latency (SOL); total sleep time (TST); wake after sleep onset (WASO); sleep efficiency (SE); number and duration of awakenings (AWK); diurnal motor activity (DMA) and diurnal total sleep time (DTST). Results: Ten patients were in Stage I, 6 in Stage II and 4 in Stage III. HD patients presented lower SE and higher TIB, SOL, WASO, AWK and AWK &gt; 5 min in comparison to HC. Moreover, higher motor activity was observed in patients with HD, in particular between 2:15 and 4:00 am, from around 40 min prior to bedtime until 20 min after bedtime, and from around 20 min prior to get-up time until 50 min after get-up time. Conclusions: Actigraphy documented a specific 24-h motor pattern in HD, potentially constituting a disease signature.

Move more today, sleep better tonight? Daily associations between physical activity and sedentary behavior with sleep among young adults with and without insomnia symptoms

ObjectiveAt the between-person level, it is well-documented that individuals with more physical activity (PA) and less sedentary behavior (SB) tend to have better sleep outcomes than their peers. However, the associations at the within-person level remain unclear. This study investigated the daily associations between PA and SB with nighttime sleep among young adults with and without insomnia symptoms. MethodsData was collected through activity trackers and online questionnaires for 7 consecutive days among 147 university students, including time spent on moderate to vigorous physical activity (MVPA), light physical activity (LPA), and SB, along with sleep duration, sleep efficiency, and sleep quality. Participants were classified into two subgroups according to the presence of insomnia symptoms, which were determined by a self-reported insomnia scale. Multilevel compositional data analysis was conducted on the total sample, and separately on subsamples characterized by the presence and absence of insomnia symptoms. ResultsIn the total sample and subsample without insomnia symptoms, substitutions among MVPA, LPA, and SB were not associated with changes in sleep outcomes at the daily level. However, in the subsample with insomnia symptoms, days with more MVPA or SB and less LPA were associated with higher sleep efficiency, while days with more LPA at the expense of MVPA or SB were associated with lower sleep efficiency. ConclusionsFor young adults with insomnia symptoms, replacing LPA with MVPA on a given day may improve their sleep efficiency that night.

Factors associated with poor sleep in children with drug-resistant epilepsy.

We aimed to investigate sleep in children with drug-resistant epilepsy (DRE), including developmental and epileptic encephalopathies (DEEs). Next, we examined differences in sleep macrostructure and microstructure and questionnaire outcomes between children with well-controlled epilepsy (WCE) and children with DRE. Furthermore, we wanted to identify factors associated with poor sleep outcome in these children, as some factors might be targets to improve epilepsy and neurodevelopmental outcomes. A cross-sectional study was conducted in children 4 to 18-years-old. Children without epilepsy, with WCE, and with DRE were included. Overnight electroencephalography (EEG), including chin electromyography and electrooculography, to allow sleep staging, was performed. Parents were asked to fill out a sleep questionnaire. Classical five-stage sleep scoring was performed manually, spindles were automatically counted, and slow wave activity (SWA) in the first and last hour of slow wave sleep was calculated. One hundred eighty-two patients were included: 48 without epilepsy, 75 with WCE, and 59 with DRE. We found that children with DRE have significantly lower sleep efficiency (SE%), less time spent in rapid eye movement (REM) sleep, fewer sleep spindles, and a lower SWA decline over the night compared to children with WCE. Subjectively more severe sleep problems were reported by the caregivers and more daytime sleepiness was present in children with DRE. Least absolute shrinkage and selection operator (LASSO) regression showed that multifocal interictal epileptiform discharges (IEDs), benzodiazepine treatment, and longer duration of epilepsy were associated with lower SE% and lower REM sleep time. The presence of multifocal discharges and cerebral palsy was associated with fewer spindles. Benzodiazepine treatment, drug resistance, seizures during sleep, intellectual disability, and older age were associated with lower SWA decline. Both sleep macrostructure and microstructure are severely impacted in children with DRE, including those with DEEs. Epilepsy parameters play a distinct role in the disruption REM sleep, spindle count, and SWA decline.

Childhood Adversity and Adolescent Epigenetic Age Acceleration: The Role of Adolescent Sleep Health.

We investigated how a dimension of early life adversity (ELA) capturing threat in the home relates to later epigenetic age acceleration in adolescence through sleep (duration, efficiency, and timing), to empirically test theoretical models suggesting the importance of sleep as a key mechanism linking ELA with poor health outcomes, and to expand the limited literature on sleep and epigenetic aging among youth. We utilized data from 861 participants from the Future of Families and Child Wellbeing Study (FFCWS) who participated in the actigraphy sub study at age 15. Sleep variables used were average total sleep time (TST), sleep efficiency (SE), and sleep onset timing. Home threat was determined at ages 3, 5, and 9 from parent reports on the Child Conflict Tactics Scale (CTS-PC), and epigenetic aging was measured through DNA methylation analyses of saliva samples collected at age 15. Higher levels of childhood home threat exposure were associated with less adolescent TST, lower SE, and later sleep onset timing. Adolescent SE and timing were associated with a faster pace of aging and epigenetic age acceleration. Sleep efficiency and timing mediated the link between childhood home threat exposure and adolescent epigenetic aging. Epigenetic embedding of childhood threat exposure in the home may occur through adversity-related sleep disturbances in adolescence. Findings warrant greater attention to pediatric sleep health in theoretical models of biological embedding of adversity and point to the examination of improving sleep health as a potential way to prevent adversity-related epigenetic age acceleration.

Biopsychosocial factors intersecting with weekly sleep difficulties in the menopause transition

ObjectivesSleep difficulties are common in the menopause transition and increase risk for a variety of physical and psychological problems. The current study investigated potential interactions between psychosocial variables and within-person changes in ovarian hormones in predicting perimenopausal sleep problems as well as the potential interactions between poor sleep and psychosocial factors in predicting worsened mood, affect, and attention. Study designThe sample included 101 perimenopausal individuals. Participants completed 12 weekly assessments of self-reported sleep outcomes, depressive mood and affect, and attention function, and of estrone glucuronide (E1G) and pregnanediol glucuronide (PdG) levels (urinary metabolites of estradiol and progesterone, respectively); they also had 24-h tracking of vasomotor symptoms. Other psychosocial variables such as trauma history and stressful life events were assessed at baseline. ResultsA history of depression, baseline depressive symptoms, trait anxiety, and more severe and bothersome vasomotor symptoms predicted worsened sleep outcomes. Recent stressful life events, trauma history, and person-centred E1G and PdG changes did not predict sleep outcomes. However, there was an interaction whereby person-centred E1G decreases predicted lower sleep efficiency in those with higher baseline depressive symptoms. Higher baseline depression and trauma history also amplified the effect of vasomotor symptoms on sleep outcomes. In evaluating the effect of poor sleep on psychological and cognitive outcomes, stressful life events emerged as a moderating factor. Finally, trauma history and poor sleep interacted to predict worsened attention function. ConclusionsThe current study suggests that certain individuals may be at greater risk of perimenopausal sleep problems and the resulting negative effects on mood and cognition.

Associations between habitual sleep characteristics and cardiometabolic disease risk in corporate executives

ObjectivesCorporate executive job demands may lead to poor sleep habits, increasing their risk for cardiometabolic disease. This study aimed to describe and explore associations between objectively measured habitual sleep characteristics and cardiometabolic disease risk of corporate executives, while accounting for occupational, psychological, and lifestyle factors. MethodsHabitual sleep was measured using wrist-worn actigraphy and a sleep diary over seven consecutive days in 61 (68.3% men) corporate executives aged 46.4 ± 8.7years. A composite cardiometabolic disease risk score was determined using body mass index, waist circumference, blood pressure and fasting glucose and lipid concentrations. Prediction models were built using a backward stepwise selection approach to explore associations between sleep characteristics and cardiometabolic disease risk factors adjusting for occupational, psychological, and lifestyle covariates. ResultsAverage total sleep time was 6.60 ± 0.75 hours, with 51.7% of participants reporting poor sleep quality and 26.2% extending their weekend sleep. Adjusted models showed that lower sleep efficiency (β = −0.25, 95%CI: −0.43; −0.08, P = .006), shorter weekday total sleep time (β = −1.37, 95% CI: −2.41, −0.32; P = .011) and catch-up sleep (β = 0.84, 95%CI: 0.08, 1.60, P = .002) were associated with higher cardiometabolic disease risk scores. Adjusted models also found that shorter average time-in-bed (ß=−2.00, 95%CI: −3.76; −0.18, P = .031), average total sleep time (ß=1.98, 95%CI: −3.70; −0.25, P = .025) and weekday total sleep time (β = −2.13, 95%CI: −3.56; −0.69, P = .025) as well as catch-up sleep (β = 1.67, 95% CI: 0.52; 2.83; P = .012) were all associated with a higher body mass index. ConclusionCorporate executives who compromise sleep duration during the working week may increase their risk for obesity and future cardiometabolic disease.

Comparing sleep measures in cancer survivors: self-reported sleep diary versus objective wearable sleep tracker.

Cancer survivors are increasingly using wearable fitness trackers, but it is unclear if they match traditional self-reported sleep diaries. We aimed to compare sleep data from Fitbit and the Consensus Sleep Diary (CSD) in this group. We analyzed data from two randomized clinical trials, using both CSD and Fitbit to collect sleep outcomes: total sleep time (TST), wake time after sleep onset (WASO), number of awakenings (NWAK), time in bed (TIB), and sleep efficiency (SE). Insomnia severity was measured by Insomnia Severity Index (ISI). We used the Wilcoxon signed rank test, Spearman's rank correlation coefficients, and the Mann-Whitney test to compare sleep outcomes and assess their ability to distinguish insomnia severity levels between CSD and Fitbit data. Among 62 participants, compared to CSD, Fitbit recorded longer TST by an average of 14.6 (SD = 84.9) minutes, longer WASO by an average of 28.7 (SD = 40.5) minutes, more NWAK by an average of 16.7 (SD = 6.6) times per night, and higher SE by an average of 7.1% (SD = 14.4); but shorter TIB by an average of 24.4 (SD = 71.5) minutes. All the differences were statistically significant (all p < 0.05), except for TST (p = 0.38). Moderate correlations were found for TST (r = 0.41, p = 0.001) and TIB (r = 0.44, p < 0.001). Compared to no/mild insomnia group, participants with clinical insomnia reported more NWAK (p = 0.009) and lower SE (p = 0.029) as measured by CSD, but there were no differences measured byFitbit. TST was the only similar outcome between Fitbit and CSD. Our study highlights the advantages, disadvantages, and clinical utilization of sleep trackers in oncology.

Actigraphy-based sleep and muscle sympathetic nerve activity in humans.

Short and insufficient sleep are prevalent and associated with cardiovascular disease, with the sympathetic nervous system as a suspected mediator. The purpose of the present study was to investigate the association between objective, actigraphy-based total sleep time (TST), sleep efficiency (SE), and cardiovascular and sympathetic regulation in healthy adults. We hypothesized that short TST and low SE would be associated with elevated resting blood pressure, heart rate (HR), and muscle sympathetic nerve activity (MSNA). Participants included 94 individuals [46 males, 48 females, age: 30 ± 15 yr, body mass index (BMI): 26 ± 4 kg/m2]. All participants underwent at least 7 days of at-home, wristwatch actigraphy monitoring (avg: 10 ± 3 days). Seated blood pressures were assessed using brachial blood pressure measurements, followed by a 10-minute supine autonomic testing session consisting of continuous HR (electrocardiogram), beat-by-beat blood pressure (finger plethysmograph), and MSNA (microneurography) monitoring. Partial correlations were used to determine the relationship between sleep and cardiovascular parameters while accounting for the influence of age, sex, and BMI. TST was not associated with MAP (R = -0.105, P = 0.321), HR (R = 0.093, P = 0.383), or MSNA burst frequency (BF; R = -0.168, P = 0.112) and burst incidence (BI; R = -0.162, P = 0.124). Similarly, SE was not associated with MAP (R = -0.088, P = 0.408), HR (R = -0.118, P = 0.263), MSNA BF (R = 0.038, P = 0.723), or MSNA BI (R = 0.079, P = 0.459). In contrast to recent preliminary findings, our results do not support a significant association between actigraphy-based sleep duration or efficiency and measures of resting blood pressure, heart rate, and MSNA.NEW & NOTEWORTHY The present study investigated the independent association between actigraphy-based sleep duration, efficiency, and measures of blood pressure, heart rate, and muscle sympathetic nerve activity (MSNA) in adult males and females. Contrary to our hypothesis, the findings do not support an independent association between habitual sleep and cardiovascular or sympathetic neural activity. However, these findings do not preclude a potential association between these parameters in populations with sleep disorders and/or cardiovascular disease.

The relationship between wearable-derived sleep features and relapse in Major Depressive Disorder

BackgroundChanges in sleep and circadian function are leading candidate markers for the detection of relapse in Major Depressive Disorder (MDD). Consumer-grade wearable devices may enable remote and real-time examination of dynamic changes in sleep. Fitbit data from individuals with recurrent MDD were used to describe the longitudinal effects of sleep duration, quality, and regularity on subsequent depression relapse and severity. MethodsData were collected as part of a longitudinal observational mobile Health (mHealth) cohort study in people with recurrent MDD. Participants wore a Fitbit device and completed regular outcome assessments via email for a median follow-up of 541 days. We used multivariable regression models to test the effects of sleep features on depression outcomes. We considered respondents with at least one assessment of relapse (n = 218) or at least one assessment of depression severity (n = 393). ResultsIncreased intra-individual variability in total sleep time, greater sleep fragmentation, lower sleep efficiency, and more variable sleep midpoints were associated with worse depression outcomes. Adjusted Population Attributable Fractions suggested that an intervention to increase sleep consistency in adults with MDD could reduce the population risk for depression relapse by up to 22 %. LimitationsLimitations include a potentially underpowered primary outcome due to the smaller number of relapses identified than expected. ConclusionOur study demonstrates a role for consumer-grade activity trackers in estimating relapse risk and depression severity in people with recurrent MDD. Variability in sleep duration and midpoint may be useful targets for stratified interventions.

Polysomnography parameters in a large cohort of people with multiple sclerosis

BackgroundDisordered and disturbed sleep is quite common among people with multiple sclerosis (PwMS). It is associated with fatigue one of most disabling symptoms in MS. This study aims at comparing polysomnographic (PSG) sleep parameters in a large single cohort of PwMS from a single center to that of the published norms. Hence establishing PSG parameters in PwMS. MethodsThis is a retrospective review of 299 consecutive adult PwMS who were seen and evaluated with an overnight PSG at a Comprehensive MS Care Center between 11/19/2001 to 9/17/2014. Data extracted from the PSG included Total Sleep Time (TST), sleep efficiency (SE), sleep onset latency (SOL), Relative REM latency, total apnea-hypopnea indices (AHI), spontaneous arousal indices (AI), total periodic leg movements indices (PLMI) and, sleep architecture metrics including percentage spent in stages N1/N2, N3, and REM. ResultsPwMS, compared to normative data, had, on average, 85.9 min shorter TST (p < 0.001), 27.3 min longer SOL (p < 0.0001), 62.1 min longer REM latency (p < 0.0001), 10.7 % lower SE (p < 0.0001), 16.4 % more N1/N2 (p < 0.0001) and 11.4 % less N3 (p < 0.0001). REM latency The prevalence of Obstructive Sleep Apnea (OSA) was high at 60.7 % and the mean AHI was higher by 11.1 events per hour (p < 0.0001). ConclusionsThis study establishes PSG parameters in the largest PwMS cohort reported to date. It is important to be vigilant of sleep complaints in PwMS. Future prospective large single cohort studies with standardized methods are needed to further understand sleep disturbances in PwMS as well as their causes and implications.