Objective Sleep Assessment Research Articles

Sleep effects of Ketogenic diet in pediatric patients with migraine: Preliminary data of a prospective study

Objective/backgroundKetogenic dietary therapies’ effects on sleep have been poorly investigated up to date. Preliminary results of a prospective study aimed at evaluating possible sleep changes in pediatric patients with migraine treated with classic ketogenic diet are presented. Patients/methodsIncluded patients were aged 14-18 years and had a diagnosis of chronic migraine. A customized classic ketogenic diet was drawn up for all patients and all participants underwent neurological, nutritional and subjective and objective sleep assessment at baseline and after three months of follow-up (standardized sleep questionnaires, polysomnography, actigraphy). ResultsThe majority of patients reported an improvement in migraine symptoms and quality of life. As far as sleep effects, a possible sleep stabilization was evidenced according to actigraphic data, and polysomnographic data showed a slight increase in total sleep time and sleep efficiency together with a reduction in waking time during night and a trend of NREM stage 1 decrease and REM increase. ConclusionsFuture analyses on a broader population are needed to shed light on the ketogenic dietary therapies’ effects on sleep and future research should be devoted to identify influence of possible individual and diet characteristics, and biochemical related changes.

The objective assessment of sleep in cluster headache: State of the art and future directions.

Several lines of evidence suggest that cluster headache is related to chronobiology and sleep. Nevertheless, the nature of such a relationship is unclear. In this view, the objective evaluation of sleep in cluster headache has strong theoretical and clinical relevance. Here, we provide an in-depth narrative review of the literature on objective sleep assessment in cluster headache. We found that only a small number of studies (N = 12) focused on this topic. The key research aims were directed to assess: (a) the relationship between cluster headache and sleep breathing disorders; (b) the temporal relationship between sleep stages/events and cluster headache attacks; (c) sleep macrostructure in patients with cluster headache. No studies considered sleep microstructure. The reviewed studies are heterogeneous, conducted by a few research groups, and often characterised by relevant methodological flaws. Results are substantially inconclusive considering the main hypothesis. We outline several methodological points that should be considered for future research, and suggest that evaluating sleep microstructure, local sleep electrophysiology and actigraphic measures may strongly increase knowledge on the relationship between sleep and cluster headache.

The Potential Role of Sleep in Post-stroke Motor Learning

Stroke is the primary contributor to the commencement of adult disability in the United Kingdom, and individuals who survive a stroke frequently encounter challenges in reacquiring motor abilities, which has a substantial influence on their overall well-being. Sleep disturbance is a prevalent issue affecting approximately 50% of those who have experienced a stroke. The established literature demonstrates the advantageous impacts of sleep on motor learning in individuals without health complications. However, the precise contribution of sleep to motor learning in individuals recovering from stroke remains inadequately comprehended. The objective of this review was to analyze and consolidate the available research pertaining to motor learning after stroke, with the intention of ascertaining the presence and mechanisms of this association. Sleep-induced motor learning has two distinct phases, namely sleep preceding learning (SBL) and sleep after learning (SAL). These stages facilitate the consolidation of memory and reinforce the connections between different regions of the cerebral cortex, thereby decreasing the need for the medial temporal lobe (MTL) to bind information. There is a limited yet promising body of evidence suggesting that sleep has a role in modulating motor learning and rehabilitation outcomes following a stroke. There is evidence suggesting that sleep has a positive impact on motor learning following a stroke. Several studies have shown that stroke patients exhibit increased tracking accuracy after a night of sleep compared to those who do not sleep. Sleep disruptions have an adverse effect on the functional recovery of those who have experienced a stroke, with a special emphasis on those who have suffered from moderate strokes. There exists a correlation between suboptimal sleep patterns and impaired motor recovery following a stroke, however the use of sedative medications does not yield substantial enhancements in sleep quality or rehabilitation outcomes. Moreover, the utilization of sedatives may potentially have adverse effects on memory function and neural connectivity. Although the current research shows promise, it is important to acknowledge its limitations, which include the use of subjective sleep assessments and cross-sectional study designs. In order to demonstrate a more conclusive relationship between sleep and post-stroke motor recovery, future research endeavors should incorporate objective sleep assessment techniques, longitudinal methodologies, and randomized crossover designs. In summary, the current body of research suggests a potentially beneficial impact of sleep on motor learning following a stroke. However, it is important to exercise caution when interpreting these findings due to limitations in the methodologies employed. In order to comprehensively comprehend the influence of sleep on post-stroke motor recovery, it is imperative to conduct further research employing robust study designs and objective sleep assessment techniques. Such investigations have the potential to enhance rehabilitation efforts and mitigate healthcare expenses.

Effects of exercise timing and intensity on physiological circadian rhythm and sleep quality: a systematic review.

Humans show near-24-h physiological and behavioral rhythms, which encompass the daily cycle of sleep and wakefulness. Exercise stimulates circadian rhythms, including those of cortisol, melatonin, and core body temperature, and affects sleep quality. We systematically reviewed studies that examined the effects of exercise intensity and timing on physiological circadian rhythms and sleep quality. In this systematic review, we used the online databases PubMed, Science Direct, Web of Science, and Embase. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent and experienced systematic reviewers performed the search and selected relevant studies. The participant, intervention, comparison, and outcome characteristics were: (1) adults; (2) exercise treatment; (3) no exercise treatment or different types of exercise (pre-exercise baseline); (4) cortisol, melatonin, or core body temperature measurement, and subjective or objective sleep quality assessments. We identified 9 relevant articles involving 201 participants (77.1% of whom were male). Our review revealed that short-term evening exercise delayed melatonin rhythm and increased nocturnal core body temperature; however, no negative effects on non-rapid eye movement sleep and sleep efficiency were observed. Moreover, no differences in sleep quality were observed between acute high-intensity and moderate-intensity exercises. With long exercise durations, the core body temperature tended to increase and return to baseline levels at 30-120 min. Our review showed that short-term evening exercise and high-intensity exercise did not have a significant negative effect on sleep quality but physiological circadian rhythm tended to alter. Longterm morning exercise tended to decrease cortisol concentrations after awakening and improve sleep quality. Future studies should examine the effects of long-term exercise timing and intensity on circadian rhythm and sleep.

Associations between Birth Weight and Adult Sleep Characteristics: A Cross-Sectional Analysis from the UAEHFS.

Abnormal birth weight, particularly low birth weight (LBW), is known to have long-term adverse health consequences in adulthood, with disrupted sleep being suggested as a mediator or modifier of this link. We thus aimed to assess the associations between birth weight and self-reported adult sleep characteristics: sleep duration, difficulty waking up in the morning, daily nap frequency, sleep problems at night, snoring, daytime tiredness or sleepiness, and ever-stop breathing during sleep. This cross-sectional analysis used the United Arab Emirates Healthy Future Study data collected from February 2016 to March 2023 involving 2124 Emiratis aged 18-61 years. We performed a Poisson regression under unadjusted and age-sex-and-BMI-adjusted models to obtain the risk ratio and its 95% confidence interval for our analysis of the association between birth weight and each adult sleep characteristics, compared to individuals with normal birth weight (≥2.5 kg). Those with LBW had significantly a 17% increased risk of difficulty waking up in the morning, compared to those with normal birth weight. In addition, females with LBW history were also at an increased risk of reporting difficulty waking up in the morning. Studies with objective sleep assessments that include measurements of more confounding factors are recommended to confirm these risks.

Objective assessment of fatigue, sleep and insomnia in breast cancer survivors on estrogen deprivation therapy.

TPS12145 Background: Fatigue, insomnia and sleep problems are common among breast cancer survivors (BCS). These symptoms remain underassessed, underreported and undertreated. Validated and objective measures of sleep metrics have yet to be widely incorporated into BCS studies to help examine the role that these play on patient patient reported fatigue and insomnia. While more than 50% of BCS experience fatigue and insomnia, most research on BCS fatigue is limited to short-term, self-report data that does not objectively assess sleep metrics. Estrogen Deprivation Therapy (EDT) has been shown to exacerbate sleep problems and contribute to perceptions of fatigue and insomnia, yet there is a paucity of research examining the specific effects of EDT on sleep metrics over time, especially objective measures. Wrist actigraphy is a non-invasive, objective measure of rest/activity cycles and sleep via a wrist-worn device. This study utilizes a novel instrument, called Readiwatch (Fatigue Sciences). It is widely validated in the military and in industry but has not been used in patient studies. The Readiwatch assesses fatigue and estimates cognitive performance, based on the Sleep Activity and Task Effectiveness (SAFTE) model developed in conjunction with the Department of Defense in 2004. The Readiwatch syncs with the Fatigue Avoidance Scheduling Tool (FAST) app on the participant’s smartphone to provide a score, called Readiscore, based on previous sleep and activity. It has been shown to have greater than 92% accuracy with lab polysomnography results. The Readiscore also serves as a “cognition” measure that represents the person’s cognitive capacity based on sleep metrics. This novel, objective feedback to the BCS could be very accessible and useful in community medical practice. Methods: This single-center, pilot study of BCS, receiving endocrine therapy, possessing a smartphone and Scoring >8 on the Insomnia Severity Index (ISI), has enrolled 25 of 50 planned participants. Participants wear the Readiwatch for two months to objectively assess their sleep metrics. Patient reported levels of fatigue and insomnia will be assessed prior to, midway, and following the two-month period. Participants document their self-reported experiences through surveys and track their own sleep and fatigue metrics using their smartphone app. At the conclusion of the study participants are provided with personalized feedback about their sleep metrics, along with detailed information related to sleep hygiene. Data analysis will model the effect of actigraphy fatigue measures on reported pain, anxiety, depression, and cognitive impairment and will also examine sleep metrics, perceptions of fatigue and insomnia scores in relation to type of EDT the patient is currently undergoing to determine if there are specific types of adjuvant therapy that are associated with fewer fatigue and insomnia problems.

0388 Comparison of objective and subjective sleep evaluations based on with or without insomnia symptoms among Japanese city employees

Abstract Introduction Discrepancies between subjective and objective assessments of sleep duration and onset latency have been reported among insomnia patients. However, such discrepancies have not been well studied in the general population or working populations with sleep EEG measurements. The aim of this study was to compare subjective and objective assessments of sleep at home in a working population. Methods Between 2017 and 2019, a questionnaire survey including the Athens Insomnia Scale (AIS) and home 1-Ch electroencephalograph (EEG) measurements were conducted among municipal employees in Koka, Shiga Prefecture, Japan (NinJaSleep study). Sleep duration and sleep onset latency (SL) on weekdays answered in the questionnaire were used as the subjective evaluation. Sleep duration and SL determined with 1-Ch EEG were used as the objective evaluation. AIS≥6 was defined as having insomnia. The study protocol was approved by the Ethics Committee of the Shiga University of Medical Science. Results 646 employees (44.7 ± 11.5 years, AIS: 5.4 ± 3.6 points) participated in the study. In the with-insomnia group (AIS≥6, n=274), no significant difference was found between subjective and objective sleep duration (347.1±75.8 min vs. 355.1±78.9 min, p=0.153), and subjective SL was longer than objective SL (24.5±20.2 min vs. 19.5±18.8 min, p=0.002). In the without-insomnia group (AIS< 6, n=372), no significant differences were found between subjective and objective evaluations in both sleep duration (372.3±64.6 min vs. 369.9±78.6 min, p=0.597) and SL (18.9±15.8 min vs. 16.9±12.3 min, p=0.259). Conclusion In the with-insomnia group, subjective SL was perceived longer than the objective SL. No differences were found between subjective and objective sleep duration both in with and without insomnia groups, which may come from the study performed in a working population. Support (if any) Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. / MSD K.K. The funders had no role in the study design, data collection, analyses, interpretation, writing of the manuscript, or in the decision to publish the results.

0882 The Longitudinal Relationship between Objective Sleep and Cardiovascular Parameters During Pregnancy

Abstract Introduction Growing evidence shows the important role of sleep on cardiovascular health in pregnant women with nearly 50% self-reporting poor sleep quality and 30% insufficient sleep. These sleep disturbances have been associated with adverse perinatal outcomes (e.g., hypertension, preterm births). Many studies have only used self-reported questionnaires during pregnancy. However, a few studies have utilized sleep labs and found that subjective and objective assessments of sleep varied from poor to low associations. The aim of this study was to examine the longitudinal relationship between objective sleep and cardiovascular parameters in pregnant women. Methods Seventeen healthy pregnant women with 88% self-identifying as Hispanic were consented to participate in the longitudinal observation study. Their average age was 27.8 years (SD=4.48). A validated Oura ring was used to daily monitor objective sleep and cardiovascular parameters across the pregnancy, including resting heart rate (HR), heart rate variability (HRV) indicated by RMSSD (root mean square of successive differences) of interbeat intervals, deep, light, and Rapid EYE Movement (REM) sleep, awake time and sleep onset latency. Mixed effects models were conducted to analyze daily changing patterns of these parameters using R-4.2.0 for Mac. Results Over the pregnancy, when deep and light sleep increased by 1 hour, heart rate decreased by 5.55 bpm (p< 0.001) and 1.32 bpm (p = 0.01), respectively; when REM sleep increased by 1 hour, heart rate increased by 2.15 bpm (p =0.049). Conversely, when deep and light sleep increased by 1 hour, RMSSD increased by 10.32 ms (p< 0.001) and 2.93 ms (p< 0.02), respectively; when REM sleep increased by 1 hour, RMSSD decreased by 7.27 ms (p=0.001). There were no significant associations between HR/RMSSD and awake time/sleep onset latency. Conclusion This study appears to be the first to investigate the longitudinal relationship between sleep and cardiovascular parameters among primarily Hispanic pregnant women in the U.S. in a non-lab setting. Our study provides preliminary evidence that longer deep/light sleep and shorter REM sleep may improve cardiovascular health among pregnant women. Support (if any) National Science Foundation grants including the Smart and Connected Communities (CNS: 1831918) and Collaborative Research: Integrative Heterogeneous Learning for Intensive Complex Longitudinal Data (DMS: 2210640).

0625 Sleep when the baby sleeps? The effect of daytime nap behaviors on postpartum depression severity: a stress buffering hypothesis

Abstract Introduction The early postpartum is a time of expected maternal sleep loss, normalized as part of infant care. While short duration and disrupted nocturnal sleep are posited risk factors for postpartum depression (PPD), the role of daytime sleep remains less understood, despite the widespread recommendation that mothers sleep when their baby is sleeping. This study examined associations between napping, stress, and longitudinal PPD in a sample of in a sample of healthy first-time mothers, using a prospective ambulatory field study design. Methods Fifty primiparous women (62% non-White; mean age=32 years) without a history of sleep disorders or psychopathology completed 10-days (9-nights) of actigraphy and sleep diaries at postpartum week 6. Sleep variables included nighttime duration and efficiency, and daytime nap frequency, timing and duration. Participants completed 3-days of superimposed ecological momentary assessment (EMA) rating naturalistic infant-related stressors (task demand; effort-reward-imbalance) at four daily intervals. Hierarchical mixed models tested whether daytime sleep characteristics predicted lower depression levels (via Edinburgh Postnatal-Depression Scale - EPDS) at 6-weeks, 8-weeks, and 3-months postpartum. Time-varying within-person covariates included time-of-day, baseline depression and anxiety (via Generalized-Anxiety-Disorder-7 scores), and previous night sleep. To test the putative stress-protective role of napping, we examined pre-post nap differences in EMA ratings. Results Sixty percent (n = 30/47) of women napped regularly (>3x/1 week, between 1-5 PM, < 90 min by both diary and actigraphy), rating 80% of these naps “intentional.” Women with greater nap regularity at 6-weeks had lower depression levels at all timepoints (Betas = -2.4(1.6); -1.4(.5), -.5(.01) ps<.001, respectively), and less of an increase in depression symptoms at 3-months postpartum, compared to non-nappers [Beta(SE)=-1.2 (.5); R^2=.21; p<.001]. At 6-weeks, regular nappers reported lower stress post-nap (effort-reward-imbalance; demand) [Beta(SE)=-6.3(1.4); 1.2(.12,), R^2=.27, .32, respectively; ps<.01]. Conclusion This study demonstrates a contemporaneous mood-protective role of daytime sleep in a perinatal sample, using 24-hr objective sleep assessment coupled with daily assessments of naturalistic stressors. Moreover, these results provide support for the protective role of regular daytime sleep on development of PPD over time. Among new mothers who regularly nap, lowered post-nap stress may be one pathway through which daytime sleep buffers against PPD severity. Support (if any) NIMH-1R36MH118000-01, CTSI89431, T32-HL007713

Assessing a Sleep Interviewing Chatbot to Improve Subjective and Objective Sleep: Protocol for an Observational Feasibility Study

Sleep disorders are common among the aging population and people with neurodegenerative diseases. Sleep disorders have a strong bidirectional relationship with neurodegenerative diseases, where they accelerate and worsen one another. Although one-to-one individual cognitive behavioral interventions (conducted in-person or on the internet) have shown promise for significant improvements in sleep efficiency among adults, many may experience difficulties accessing interventions with sleep specialists, psychiatrists, or psychologists. Therefore, delivering sleep intervention through an automated chatbot platform may be an effective strategy to increase the accessibility and reach of sleep disorder intervention among the aging population and people with neurodegenerative diseases. This work aims to (1) determine the feasibility and usability of an automated chatbot (named MotivSleep) that conducts sleep interviews to encourage the aging population to report behaviors that may affect their sleep, followed by providing personalized recommendations for better sleep based on participants' self-reported behaviors; (2) assess the self-reported sleep assessment changes before, during, and after using our automated sleep disturbance intervention chatbot; (3) assess the changes in objective sleep assessment recorded by a sleep tracking device before, during, and after using the automated chatbot MotivSleep. We will recruit 30 older adult participants from West London for this pilot study. Each participant will have a sleep analyzer installed under their mattress. This contactless sleep monitoring device passively records movements, heart rate, and breathing rate while participants are in bed. In addition, each participant will use our proposed chatbot MotivSleep, accessible on WhatsApp, to describe their sleep and behaviors related to their sleep and receive personalized recommendations for better sleep tailored to their specific reasons for disrupted sleep. We will analyze questionnaire responses before and after the study to assess their perception of our proposed chatbot; questionnaire responses before, during, and after the study to assess their subjective sleep quality changes; and sleep parameters recorded by the sleep analyzer throughout the study to assess their objective sleep quality changes. Recruitment will begin in May 2023 through UK Dementia Research Institute Care Research and Technology Centre organized community outreach. Data collection will run from May 2023 until December 2023. We hypothesize that participants will perceive our proposed chatbot as intelligent and trustworthy; we also hypothesize that our proposed chatbot can help improve participants' subjective and objective sleep assessment throughout the study. The MotivSleep automated chatbot has the potential to provide additional care to older adults who wish to improve their sleep in more accessible and less costly ways than conventional face-to-face therapy. PRR1-10.2196/45752.

Transdiagnostic association between subjective insomnia and depressive symptoms in major psychiatric disorders.

In psychiatric disorders, comorbid depressive symptoms are associated with clinically important issues such as reduced quality of life, a poor prognosis, and increased suicide risk. Previous studies have found a close relationship between insomnia and depressive symptoms in major depressive disorder (MDD), and that actively improving insomnia heightens the improvement of depressive symptoms. This study aimed to investigate whether the association between insomnia and depressive symptoms is also found in other psychiatric disorders besides MDD. The subjects were 144 patients with MDD (n = 71), schizophrenia (n = 25), bipolar disorder (n = 22), or anxiety disorders (n = 26). Sleep status was assessed subjectively and objectively using the Athens Insomnia Scale (AIS) and sleep electroencephalography (EEG), respectively. Sleep EEG was performed using a portable EEG device. Depressive symptoms were assessed using the Beck Depression Inventory. Subjective insomnia, as defined by the AIS, was associated with depressive symptoms in all disorders. Moreover, in schizophrenia, a relation between depressive symptoms and insomnia was also found by objective sleep assessment methods using sleep EEG. Our findings suggest that the association between subjective insomnia and depressive symptoms is a transdiagnostic feature in major psychiatric disorders. Further studies are needed to clarify whether therapeutic interventions for comorbid insomnia can improve depressive symptoms in major psychiatric disorders, similar to MDD.

Feasibility of a new homebased ballistocardiographic tool for sleep-assessment in a real-life context among workers.

There is a need for simple and suitable tools for assessing sleep in a natural home environment. This study explores the feasibility in terms of implementation and acceptability of a new homebased ballistocardiographic (BCG) tool for objective sleep-assessment in a real-life context. The participants included thirty-nine workers, taking part in two seven nights' sleep-assessment periods. Objective data regarding sleep was collected with BCG. Subjective data regarding sleep was collected with a sleep diary. Implementation was analysed by determining the number of nights with usable signal quality and comparing with the total number of potential nights and by exploring associations between objective and subjective sleep data. Acceptability was analysed by categorizing the participants' experiences of how the BCG tool impacted the sleep. In terms of implementation, usable BCG data increased from 40% at assessment phase 1 to 70% during assessment phase 2. Moreover, in assessment phase 2, there was a significant moderate correlation between the 'time in bed' assessed by the BCG and in sleep diary by participants in the first five nights. In terms of acceptability, almost one third of the participants did not experience any impact of the BCG on the sleep. Two participants experienced a major negative impact on the sleep. This study indicates that the novel BCG tool could be feasible for objective assessing of sleep in workers natural home-environment in the future, but there is still a need for development of the BCG both regarding technology and implementation process.

Effect of Aerobic Exercise Training on Sleep and Core Temperature in Middle-Aged Women with Chronic Insomnia: A Randomized Controlled Trial

Exercise represents a viable non-pharmacological intervention to help treating insomnia but the interaction mechanisms between sleep and physical activity still remain poorly understood. The aim of this study was to investigate the effect of a aerobic exercise training intervention on sleep and core temperature. Twenty-four adult women suffering from insomnia participated in this study. They were randomized into an exercise group and a control group. Aerobic exercise training consisted in moderate to vigorous aerobic exercise training for 12 weeks. Outcome measures included both subjective (Insomnia Severity Index, ISI) and objective (actigraphy recordings) sleep quality assessments, and core body temperature continuously recorded for a minimum 24 h. The exercise group showed a decrease in ISI (p < 0.001) and in various objective sleep parameters. The core temperature batyphase value was lowered (p = 0.037) whereas its amplitude was larger (p = 0.002). We also found a tight correlation between the evolution of insomnia and the evolution of mean night-time core temperature and batyphase values. A moderate to vigorous aerobic exercise program appears to be an effective non-drug therapy for improving sleep in women with insomnia. In addition, exercise programs should aim to increase core body temperature during practice to induce sleep-promoting adaptations and rebound.

Characterization of sleep among deaf individuals

ObjectivesNumerous health disparities are documented in deaf population research, but few empirical sleep assessments exist for this under-served population, despite knowledge that sleep contributes to physical and mental health disparities. We sought to document subjective and objective sleep in deaf adults with cross-sectional and prospective measures. MethodsTwenty deaf participants completed validated sleep and mental health questionnaires, 2-weeks of nightly sleep diaries and continuous wrist-worn actigraphy monitoring, and 1-week of nightly, reduced-montage EEG recordings. ResultsQuestionnaire data suggest high prevalence of insomnia (70%), poor sleep (75%), daytime sleepiness (25%) and nightmares (20%) among participants. Strong correlations were found between depression and sleep quality, fear of sleep, and insomnia severity (p’s < .005). Objective sleep assessments suggest elevated wake after sleep onset and low sleep efficiency and sleep duration. ConclusionsThe prevalence of sleep disturbance recorded from self-report and objective sleep measures provides preliminary evidence of sleep health disparity among deaf adults.

Habitual night waking associates with dynamics of waking cortical theta power in infancy.

The implications of the substantial individual differences in infant sleep for early brain development remain unclear. Here, we examined whether night sleep quality relates to daytime brain activity, operationalized through measures of EEG theta power and its dynamic modulation, which have been previously linked to later cognitive development. For this longitudinal study, 76 typically developing infants were studied (age: 4-14 months, 166 individual study visits) over the course of 6months with one, two, three, or four lab visits. Habitual sleep was measured with a 7-day sleep diary and actigraphy, and the Brief Infant Sleep Questionnaire. Twenty-channel EEG was recorded while infants watched multiple rounds of videos of women singing nursery rhymes; oscillatory power in the theta band was extracted. Key metrics were average theta across stimuli and the slope of change in theta within the first novel movie. Both objective and subjective sleep assessment methods showed a relationship between more night waking and higher overall theta power and reduced dynamic modulation of theta over the course of the novel video stimuli. These results may indicate altered learning and consolidation in infants with more disrupted night sleep, which may have implications for cognitive development.

Actigraphy-measured sleep concordance, night-wakings, intraindividual sleep variability in parents and their children-Associations with childhood sleep disturbances.

The relationship between the sleep of parents and their children has primarily been studied using self-reported measures, but data using objective sleep assessments are limited. In particular, objective assessments of sleep disturbance and night-wakings in parents in relation to their children's night-wakings is underexamined. This pilot study employed actigraphy to determine concordance in sleep-wake patterns between parents and their children, and examine temporal links between their wakings lasting five min or longer. The study also explored individual variability in parents' sleep based on parent-reported sleep disturbances in children. A total of 20 parents and children (aged 2-12 years, no co-sleepers) contributed actigraphy data for the 14-night study, totalling 280 nights of data. Parents reported their sleep quality using the Pittsburgh Sleep Quality Index, and children's sleep using the Children Sleep Habits Questionnaire. Concordance analysis of actigraphy data revealed an average of 70.6% match in sleep/wake state between parents and children. Parents were three times more likely to have an awakening within 10 min of their child waking than vice versa. Parent-reported sleep disturbances in children were associated with poorer actigraphic sleep outcomes for both the parent and child. Parents of poorly sleeping children demonstrated greater variability in their bedtime, and wake after sleep onset. Further examination of temporal links between parent-child sleep can improve our understanding of factors that predispose or precipitate sleep disturbances across families. Given the high concordance in parent-child sleep and poorer actigraphy sleep outcomes in parents of children with sleep disturbances, there is a need to deliver efficacious sleep interventions at the family level.

Objective assessment of sleep and fatigue risk in emergency medicine physicians.

Fatigue is a state of physical and mental exhaustion in which people feel exhausted or drained of energy. Shift workers are highly vulnerable to fatigue, and this is especially true of emergency physicians (EPs). Shift scheduling (shift hours, frequency/length of breaks, time of shift, and number of hours off between shifts) can affect levels of fatigue in EPs. When EPs are fatigued, they experience decrements in cognition, resulting in an increased risk of errors. This study assessed the state of fatigue in EPs in the emergency department of a large, urban hospital using objective measures (sleep metrics and shift scheduling) over multiple months. Seventeen EPs, nine females, wore wrist-activity monitors called ReadiBands for 2 months. The ReadiBand is an objective actigraphy measure that communicates with a smartphone application to quantify sleep metrics and predict future fatigue. Throughout the 3083 on-shift hours of data, analyses revealed that EPs have poor sleep quality (mean ± SD 7.71 ± 1.84/10) and sleep quantity (mean ± SD 6.77 ± 1.66 h), with sleep efficiency within "normal" ranges (mean ± SD 87.26 ± 9.00). Participants spent 725 h (23.52%) on shifts with fatigue scores indicative of significant impairment (equivalent to BAC of .08%). In addition, results indicated that shift type (day, evening, night) was significantly associated with fatigue score, where night shifts were associated with higher fatigue scores. Fatigue is an issue for many EPs. The present study addressed the percentage of time EPs are in a fatigued state when on shift over an extended duration of time. More research is needed to examine system-level interventions for reducing fatigue in EPs.

Dark nighttime interventions and sleep quality in intensive care unit patients: A systematic review and meta‐analysis

AbstractBackgroundSleep disturbances resulting from adverse clinical and environmental conditions are associated with unfavourable outcomes in critically ill patients.AimTo collect evidence on the effect of dark nighttime interventions on sleep quality and daytime sleepiness in intensive care unit (ICU) patients.Study DesignThe study followed the Preferred Reporting Items for Systematic reviews and Meta‐Analyses recommendations. This is a systematic review and meta‐analysis of experimental and quasi‐experimental studies, developed with adult patients admitted to ICUs and submitted to measures such as environmental brightness reduction, eye mask or blue light‐blocking glass use at night. Outcomes were subjective or objective sleep quality and excessive daytime sleepiness. Search was carried out in the PubMed/MEDLINE, Cochrane Library, Embase, Virtual Health Library, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and Scopus databases, using grey literature. Covidence software, Cochrane tools and Grading of Recommendations Assessment, Development and Evaluation were used, and a meta‐analysis was performed using RevMan software.ResultsThirteen articles were included in the systematic review and seven studies were included in the meta‐analysis. There were 3 trials with 175 participants regarding lighting reduction and environmental noise control versus the usual routine, 2 of these trials, with 96 patients, were compiled in meta‐analysis in which it was observed a significant statistical improvement in subjective sleep quality, mean difference (MD) of 11.89 points (0–100); 95% confidence interval (CI) 8.0–15.76, evidence set with moderate certainty, as well as this same intervention, reduced daytime sleepiness in 2 trials, 135 participants (standardized MD −0.63; 95% CI −0.98 to −0.28), with low certainty evidence. Eye masks versus usual routine, 2 trials, 126 participants, improved subjective sleep quality (MD of 10 points; 95% CI 7.97–12.03), with moderate certainty of evidence. Eye mask use combined with other therapies versus usual routine, 5 trials, 204 participants, improved subjective sleep quality in all studies, with low certainty of evidence. Objective sleep assessment was not improved with these interventions.ConclusionsThis review shows some benefits of nighttime interventions on subjective sleep quality and excessive sleepiness, however, there is an urgent need to conduct better and more robust studies in this field.Relevance to Clinical Practiceapplying measures such as lighting reduction and eye mask use significantly improves sleep quality.

Sleep Disturbances and Disorders in Patients with Knee Osteoarthritis and Total Knee Arthroplasty.

There is increasing evidence that patient-reported outcomes following total knee arthroplasty (TKA) are associated with psychosocial factors and pain catastrophizing. Sleep disturbance, pain, and mental health have a complex interaction, which, if unrecognized, can be associated with impaired patient-reported outcomes and dissatisfaction following TKA. The gold standard of objective sleep assessment is polysomnography, which is not feasible to use routinely for TKA patients. Wearable devices are a validated and less costly alternative. Subjective sleep measures, such as the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, or Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive test sleep domains, are simple to administer and provide additional insight into sleep disturbance. Although objective and subjective measures do not correlate precisely, they can be informative together. Sleep disturbances in the elderly population are common and multifactorial in etiology, stemming from the interplay of sleep disorders, medication side effects, and pain. Commonly prescribed medications following TKA as well as postoperative pain can exacerbate underlying sleep disturbances. Obstructive sleep apnea (OSA) is prevalent in patients seeking TKA. In the setting of OSA, postoperative opioids can cause respiratory depression, resulting in consequences as severe as death. A standardized multimodal pain protocol including anti-inflammatories and gamma-aminobutyric acid (GABA) analogues may allow for decreased reliance on opioids for pain control. Surgeons should reassure patients that postoperative sleep disturbance is common and transient, collaborate with the patient's primary care doctor to address sleep disturbance, and avoid prescription of pharmaceutical sleep aids.

Relationships between sleep efficiency and lifestyle evaluated by objective sleep assessment: SLeep Epidemiology Project at University of Tsukuba.

ABSTRACTObjectively measured sleep efficiency has recently been shown to be associated with health problems. Although several factors have previously been reported to be associated with sleep efficiency, most of these studies were conducted on older or younger adults, and the factors associated with sleep efficiency in healthy workers remain unknown. The aim of this study was to investigate the relationship between sleep efficiency and lifestyle factors using sleep measurement data recorded by an activity meter worn by workers. In total, 693 workers (male, 43.6%; mean age, 42.7 ± 11.3 years) were recruited from five offices in 2017. Sleep was measured over the period of 1 week by actigraphy. Workers’ attributes, lifestyle habits, and occupational stress were identified using a questionnaire, and the association of sleep efficiency with lifestyle, occupational stress, and attributes was explored by logistic regression analysis. A logistic regression analysis using attributes and occupational stress as adjustment variables revealed that “longer sleeping hours on weekends than on weekdays” [odds ratios (OR), 0.66; 95% confidence interval (CI), 0.47–0.94], “water ingestion at bedtime” [OR, 2.09; 95% CI, 1.28–3.41], and “smartphone use at bedtime” [OR, 1.90; 95% CI, 1.28–2.83] were associated with decreased sleep efficiency. This study found that lifestyle habits were associated with sleep efficiency among workers. It is necessary to verify whether intervention in these lifestyle habits would contribute to the improvement of sleep efficiency in future studies.