Objective Sleep Parameters Research Articles

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).

0922 Interference of racial and socioeconomic factors in the sleep of a large Brazilian city: lessons for comparisons between countries

Abstract Introduction Investigation on the effects of racial and socioeconomic parameters on sleep has markedly increased along the years. The vast majority of these studies take place on countries in North America or Europe, thus making it necessary that new initiatives are conducted in developing nations. The objective of this study was to evaluate how race and socioeconomic factors influence sleep in the city of São Paulo, Brazil. Methods Health and sleep parameters of participants of the EPISONO (2007) study were assessed with validated questionnaires and a night of polysomnographic examination. Data regarding their self-identified race was collected during this protocol. Among the applied questionnaires, scores in the Critério de Classificação Econômica Brasil (CCEB) questionnaire were adopted in this analysis. General Linear Models were used to investigate the relationship between objective sleep parameters and the racial and socioeconomic classification according to the CCEB questionnaire. Results 1,008 participants of the EPISONO were included (mean age=42.3 years; 574 women). Class C Blacks had greater total sleep time (TST) than Class A Whites, while Class C Asians presented less TST. Indigenous participants had reduced wake after sleep onset (WASO) time when sided to Whites and, similarly, Class D Blacks presented lower WASO compared to Class A Whites. Arousal index was lower in Class B and C individuals when comparing to Class A individuals and higher in Class C Blacks when compared to Class A Whites. Conclusion The variety of results when comparing socioeconomic and racial factors highlights the richness of the interplay between these parameters. While some findings are similar to those of North American and European studies, there are differences underlining the necessity of evaluating the socioeconomic and racial background of each population cautiously. Future research on sleep patterns of the Brazilian population concerning the effect of race and socioeconomic status is essential and a promising frontier of investigation to be explored. Support (if any) Our studies are supported by Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES Finance Code 001 to GLF) and Conselho Nacional de Desenvolvimento Científico Tecnológico (CNPq – Grant #141445/2021-1 to GLF); S.T. and M.L.A. received CNPq fellowships.

0336 Tele-Self CBTi: Results of a Randomized Controlled Trial of a Nurse-Supported Self-Management Intervention for Insomnia Disorder

Abstract Introduction Approximately half of all Veterans meet diagnostic criteria for Insomnia Disorder. Cognitive Behavioral Therapy for Insomnia (CBTi) is recommended as first-line treatment but access is limited. Self-help CBTi could increase patient access and is more effective with provider support. Self-help CBTi has not been evaluated in those with significant mental health morbidity or Veterans; a population having greater medical and mental health morbidity and more severe sleep difficulties than non-Veterans. Methods Treatment-seeking Veterans were randomly assigned to 6 sessions of Tele-Self CBTi or Health Education Control (HEC). Nurses without sleep medicine experience were trained to deliver Tele-Self CBTi; the combination of provider support plus professionally designed patient and provider CBTi treatment manuals developed through an iterative process integrating expert and patient feedback. Both arms received nurse phone contacts (≤20 minutes). Outcomes including insomnia severity, subjective and objective sleep parameters, fatigue and mood were assessed at baseline, post-treatment (8 weeks), and 6 months. Results Study participants (N=178) were 55 years of age (SD=13), mostly male (72%), with a mental health condition (83%), and about half African American (43%) and half Caucasian (49%). At post-treatment, Veterans randomized to Tele-Self CBTi realized greater reductions in insomnia severity (ISI estimated mean improvement 5.7 vs 2.0, p<.001) and greater improvements in fatigue and depression symptoms (ps<.04). At 6 months, ISI findings were sustained (5.3 vs. 2.4, p<.001) and more Tele-Self CBTi than HEC participants (32% vs 10%) scored below the cutoff suggestive of insomnia disorder (ISI< 11) (p=.001). Preliminary findings also suggest better post-treatment outcomes for Tele-Self CBTi on sleep diary SOL (25 vs 45 minutes) and WASO (34 vs 55 minutes). Conclusion A self-management CBTi requiring minimal provider resources was effective in reducing insomnia severity in veterans with considerable mental health co-morbidity. Tele-Self CBTi can help bridge the gap between unavailable resources and high demand for services and can serve as the entry level in stepped-care treatment for insomnia disorder. Future research is needed to identify characteristics of patients most likely to benefit from Tele-Self CBTi. Support (if any) Funding was provided by Veterans Affairs Office of Research and Development (CIN 13-410 and IIR 16-281).

0742 Is sleep altered during the menstrual cycle? A polysomnography study from EPISONO

Abstract Introduction During the reproductive life, woman experiences changes in their hormone levels that characterize her menstrual cycle. This monthly event provides hormonal and body conditions to development of pregnancy and lactation. In addition to alterations in hormones, some women present physical and psychological complaints according to the phase of the menstrual cycle. Sleep has been reported to be deteriorated during menses; however, no conclusive results have been stated. The aim of our study was to evaluate the objective and subjective sleep during 3 different time-points of the menstrual cycle. Methods For this study we used the São Paulo Epidemiological Sleep Study (EPISONO) database. Ninety-one women were distributed in follicular (F) phase (N=27), luteal (L) phase (N=39) and menstruation (M, N=25) and undergone a one-night polysomnography. Blood samples and women’s questionnaire data were collected to investigate hormonal levels and information about the menstrual cycle to identify the phase of the cycle during the polysomnography exam. The objective sleep parameters analyzed were: sleep efficiency, sleep latency, REM sleep latency, total sleep time, awakenings index, percentage of stage 1, 2, N3 sleep and REM sleep. The following questionnaires were applied to assess the subjective sleep: Pittsburgh Sleep Quality Index, Insomnia Severity Index, Chalder Fatigue Scale, Beck Anxiety Inventory, Beck Depression Inventory and Epworth Sleepiness Scale. For the statistical analysis we used the Kruskal-Wallis test and post-hoc Dunn, with p< 0.05. Results Women in follicular phase exhibited significantly higher sleep efficiency (89.9±9.6%) when compared to luteal (83.7±12.7%; p=0.02) and menstruation (83±10.8%; p=0.008) groups. During the follicular phase the sleep latency was statistically reduced (7.1min) compared to other time-points of the menstrual cycle (L=15.9min; M=22.3min; p=0.02; p=0.03, respectively). The other objective sleep parameters and the results of the questionnaires applied did not present statistical differences during the menstrual cycle. Conclusion Women in follicular phase showed better sleep than the other time-points of the menstrual cycle. The sleep latency during menstruation was 3 times longer than the follicular phase, indicating that menstruation may be one of the causes of sleep complaints in women. Support (if any) AFIP and CNPq.

0673 Sleep in PTSD: A Subjective Concern

Abstract Introduction Sleep complaints are a hallmark of posttraumatic stress disorder (PTSD). Prior studies examining sleep abnormalities in PTSD are inconsistent, with some reporting objective sleep changes including associated obstructive sleep apnea (OSA), possibly due to moderating variables including advancing age, traumatic brain injury (TBI), and medications. We sought to compare sleep disorders and objective and subjective sleep metrics in service members with and without PTSD while controlling for these potential confounders. Methods Case-controlled observational cohort study performed at an academic military sleep center. Detailed sleep history, sleep-related questionnaires, trauma history, and video-polysomnography was performed. Patients with a history of TBI, abnormal neuroimaging, or psychoactive medication use (antidepressants, antipsychotics, anxiolytics) were excluded. Results Patients (N=169, 124 males) were active duty service members (median age 37.1 years) reporting a sleep complaint. Of these, 43 (25.4%) had PTSD vs 126 (74.6%) without PTSD. In patients with PTSD vs no PTSD, there was no significant difference in the rate of OSA, mean total sleep time, sleep efficiency, mean apnea-hypopnea index, sleep stage percentage, or any other polysomnogram (PSG) variable. Stage N3 sleep was non-significantly increased in patients with PTSD (18% vs 14%, p=0.078). Subjective sleepiness was similar between those with and without PTSD (Epworth Sleepiness Score 12.9 vs 11.9, p=0.35). However, subjective insomnia symptoms (Insomnia Severity Index 20.4 vs 15.2, p< 0.0001) and perceived sleep quality (Pittsburgh Sleep Quality Index 15.4 vs 11.1, p< 0.0001) were worse in those with PTSD vs no PTSD. Conclusion In a relatively young active duty cohort with no history of psychoactive medication use or TBI, patients with PTSD had more subjective sleep complaints than those without PTSD but objective sleep parameters, including PSG variables and OSA rate, did not differ significantly. The higher stage N3 (slow wave) sleep percentage, though not statistically significant, suggests that PTSD patients sleep better in a monitored sleep lab than in their habitual sleeping environment. Support (if any)

0623 Effects of bright light therapy on objective and subjective sleep in patients with non-seasonal depression and eveningness

Abstract Introduction This study reported the effect of bright light therapy with gradual advanced timing on the sleep parametersin patients with major depressive disorder (MDD) and eveningness. Methods A total of 93 adults were randomized to receive either 10,000 lux bright light therapy (BLT group) or 50lux dim red light therapy (placebo group) for a total of 5 weeks. Timings of both treatments were initiated at their habitual wake time and was advanced gradually each week. Sleep diary data were collected weekly. Actigraphic data were collected at the baseline and during the last week of the 5-week treatment. Sleep parameters including time in bed (TIB), sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE) were extracted. Concordance of the sleep diary and actigraphy sleep parameters were assessed by Pearson’s correlation with p-value adjusted for multiple comparisons. The changes of sleep parameters between the two groups were assessed by linear mixed model. Results Significant correlations between sleep diary and actigraphy were found for WASO (r=0.35, p = 0.01) and TST (r=0.40, p=0.01), but no correlation was found for TIB, SOL and SE. A greater advance in the diary-based light-out time (group*time p=0.03, 15 vs 32min) and rise time (group*time p=0.04, 38 vs 53min) was found in the BLT group compared to placebo group, while dairy-based WASO, TST and SE comparably improved with time in both groups. However, there were no significant difference between the two groups in all of the actigraphic parameters after treatment. Conclusion Five-week of either type of light therapy with gradual advance in timing improved subjective WASO, TST and SE, while BLT led to a greater advance in the light-out time and rise time when compared to the placebo group. These changes were not captured by the actigraphic measurements. The discrepancies between subjective and objective sleep parameters suggested the need to consider incorporating multiple measures when assessing sleep in patients with depression and eveningness. Support (if any) This project was supported by the Health and Medical Research Fund, The Government of Hong Kong SAR (Ref 12131131).

Subjective and objective sleep and circadian parameters as predictors of depression-related outcomes: A machine learning approach in UK Biobank

BackgroundSleep and circadian disruption are associated with depression onset and severity, but it is unclear which features (e.g., sleep duration, chronotype) are important and whether they can identify individuals showing poorer outcomes. MethodsWithin a subset of the UK Biobank with actigraphy and mental health data (n = 64,353), penalised regression identified the most useful of 51 sleep/rest-activity predictors of depression-related outcomes; including case-control (Major Depression (MD) vs. controls; postnatal depression vs. controls) and within-case comparisons (severe vs. moderate MD; early vs. later onset, atypical vs. typical symptoms; comorbid anxiety; suicidality). Best models (of lasso, ridge, and elastic net) were selected based on Area Under the Curve (AUC). ResultsFor MD vs. controls (n(MD) = 24,229; n(control) = 40,124), lasso AUC was 0.68, 95 % confidence interval (CI) 0.67–0.69. Discrimination was reasonable for atypical vs. typical symptoms (n(atypical) = 958; n(typical) = 18,722; ridge: AUC 0.74, 95 % CI 0.71–0.77) but poor for remaining models (AUCs 0.59–0.67). Key predictors across most models included: difficulty getting up, insomnia symptoms, snoring, actigraphy-measured daytime inactivity and lower morning activity (~8 am). In a distinct subset (n = 310,718), the number of these factors shown was associated with all depression outcomes. LimitationsAnalyses were cross-sectional and in middle-/older aged adults: comparison with longitudinal investigations and younger cohorts is necessary. DiscussionSleep and circadian measures alone provided poor to moderate discrimination of depression outcomes, but several characteristics were identified that may be clinically useful. Future work should assess these features alongside broader sociodemographic, lifestyle and genetic features.

Effect of Emotional Distress on Sleep Physiology in Underserved Pregnant Women [ID: 1381497

INTRODUCTION: Pregnancy is characterized by an altered pattern of emotions and sleep. The aim of this study was to examine the effect of emotional distress on objective sleep parameters in underserved pregnant women during the COVID-19 pandemic. METHODS: Institutional review board approval was obtained for the study. This was a longitudinal observation study in which we administered weekly validated self-reported surveys (Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, COVID-19-related anxiety, and life-related stressors) to consented pregnant women over the course of their second and third trimesters (n=13). The independent variable, subjective emotional distress, was derived from a sum score of these weekly surveys. A wearable device was used to measure objective sleep physiological data, such as the rapid eye movement (REM), deep, and light sleep stages. The dependent variables were obtained from weekly average scores of the sleep data. Multilevel analysis was conducted, controlling for relevant covariates. RESULTS: Adjusting for gestational age, maternal age at enrollment, and prepregnancy body mass index, higher emotional distress was associated with a shorter duration of deep sleep (b=−.65, P<.05) and longer duration of REM sleep (b=.79, P<.01). There was no significant relationship between emotional distress and light sleep. CONCLUSION: Our study appears to be the first to provide preliminary evidence that emotional distress negatively affects sleep in terms of decreased deep sleep and increased REM sleep during pregnancy. Findings suggest that further research is needed to understand the role of sleep in the relationships between emotional distress and adverse maternal and infant health outcomes.

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.

Sleep Disturbances in Adolescents with Attention-Deficit/Hyperactivity Disorder.

Delayed sleep phase syndrome (DSPS) and insomnia disorders are prevalent in adolescents and are comorbid with attention-deficit/hyperactivity disorder (ADHD), but only limited information is available regarding the prevalence of DSPS and insomnia in adolescents with ADHD. Moreover, previous studies comparing objective sleep parameters averaged the findings across all participants of each group (ADHD, control) regardless of each individual's level of reported sleep disturbance. This might have resulted in inconsistency between information obtained by objective and subjective sleep measures in adolescents with ADHD. The objectives of the present study were 1) to compare the prevalence of risk for DSPS and insomnia in adolescents with ADHD and control adolescents in our samples; 2) to compare objectively measured sleep characteristics of adolescents with ADHD and controls while taking into consideration their levels of risk for DSPS or their level of insomnia; and 3) to compare the ADHD symptom levels of adolescents with moderate/high and low risk for DSPS or insomnia. Seventy-three adolescents (37 ADHD, 36 controls) aged 12-15years participated in a cross-sectional study. Actigraphy was used to characterize objective sleep parameters and parents' or adolescents' reports were used to characterize subjective sleep parameters. Of the participants in the ADHD and control groups, 33.33% and 27%, respectively, had moderate/high levels of risk for DSPS. Adolescents in the high-risk group for DSPS had an objectively measured delayed sleep schedule and more variable sleep duration, time in bed, and sleep efficiency compared to adolescents in the low-risk group for DSPS, regardless of their ADHD diagnosis. Adolescents with higher levels of insomnia spent more time in bed and had more variable sleep efficiency compared to adolescents with no insomnia, regardless of their diagnosis. The prevalence of moderate/high risk for DSPS was similarly high in adolescents with ADHD and controls. Participants' subjective reports of sleep disturbances were consistent with their objective sleep parameters when the type and level of subjectively defined sleep disturbance were considered. ADHD symptom levels were not different in adolescents with moderate/high or low risk for DSPS or insomnia.

Comparative efficacy of hypnotics in young and middle-aged adults with insomnia: a systematic review and network meta-analysis.

Insomnia is highly prevalent in modern society. However, the hierarchical selection of hypnotics in young and middle-aged adults with insomnia remains unclear. We aimed to compare the efficacy and daytime drowsiness associated with different hypnotics for treating insomnia in young and middle-aged adults. We searched Embase, PubMed, Cochrane Library, and ProQuest Dissertations and Theses A&I databases from inception until December 15, 2021. We also manually searched reference lists and relevant publications. The literature search, data collection, and risk of bias evaluation were all carried out separately by pairs of reviewers. We included randomized control trials (RCTs) that compared hypnotics approved by the Food and Drug Administration. The R and Stata software were both used to perform the meta-analysis. In total, 117 RCTs comprising 22,508 participants with the age of 18 to 65years were included. Assessment of the efficacy of the hypnotics and adverse events (drowsiness) revealed that zolpidem improved all objective sleep parameters (oTST, oSOL, oWASO, and oSE), zopiclone increased oTST and oSE and reduced oSOL, and daridorexant increased oTST and reduced oWASO. Regarding subjective sleep outcomes, zolpidem exhibited beneficial effects on sTST, sSOL, and sWASO. Zaleplon reduced sSOL, and zopiclone was the recommended hypnotic for improving SQ. Zolpidem was associated with drowsiness effect (odds ratio = 1.82; 95% confidence interval = 1.25 to 2.65). The results of sensitivity analysis remained unchanged after the exclusion of studies reporting long-term effects. Zolpidem is recommended for managing sleep-onset insomnia and sleep maintenance insomnia but should be used with caution because of daytimedrowsiness effects. Daridorexant is recommended as a promising agent for managing sleep maintenance insomnia.

Socioeconomic disparities, nighttime bedroom temperature, and children's sleep

We investigated associations between family income-to-needs, nighttime bedroom temperature (NBT), and children's sleep. Using a sample of 46 children (Mage = 11.5), we recorded NBT and objective sleep parameters via actigraphy nightly for one week to evaluate within- (night-to-night) and between-person associations. We found consistent evidence for a curvilinear association between NBT and sleep variables at the between-person level, indicating that children who slept in rooms that were “too hot” or “too cold” experienced poorer sleep. Moreover, children in lower income-to-needs families had more extreme NBTs. There was some evidence that family income-to-needs is indirectly related to sleep via NBT, but with interpretational caveats. These findings point to NBT as a potentially modifiable variable, which has implications for practical applications to mitigate effects of socioeconomic disparities on children's sleep.

A low-threshold sleep intervention for improving sleep quality and well-being.

Approximately one-third of the healthy population suffer from sleep problems, but only a small proportion of those affected receive professional help. Therefore, there is an urgent need for easily accessible, affordable, and efficacious sleep interventions. A randomized controlled study was conducted to investigate the efficacy of a low-threshold sleep intervention consisting of either (i) sleep data feedback plus sleep education or (ii) sleep data feedback alone in comparison with (iii) no intervention. A total of 100 employees of the University of Salzburg (age: 39.51 ± 11.43 years, range: 22-62 years) were randomly assigned to one of the three groups. During the 2-week study period, objective sleep parameters were assessed via actigraphy. In addition, an online questionnaire and a daily digital diary were used to record subjective sleep parameters, work-related factors, as well as mood and well-being. After 1 week, a personal appointment was conducted with participants of both experimental group 1 (EG1) and experimental group 2 (EG2). While the EG2 only received feedback about their sleep data from week 1, the EG1 additionally received a 45-min sleep education intervention containing sleep hygiene rules and recommendations regarding stimulus control. A waiting-list control group (CG) did not receive any feedback until the end of the study. Results indicate positive effects on sleep and well-being following sleep monitoring over the course of 2 weeks and minimal intervention with a single in-person appointment including sleep data feedback. Improvements are seen in sleep quality, mood, vitality, and actigraphy-measured sleep efficiency (SE; EG1), as well as in well-being and sleep onset latency (SOL) in EG2. The inactive CG did not improve in any parameter. Results suggest small and beneficial effects on sleep and well-being in people being continuously monitored and receiving (actigraphy-based) sleep feedback when paired with a single-time personal intervention.

Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Adolescents

Objective: This study examined associations between objective and subjective sleep parameters, and mental health symptoms (internalizing symptoms, externalizing symptoms, and irritability) and whether these relationships differed for adolescents with and without ADHD. Method: Participants were 373 adolescents aged 10 to 19 years (M = 13.21, SD = 2.37). Sleep was measured both via actigraphy and self- and parent-report scales. Mental health symptoms were measured via a range of validated measures. Results: Few relationships were detected when examining actigraphy variables. Subjective sleep parameters were associated with almost all mental health variables. Some relationships were moderated by ADHD status, generally consistent with stronger relationships between subjective sleep quality and mental health in the non-ADHD group. Conclusion: Sleep problems, particularly subjective difficulties, are associated with a range of mental health outcomes, regardless of the presence of ADHD. Sleep problems may be a beneficial intervention target for adolescents experiencing mental health issues.

Do Sleep-Related Metacognitive Strategies Shape My Sleep? The Relationships between Strategies for Controlling Sleep-Related Intrusive Thoughts and Subjective and Objective Sleep Quality in Young Adulthood and Older Age

This study examined the associations between thought control strategies and subjective and objective sleep quality, across the adult lifespan. One hundred forty-nine individuals without insomnia (age range 18-86 years; M = 45.35, SD = 20.53) completed the Thought Control Questionnaire Insomnia-Revised for assessing sleep-related thought control strategies. Self-reported sleep quality was measured with the Pittsburgh Sleep Quality Index. Then, subjective and objective sleep parameters (i.e., total sleep time, sleep onset latency, sleep efficiency) were recorded through a sleep diary and an actigraph across 7 days. Results from linear mixed-effects models showed that a worry strategy was associated with longer subjective sleep latency and shorter subjective total sleeping time. An aggressive suppression strategy was associated with longer subjective total sleeping time. No such involvement of thought control strategies was detected for subjective sleep efficiency and all of the objective sleep parameters. Other individual differences (i.e., age, sex, circadian preference, self-reported sleep quality) also explained both subjective and objective sleep parameters, though to a different extent depending on the sleep parameter considered. The assessment of sleep-related thought control strategies, along with other individual characteristics, should be considered to account for individual differences in sleep quality and implement practices/interventions to support it in adulthood and older age.

An ecological approach to clinically assess nightmares in military service members with severe PTSD

BackgroundTrauma-related nightmares (TRNs) are distressing events which contribute to insomnia severity, chronicity and treatment resistance of PTSD. Therefore, recording TRNs is a crucial technical challenge in order to understand their physiopathological patterns and their impact on sleep. However, TRNs are difficult to record during a single night in a sleep laboratory, which, moreover, is likely to be considered by patients as a protective sleep environment that is therefore not representative of home sleep conditions. MethodIn the present study, we investigate if objective sleep measures acquired at-home using two ambulatory devices is of clinical value by correlating with PTSD patients' complaints about sleep and nightmares. A secondary objective is to relate awakenings associated with TRNs to sleep stages and to provide new insights into the use of electrodermal activity (EDA) as a potential physiological marker of TRNs. Sixty veterans and active-duty service members were assessed by questionnaires and recorded for 5 consecutive nights in their homes. ResultsOur approach firstly identified positive correlations between subjective and objective sleep parameters (total sleep time, sleep-onset latency and TRNs frequency). We also developed a method of synchronization between the two ambulatory devices that allowed us to match 200 TRNs (reported by event marker push button) with sleep stages corresponding to 91 nights and 37 patients. Most awakenings associated with TRNs occurred during NREM sleep (65.5% versus 34.5% during REM sleep). Our results also reveal significant differences in the frequency of EDA peaks 10 min before the reported events, with a lower frequency in REM (13.7 peaks) than in NREM (24.8 peaks) awakenings associated with TRNs. This EDA peaks frequency in REM sleep is not statistically different from that in REM sleep preceding awakenings that are not associated with TRNs. ConclusionThe development of wearable devices to collect physiological parameters is of interest in clinical practice to improve our knowledge of sleep and trauma-related nightmares in patients with PTSD.

Objective Sleep in Atopic Dermatitis: A Meta-Analysis.

Background: The evidence regarding objective sleep especially for the sleep architecture in atopic dermatitis (AD) was limited and not well summarized. Objective: To determine the objective sleep in AD patients as well as its confounders. Methods: We searched PubMed/Medline, Embase, and PsycInfo up to May 2021. Case-control studies or cohort studies that recruited AD patients and healthy controls and reported objective sleep parameters assessed by polysomnography or actigraphy were included. Results: A total of 7 studies with 173 AD patients and 122 controls were analyzed. Specifically, AD patients have significantly decreased total sleep time (TST, -13.797 minutes) and sleep efficiency (SE, -5.589%) accompanied by prolonged wake time after sleep onset (WASO, 29.972 minutes) and rapid eye movement sleep latency (31.894 minutes, all P < 0.05). Furthermore, subgroup analyses showed more WASO in severe AD subgroup compared with nonsevere AD subgroup (51.323 minutes vs 20.966 minutes, P = 0.032), less SE in male-majority subgroup compared with female-majority subgroup (-9.443% vs -4.997%, P = 0.018), and less TST in adult subgroup compared with child subgroup (-41.045 vs -4.016 minutes, P = 0.037). Conclusion: Objective sleep was worse in AD patients, especially among patients with severe AD, males, and adults. AD appears to more predispose difficulty in sleep maintenance rather than falling asleep.

Pre-sleep arousal induced by suspenseful series and cliffhangers have only minor effects on sleep: A sleep laboratory study

Pre-sleep arousal impairs sleep. Therefore, watching suspenseful TV series before sleep is not recommended as they increase arousal. In particular, the consumption of multiple episodes of the same suspenseful TV series in one sitting – termed binge-watching – could lead to large increases in physiological arousal delaying sleep onset. Furthermore, abrupt endings during critical scenes – termed cliffhangers – result in unfinished story lines, which further increase cognitive arousal and could negatively impact sleep architecture and the number of awakenings. However, the effects of binge-watching and cliffhangers on objective sleep parameters are still unknown.Here we tested in a controlled sleep-laboratory setting whether pre-sleep arousal induced by watching 3–4 episodes of a suspenseful TV series has negative effects on sleep in 50 healthy young participants (39 females, mean age = 22.62 ± 2.60 (SD)). Watching a neutral TV series served as a control condition, according to a within-subject design. In one group of participants, the suspenseful TV series ended with a cliffhanger. In the other group, the same TV series ended where no ongoing action was interrupted. Pre-sleep arousal was measured both subjectively with the self-reported level of stress and objectively with the mean heart rate and cortisol level. As expected, suspenseful TV series induced higher cognitive and physiological pre-sleep arousal than neutral control TV series, with highest values for TV series with cliffhangers. In spite of the high pre-sleep arousal, participants fell asleep faster after watching the suspenseful compared with the neutral TV series (F(1,48) = 4.89, p = 0.032, η2 = 0.09). Sleep architecture and the number of awakenings remained unaffected. However, in the first two sleep cycles, heart rate was still higher after watching suspenseful TV series (F(1,48) = 6.76, p = 0.012, η2 = 0.12). And only after cliffhangers, objective sleep quality – measured as the ratio between slow-wave and beta activity during sleep – was lower than in the other conditions (interaction effect, F(1,48) = 5.05, p = 0.029, η2 = 0.10).Our results speak against large impairments of pre-sleep watching of multiple episodes of suspenseful TV series and cliffhangers on sleep quality and architecture. However, unfinished narratives might induce more subtle changes in oscillatory power during sleep, possibly reflecting ongoing cognitive processing during sleep.

The developmental trajectory of sleep in children with Smith-Magenis syndrome compared to typically developing peers: a 3-year follow-up study.

To determine the trajectory of: (i) objective sleep parameters and (ii) caregiver-reported sleep questionnaire scores over 3 years in children with Smith-Magenis syndrome (SMS) compared to age-matched typically developing (TD) controls. We also aimed to (iii) describe individual profiles of change in sleep parameters over time. Week-long, overnight actigraphy and questionnaire data from 13 children with SMS and 13 age-matched TD children were collected at Time 1 and Time 2 (3 years later). Independent samples t-tests, paired samples t-tests, and Bayesian analyses were used to compare sleep parameters and sleep questionnaire scores between groups at each time point and compare data within groups to assess change over time. Sleep parameters were consistently more disrupted in the SMS group than the TD group, with significantly reduced sleep efficiency, increased wake after sleep onset and earlier get up times at both time points. This was mirrored in the questionnaire data, with children with SMS evidencing higher scores for overall sleep disturbance, night waking, and daytime sleepiness. While TD sleep parameters demonstrated expected developmental changes over 3 years, in the SMS group sleep parameters and variability between and within children remained largely stable. However, some children with SMS showed substantial variation in sleep parameters over time. Questionnaire scores remained stable over 3 years in both groups. Overall, sleep disturbance appears to be a stable feature of SMS, indicative of a divergent sleep trajectory compared to TD peers. Proactive intervention approaches should be considered for poor sleep in SMS.

Subjective and objective sleep alterations in medication-naïve children and adolescents with autism spectrum disorder: a systematic review and meta-analysis.

This study aimed to summarize the evidence on sleep alterations in medication-naïve children and adolescents with autism spectrum disorder (ASD). We systematically searched PubMed/Medline, Embase and Web of Science databases from inception through March 22, 2021. This study was registered with PROSPERO (CRD42021243881). Any observational study was included that enrolled medication-naïve children and adolescents with ASD and compared objective (actigraphy and polysomnography) or subjective sleep parameters with typically developing (TD) counterparts. We extracted relevant data such as the study design and outcome measures. The methodological quality was assessed through the Newcastle-Ottawa Scale (NOS). A meta-analysis was carried out using the random-effects model by pooling effect sizes as Hedges' g. To assess publication bias, Egger's test and p-curve analysis were done. A priori planned meta-regression and subgroup analysis were also performed to identify potential moderators. Out of 4277 retrieved references, 16 studies were eligible with 981 ASD patients and 1220 TD individuals. The analysis of objective measures showed that medication-naïve ASD patients had significantly longer sleep latency (Hedges' g 0.59; 95% confidence interval [95% CI] 0.26 to 0.92), reduced sleep efficiency (Hedges' g -0.58; 95% CI -0.87 to -0.28), time in bed (Hedges' g -0.64; 95% CI -1.02 to -0.26) and total sleep time (Hedges' g -0.64; 95% CI -1.01 to -0.27). The analysis of subjective measures showed that they had more problems in daytime sleepiness (Hedges' g 0.48; 95% CI 0.26 to 0.71), sleep latency (Hedges' g 1.15; 95% CI 0.72 to 1.58), initiating and maintaining sleep (Hedges' g 0.86; 95% CI 0.39 to 1.33) and sleep hyperhidrosis (Hedges' g 0.48; 95% CI 0.29 to 0.66). Potential publication bias was detected for sleep latency, sleep period time and total sleep time measured by polysomnography. Some sleep alterations were moderated by age, sex and concurrent intellectual disability. The median NOS score was 8 (interquartile range 7.25-8.75). We found that medication-naïve children and adolescents with ASD presented significantly more subjective and objective sleep alterations compared to TD and identified possible moderators of these differences. Future research requires an analysis of how these sleep alterations are linked to core symptom severity and comorbid behavioural problems, which would provide an integrated therapeutic intervention for ASD. However, our results should be interpreted in light of the potential publication bias.