Measures Of Sleep Disturbance Research Articles

A Pilot Study of Shoulder Placement for Actigraphy in Children

Children with neurodevelopmental disorders may have difficulty tolerating devices that monitor sleep, presenting challenges in measuring sleep disturbances in this population. Although wrist actigraphy has advantages over polysomnography, some children remain unable to tolerate wrist placement. This study piloted an alternative site for actigraphy in 8 children with autism, ages 6–10 years. Results are presented from the 2 locations (custom pocket shoulder location and wrist location) using Bland–Altman limits of agreement and other statistical measures to compare sleep onset latency, total sleep time, sleep efficiency, and wake after sleep onset. The use of an alternative actigraphy site for children with autism, who have difficulty tolerating actigraphy placement, appears promising and worthy of further study.

Insomnia and objectively measured sleep disturbances predict treatment outcome in depressed patients treated with psychotherapy or psychotherapy-pharmacotherapy combinations.

Insomnia and objectively measured sleep disturbances predict poor treatment outcomes in patients with major depressive disorder (MDD). However, prior research has utilized individual clinical trials with relatively small sample sizes and has focused on insomnia symptoms or objective measures, but not both. The present study is a secondary analysis that examines the degree to which insomnia, objective sleep disturbances, or their combination predicts depression remission following pharmacotherapy and/or psychotherapy treatment. Participants were 711 depressed (DSM criteria) patients drawn from 6 clinical trials. Remission status, defined as a score of ≤ 7 on the Hamilton Depression Rating Scale (HDRS) over 2 consecutive months, served as the primary outcome. Insomnia was assessed via the 3 sleep items on the HDRS. Objectively measured short sleep duration (total sleep time ≤ 6 hours) and prolonged sleep latency (> 30 minutes) or wakefulness after sleep onset (> 30 minutes) were derived from in-laboratory polysomnographic sleep studies. Logistic regression predicted the odds of nonremission according to insomnia, each of the objective sleep disturbances, or their combination, after adjusting for age, sex, treatment modality, and baseline depressive symptoms. Prolonged sleep latency alone (OR = 3.53; 95% CI, 1.28-9.73) or in combination with insomnia (OR = 2.11; 95% CI, 1.13-3.95) predicted increased risk of nonremission. In addition, insomnia and sleep duration individually and in combination were each associated with a significantly increased risk of nonremission (P values < .05). Findings suggest that objectively measured prolonged sleep latency and short sleep duration independently or in conjunction with insomnia are risk factors for poor depression treatment outcome.

Validity and reliability of the Taiwanese version of the Pittsburgh Sleep Quality Index in cancer patients

Background Sleep disturbance remains a common symptom among cancer patients. Assessment of sleep disturbance in cancer patients is hindered by infrequent use of standardized tools for sleep management. Objectives The purposes of this study were to validate the Taiwanese version of the Pittsburgh Sleep Quality Index (PSQI-T) and to determine detection cut-off points in cancer patients. Design A cross-sectional and descriptive correlational design. Participants A sample of 205 Taiwanese patients with various cancer diagnoses. Methods The survey included the Pittsburgh Sleep Quality Index-Taiwanese version, the MD Anderson Symptom Inventory-Taiwanese version, the Brief Fatigue Inventory-Taiwanese version, the seven-day sleep log, and Manual of Mental Disorders, Fourth Edition. Results The internal consistency Cronbach's alpha for the PSQI was 0.79. Test–retest reliability was 0.91 for the global score over a 20- to 28-day interval in a sample of 16 patients. Construct validity was established by a significant relationship of the PSQI-T global score to the total symptom severity score and the fatigue severity score. Convergent validity was examined by correlating the PSQI-T scores and scores of the DSM-IV and scores on the seven-day sleep log. Known-group validity was established by comparing PSQI-T scores for patients having low fatigue levels and those having high fatigue levels. Receiver-operating characteristic (ROC) curves were used to determine the detection cut-off points. Conclusions We found that a PSQI-T global score of 8 generates the best sensitivity and specificity for measuring sleep disturbance in cancer patients. The PSQI-T is a reliable, valid, and sensitive instrument for measuring sleep quality among Taiwanese cancer patients.

Increased Prevalence of Sleep Disorders and Medical Comorbidities in Psoriatic Arthritis Patients Compared with Patients with and without Psoriasis

Background The relationship between sleep quality and medical comorbidities of psoriasis and psoriatic arthritis is poorly understood. Objective To evaluate the association of sleep disturbance and medical comorbidities in patients with psoriasis and psoriatic arthritis compared with healthy volunteers. Methods This cross-sectional study compared patients with psoriasis, patients with psoriatic arthritis, and control participants. The Pittsburgh Sleep Quality Inventory (PSQI) and the Global Fatigue Scale were used to measure sleep disturbance and fatigue. Results The psoriatic arthritis, psoriasis, and control groups had elevated mean PSQI scores indicating poor sleep quality; the psoriatic arthritis group had the statistically highest mean score. Psoriatic arthritis patients had higher mean body mass index and a higher prevalence of diabetes, restless leg syndrome, and insomnia. Conclusions Poor sleep quality and medical comorbidities were prevalent in patients with psoriasis and psoriatic arthritis but are highest in patients with psoriatic arthritis. The link between sleep disorder, psoriatic disease, and medical comorbidities deserves more study.

Event-related potentials as a measure of sleep disturbance: A tutorial review

This article reviews event-related potentials (ERPs) the minute responses of the human brain that are elicited by external auditory stimuli and how the ERPs can be used to measure sleep disturbance. ERPs consist of a series of negative- and positive-going components. A negative component peaking at about 100 ms, N1, is thought to reflect the outcome of a transient detector system, activated by change in the transient energy in an acoustic stimulus. Its output and thus the amplitude of N1 increases as the intensity level of the stimulus is increased and when the rate of presentation is slowed. When the output reaches a certain critical level, operations of the central executive are interrupted and attention is switched to the auditory channel. This switching of attention is thought to be indexed by a later positivity, P3a, peaking between 250 and 300 ms. In order to sleep, consciousness for all but the most relevant of stimuli must be prevented. Thus, during sleep onset and definitive non-rapid eye movement (NREM) sleep, the amplitude of N1 diminishes to near-baseline level. The amplitude of P2, peaking from 180 to 200 ms, is however larger in NREM sleep than in wakefulness. P2 is thought to reflect an inhibitory process protecting sleep from irrelevant disturbance. As stimulus input becomes increasingly obtrusive, the amplitude of P2 also increases. With increasing obtrusiveness particularly when stimuli are presented slowly, a later large negativity, peaking at about 350 ms, N350, becomes apparent. N350 is unique to sleep, its amplitude also increasing as the stimulus becomes more obtrusive. Many authors postulate that when the N350 reaches a critical amplitude, a very large amplitude N550, a component of the K-Complex is elicited. The K-Complex can only be elicited during NREM sleep. The P2, N350 and N550 processes are thus conceived as sleep protective mechanisms, activated sequentially as the risk for disturbance increases. During REM sleep, the transient detector system again becomes somewhat activated, the amplitude of N1 reaching from 15 to 40% of its waking level. Very intense and/or very infrequently presented stimuli might elicit a P3-like deflection suggesting an intrusion into some aspect of consciousness. The types of experimental paradigms used in most ERP studies are quite different from those used in the study of noise and its effects on sleep. ERP studies will need to employ procedures that have greater ecological generalization; stimulus intensity needs to be lower, less abrupt, with much longer durations, and importantly, stimuli should be presented much less often.

Pediatric Obstructive Sleep Apnea and Adenotonsillectomy

Pediatric Obstructive Sleep Apnea and Adenotonsillectomy

Association Between Depressive Symptoms and Sleep Disturbances in Community‐Dwelling Older Men

To examine the association between depressive symptoms and subjective and objective measures of sleep in community-dwelling older men. Cross-sectional. Six U.S. clinical centers. Three thousand fifty-one men aged 67 and older. Depressive symptoms assessed using the 15-item Geriatric Depression Scale and categorized as 0 to 2 (normal, referent group), 3 to 5 (some depressive symptoms), and 6 to 15 (depressed); objective sleep measures ascertained using wrist actigraphy (mean duration 5.2 nights); and subjective sleep measures assessed using the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. There was a strong multivariable-adjusted association between level of depressive symptoms and subjective sleep disturbances (P-trend <.001). For example, the odds of reporting poor sleep quality were 3.7 times (95% confidence interval (CI)=2.5-5.3) higher for depressed men as for normal men, and 2.1 times (95% CI=1.7-2.6) higher for men with some depressive symptoms. For objectively measured sleep disturbances, men with more depressive symptoms had greater odds of sleep latency of 1 hour or more (P-trend=.006). There was no association between level of depressive symptoms and sleep efficiency, awakening after sleep onset, multiple long-wake episodes, or total sleep time. Excluding 384 men taking antidepressants, benzodiazepines, or other anxiolytic or hypnotics did not alter the results. Depressive symptoms have a strong, graded association with subjective sleep disturbances and are moderately associated with objectively measured prolonged sleep latency. Future studies should address temporality of depression and sleep disturbances.

Pediatric Obstructive Sleep Apnea and Adenotonsillectomy

Pediatric Obstructive Sleep Apnea and Adenotonsillectomy

The Relationship Between Objectively Measured Sleep Disturbance and Dementia Family Caregiver Distress and Burden

The aim of this study was to determine whether distress and burden were associated with objective measures of sleep disturbance in dementia caregivers. Using wrist actigraphy, sleep was measured in 60 female, Caucasian dementia family caregivers (mean age, 64.8 years). Caregivers completed questionnaires about demographics, health, depression, duration of caregiving and care recipient nighttime behavior. Care recipients completed a mental status exam. We investigated whether these measures were associated with actigraphic sleep parameters. Greater depressive symptoms among caregivers were associated with poorer sleep efficiency. Older caregiver age and poorer self-rated health were associated with longer time in bed. Sleep disturbance, which is common among dementia caregivers, might be an important index of caregiver distress (ie, depression) but might not be associated with burden (based on the care recipient's general cognitive impairment or nighttime awakenings.).

A Parent General Behavior Inventory Subscale to Measure Sleep Disturbance in Pediatric Bipolar Disorder

Sleep disturbance is a reliable marker for differentiating children with bipolar spectrum disorders from those with attention-deficit/hyperactivity disorder. Sleep-related items were extracted from the Parent General Behavior Inventory (P-GBI) to determine whether these items, as a scale unto themselves, demonstrate adequate psychometrics to be useful as a possible endophenotypic marker for bipolar spectrum disorders. From July 2003 to July 2007, 625 youths and their parents completed semistructured Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version interviews. Parents also completed the 73-item P-GBI. Participants with bipolar spectrum disorders (DSM-IV criteria) scored significantly higher than all other participants on all 7 of the sleep variables (p < .005). On receiver operating characteristic (ROC) analysis, the sleep subscale did substantially as well at discriminating participants with bipolar spectrum disorders as did either of the 2 built-in GBI scales, depression and hypomanic/biphasic (area under the ROC curve = 0.74 vs. 0.75 and 0.77, respectively). The P-GBI sleep subscale, developed in this study, is a reliable measure of a wide range of mood-related sleep problems in youths diagnosed with bipolar spectrum disorders. Sleep disturbance appears to be a promising endophenotype for further clinical investigation, and the P-GBI sleep scale may provide an inexpensive way of quantifying this trait for research. Further research needs to evaluate how parent report compares to objective measures of sleep efficiency, such as actigraphy or polysomnography.

Use of actimeters to determine awakenings by sounds of large guns

The U.S. Army has been using the day-night average sound level (DNL) to manage the community noise impact from heavy weapons noise since the late 1970's. In this case, the DNL is C-weighted as recommended by the National Academy of Sciences-National Research Council Committee on Hearing, Bioacoustics and Biomechanics (CHABA). CHABA's recommendation was justified by the fact that C-weighting (originally developed for the loudness of intense sounds) measures lower frequency sound energy in large guns which is otherwise missed by A-weighting. When the CHABA methodology was first adopted, there was relatively little night firing, but, today, night vision technology makes firing during darkness an absolute necessity for military readiness. Recognizing that the 10-dB penalty incorporated in the DNL methodology was not intended to predict sleep disturbance and that sleep disturbance may be a function of discrete noise event levels rather than annual-average noise levels, the U.S. Army Engineer Research and Development Center initiated a project to measure sleep disturbance among people living near tank gunnery ranges. A first step in this project was to evaluate whether a commonly-used instrument for measuring sleep disturbance, the actimeter, would be sensitive to awakenings from blast noise. After preliminary screening of three designs of actimeter, the preferred design was tested in cooperation with the Army Center for Health Promotion and Preventive Medicine with subjects sleeping inside the Army Research Laboratory's Hostile Environment Simulator. Subjects were exposed to nighttime blasts at two linear peak sound pressure levels (110 dB and 120 dB). The results confirmed that the preferred design would be a reliable and rugged instrument for the actual field study of awakening from live fire. This article is a government work and as such, is in the public domain and not subject to copyright.

Objective evidence of sleep disturbance in women with posttraumatic stress disorder

Although sleep disturbance is considered a hallmark of posttraumatic stress disorder (PTSD), objective evidence for sleep disturbance in patients with PTSD has been equivocal. The goal of the current investigation was to objectively examine sleep disturbance among women with PTSD in their home environment. Women with PTSD (n = 30) and a control group (n = 22) completed three nights of actigraphy monitoring. Results from actigraphy indicated that women with PTSD had poorer sleep efficiency, increased sleep latency, and more restless sleep. Actigraphy measures were moderately correlated with self-report sleep-log data, but were unrelated to scores on the Pittsburgh Sleep Quality Index. The current study provides evidence that women with PTSD have objectively measured sleep disturbance in their normal environment at home. Disturbed sleep may have important implications for the health and well-being of individuals with PTSD.

Current methodological approaches to the study of sleep disturbances and quality of life in adults with cancer: a systematic review

In recent years, sleep disturbances and the health-related quality of life (QOL) experienced by adults with cancer, during and after cancer treatment, have received increasing attention in the scientific literature. The purpose of this paper was to systematically review current methodological approaches to the study of sleep disturbances and QOL in adults with cancer. Databases were searched to identify longitudinal studies of adults with cancer that measured sleep disturbances and QOL in the past 10 years. The review was focused in five primary areas: trends in publication, measurement of sleep and QOL, study design, changes in sleep disturbances and QOL, and the level of this evidence. Of the 40 studies that met the authors' criteria for inclusion, 75% were descriptive in design and 25% were intervention studies. Studies on sleep and QOL among cancer patients have become more common since 2000, include a range of sample sizes and settings, use a variety of measures of sleep and QOL, and examine patients undergoing many types of cancer therapies. No programs of research have been developed in sleep disturbances and QOL in adults with cancer. The 'evidence' that can be drawn from such studies is obviously weak. Current approaches usually describe changes over time, but have not described whether a relationship exists between sleep disturbances and QOL in adults with cancer. Directions for future research are suggested.

Blast noise impacts on sleep

Firing large guns during the hours of darkness is essential to combat readiness for the military. At the same time most people are particularly sensitive to noise when sleeping or trying to fall asleep. Laboratory studies done by Griefahn [J. Sound and Vib. 128, 109–119 (1989)] and Luz [see Luz et al., ERDC/CERL, TR-04-26 (2004)] suggest that a time period at night may exist where people are more tolerant to large weapon impulse noise (blast noise) and therefore, are less likely to be awakened from noise events. In the fall of 2004, a field study was conducted around a military installation to determine if such a time period(s) exists. Noise monitors were set up inside and outside of residents homes to record noise levels from live military training activities and actimeters were worn by participants sleeping their natural environment to measure sleep disturbance and awakening. The method and results of this study will be presented. [Work supported by US Army Engineer Research and Development Center CERL.]

Clinical assessment of nocturnal disability in Parkinson’s disease

Research by our group and by others suggests that sleep disturbances are common in Parkinson’s disease (PD) and can occur at all stages of PD, and that virtually all PD patients suffer from varying levels of nocturnal disability causing sleep disruption.1–4⇓⇓⇓ The etiology is likely to be diverse, and includes degeneration of central sleep regulatory centers and the effect(s) of dopaminergic drugs.2,5⇓ The problem of nocturnal symptoms in PD is compounded by the fact that such symptoms arise from a multitude of causes, categorized as insomnia, motor, urinary, and neuropsychiatric symptoms, often with secondary daytime somnolence, and occasionally in the form of “sleep attacks,” although this remains controversial.6,7⇓ Conventional sleep assessment is based on anamnesis, caregiver or spouse reports, patients’ diaries, the usual PD rating scales, polysomnography, or video recordings.8 Currently available scales for measuring disability, such as the Unified Parkinson’s Disease Rating Scale (UPDRS),9 do not allow a formal clinimetric approach or do not provide a holistic assessment of sleep-related problems in PD. The newly developed and validated Parkinson’s Disease Sleep Scale (PDSS),10,11⇓ the first specific instrument designed to measure sleep disturbances in PD, aims to provide a bedside/clinical holistic measure of the nocturnal symptom complex of PD in a semi-quantitative manner. The gold standards for physiologic measurement of sleep and sleep parameters are polysomnography (PSG) and multiple sleep latency tests (MSLT). However, these tests measure sleep architecture, require measurements in specialized sleep laboratories, and are relatively expensive. Furthermore, they may not provide information on causes of sleep disabilities such as nocturnal tremor, nocturia, or akinesia. The Epworth Sleepiness Scale (ESS) has been widely used but is not specific to PD and measures only daytime somnolence.12 Problems with the use of ESS in PD include intercultural …

35 Sleep Characteristics of Young Alcohol Affected Children: A Quantitative and Qualitative Analysis

Fetal alcohol spectrum disorder refers to a group of phenotypic and behavioral anomalies associated with the use of alcohol in pregnancy, including growth retardation, craniofacial anomalies, and central nervous system involvement. Sleep disorders have been identified, but poorly described in fetal alcohol spectrum disorder. To quantitatively describe the sleep characteristics of children with fetal alcohol spectrum disorder, and to qualitatively describe the effects of sleep disruption on the affected child and their family. To develop appropriate sleep management strategies for children with fetal alcohol spectrum disorder and their families. A two part design was used. Nine children and their families were recruited from the Clinic for Alcohol and Drug Exposed Children at Children's Hospital in Winnipeg. Each study child was matched with a non-biologically related healthy control child in the same household. The first part of this research was a qualitative study of sleep using actigraphy to measure sleep disturbance. Actigraphic parameters were correlated with information from a pediatric sleep questionnaire designed for this study, and with a parent-maintained sleep log. The second part of the study consisted of a series of semi-structured interviews with the same families, with thematic analysis of the data. Actigraphic analysis showed significant differences in the mean duration of wake episodes (minutes, p=0.0072) and the mean duration of sleep episodes (minutes, p=0.0064). The differences in the number of wake episodes was also significant (p=0.0241) as was the number of sleep episodes (p=0.0214). These data support observably more restless sleep in alcohol affected children. Questionnaire analysis supports a significant degree of concern among families of these children, who identify disrupted and restless sleep patterns, along with daytime behavioral concerns including daytime fatigue and hyperactivity. Alcohol affected children were described as having five times as many sleep related behaviors as control children. Thematic analysis of the interviews supports a significant impact of sleep disruption in families caring for these children. Actigraphic analysis supports significantly disrupted sleep patterns in alcohol affected children, with frequent wakenings and greater restlessness in sleep. Families are more likely to identify sleep disruption in alcohol affected children, describing excessive movements in sleep with associated daytime fatigue and hyperactivity. While there is a significant impact of sleep disturbance and related behaviors on families caring for these children, appropriate management and understanding of these problems is important to support families who care for these children.

Parkinson's Disease Sleep Scale: validation study of a Spanish version.

The Parkinson's Disease Sleep Scale (PDSS) is the first published bedside clinical tool to specifically measure sleep disturbances in Parkinson's disease (PD). The objective of the present study was to carry out a metric analysis of a Spanish version (PDSS-SV) using a cross-sectional study of 100 PD patients who participated in the study. Usual measures for PD and mental status were applied by neurologists. Patients completed the Epworth Sleepiness Scale, Parkinson's Disease Questionnaire-39 Items (PDQ-39), and PDSS-SV. PDSS internal consistency (Cronbach's alpha, 0.77; significant item-total correlation for 11 items) was satisfactory. PDSS showed high test-retest reliability (intraclass correlation coefficient for items, 0.79-0.99; for total score, 0.94). Standard error of measurement was 9.80 (crossover) and 5.01 (longitudinal). Scores were distributed uniformly, with low floor and ceiling effect (1%). PDSS scores were correlated significantly with depression (Hamilton Depression Rating Scale, r(S) = -0.55; P < 0.0001) and quality of life (PDQ-39 Summary Index, r(S) = -0.26; P = 0.007), but not with clinical variables. Self-perception of mood disorder, pain, or hallucinations correlated individually with PDSS scores, and a factor explaining 65% of the variance was found. The assessment of PD sleep disorders with the PDSS met some basic standards required for health status measures.

An assessment of quality of sleep and the use of drugs with sedating properties in hospitalized adult patients

BackgroundHospitalization can significantly disrupt sleeping patterns. In consideration of the previous reports of insomnia and apparent widespread use of benzodiazepines and other hypnotics in hospitalized patients, we conducted a study to assess quality of sleep and hypnotic drug use in our acute care adult patient population. The primary objectives of this study were to assess sleep disturbance and its determinants including the use of drugs with sedating properties.MethodsThis single-centre prospective study involved an assessment of sleep quality for consenting patients admitted to the general medicine and family practice units of an acute care Canadian hospital. A validated Verran and Snyder-Halpern (VSH) Sleep Scale measuring sleep disturbance, sleep effectiveness, and sleep supplementation was completed daily by patients and scores were compared to population statistics. Patients were also asked to identify factors influencing sleep while in hospital, and sedating drug use prior to and during hospitalization was also assessed.ResultsDuring the 70-day study period, 100 patients completed at least one sleep questionnaire. There was a relatively even distribution of males versus females, most patients were in their 8th decade of life, retired, and suffered from multiple chronic diseases. The median self-reported pre-admission sleep duration for participants was 8 hours and our review of PharmaNetR profiles revealed that 35 (35%) patients had received a dispensed prescription for a hypnotic or antidepressant drug in the 3-month period prior to admission. Benzodiazepines were the most common sedating drugs prescribed. Over 300 sleep disturbance, effective and supplementation scores were completed. Sleep disturbance scores across all study days ranged 16–681, sleep effectiveness scores ranged 54–402, while sleep supplementation scores ranged between 0–358. Patients tended to have worse sleep scores as compared to healthy non-hospitalized US adults in all three scales. When compared to US non-hospitalized adults with insomnia, our patients demonstrated sleep disturbance and supplementation scores that were similar on Day 1, but lower (i.e. improved) on Day 3, while sleep effectiveness were higher (i.e. better) on both days. There was an association between sleep disturbance scores and the number of chronic diseases, the presence of pain, the use of bedtime tricyclic antidepressants, and the number of chronic diseases without pain. There was also an association between sleep effectiveness scores and the length of hospitalization, the in hospital use of bedtime sedatives and the presence of pain. Finally, an association was identified between sleep supplementation scores and the in hospital use of bedtime sedatives (tricyclic antidepressants and loxapine), and age. Twenty-nine (29%) patients received a prescription for a hypnotic drug while in hospital, with no evidence of pre-admission hypnotic use. The majority of these patients were prescribed zopiclone, lorazepam or another benzodiazepine.ConclusionsThe results of this study reveal that quality of sleep is a problem that affects hospitalized adult medical service patients and a relatively high percentage of these patients are being prescribed a hypnotic prior to and during hospitalization.

Sleep and Behavior in ADHD

Potential relationships between objectively measured sleep disturbances and neurobehavioral function in a community cohort of 5- to 7-year old children with parentally reported symptoms of ADHD were investigated at the University of Louisville, KY.

Worry and Sleep Length Revisited: Worry, Sleep Length, and Sleep Disturbance Ascribed to Worry

The author administered university students (N = 222; 152 women, 70 men) the Worry Domains Questionnaire (F. Tallis, G. C. L. Davey, & A. Bond, 1994) and a newly constructed scale (the Sleep Disturbance Ascribed to Worry Scale) to measure sleep disturbance attributed to worry. To revisit previous studies (i.e., E. Hartmann, F. Baekeland, & G. R. Zwilling, 1972; S. J. H. McCann & L. L. Stewin, 1988) that suggested that sleep length was positively related to worry, the author also asked the students a question about habitual sleep length. The results indicated that worry and sleep disturbance attributed to worry were negatively related to sleep length. A regression analysis revealed that worry was significantly negatively related to habitual sleep length irrespective of sleep disturbance ascribed to worry.