Sleep Perception Research Articles

A-142 The Impact of Temperament on Sleep in Term and Preterm Infants

Abstract Objective: Research has examined temperament’s effect on infant sleep. Poorer sleep has been associated with higher negative affectivity, lower surgency, and lower regulation. Limited research has examined gestational age in this association, despite findings that gestational age is individually related to temperament and infant sleep. Due to the increased risk associated with prematurity, we hypothesized that the aforementioned associations between temperament and poorer sleep would be stronger for children with lower gestational age. Methods: Socioeconomically diverse term and preterm caregiver/infant dyads (N=571) were recruited in a longitudinal, multisite study. Temperament was measured at 9 months using the Infant Behavior Questionnaire. Infant sleep (IS) and parent perception of sleep (PP) were measured at 15 months using the Brief Infant Sleep Questionnaire. Correlational analyses examined associations between temperament and sleep, while regression analyses explored gestational age as a moderator in this association. Results: Higher negative affectivity was associated with poorer IS and PP (r=-.18, r=-.20, respectively, p<.01). Higher surgency was only associated with poorer IS (r=-.16, p<.01), while higher regulation/orienting was only associated with better PP (r=.16, p<.01). Gestational age was not a significant moderator. Conclusion: Lack of moderation suggests gestational age does not differentially affect the association between temperament and sleep. Higher negative affectivity and higher surgency were associated with poorer IS, suggesting a target group for intervention. Children with higher negative affectivity may be more likely to receive intervention than those with higher surgency, as parents view their sleep as problematic. Children with higher surgency may require increased monitoring to receive intervention when warranted.

Discordant Subjective Perception of Sleep in Patients with Obstructive Sleep Apnea and Insomnia: A Retrospective Study.

BackgroundFactors affecting subjective perception of sleep are unclear but clinically important. We investigated the differences in subjective sleep perception of patients with obstructive sleep apnea (OSA) and insomnia disorder (ID).Material/MethodsFrom our Sleep Medicine Center database, 33 patients with OSA and 69 with ID were selected and assessed with the Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder screen, Patient Health Questionnaire-9, Epworth Sleepiness Scale, Pre-sleep Arousal Scale (PSAS), and polysomnography.ResultsIn subjective sleep tests, PSQI total score, sleep quality, sleep onset latency (SOL), total sleep time, and sleep efficiency (SE) were higher in patients with ID. In objective sleep tests, patients with OSA had longer total sleep time, shorter SOL, lower percentage of stage N3, less SE, higher percentage of stage N1, more arousals, and higher arousal index. Hyperarousal state evaluation showed cognitive hyperarousal significantly higher with ID. Subjective sleep perception with OSA correlated positively with PSAS total score, cognitive hyperarousal, and percentage of stage N2 and negatively with percentage of REM, apnea-hypopnea index, and desaturation index. Subjective sleep perception of patients with ID correlated positively with PSAS total score, cognitive hyperarousal, SOL, N3 sleep latency, and REM sleep latency and negatively with SE.ConclusionsSubjective sleep perception of OSA patients was mainly related to sleep structure and respiratory events, and that of ID patients, to sleep latency. Individual cognitive hyperarousal levels may be involved in negative subjective sleep perception. Clinicians should be aware that OSA patients may not actually experience adequate sleep.

Morning perception of sleep, stress and mood, and its relationship with overnight physiological sleep processes in adolescents

Morning perception of sleep, stress and mood, and its relationship with overnight physiological sleep processes in adolescents

The underestimation of sleep duration phenotype is associated with better treatment response to cognitive behavior therapy for insomnia in patients with chronic insomnia: a preliminary study.

To examine treatment response to cognitive behavior therapy for insomnia (CBT-I) in patients with chronic insomnia with and without underestimation of sleep duration. We studied 41 patients with chronic insomnia who had received 5-week CBT-I. Self-reported and objective sleep were assessed with sleep diary and actigraphy, respectively. Sleep perception was calculated as self-reported total sleep time/objective total sleep time. The underestimation of sleep duration group was defined based on sleep perception less than the median of the overall sample (85%). Insomnia Severity Index was used to assess the severity of insomnia. The total scores of Insomnia Severity Index decreased significantly after CBT-I in both groups with and without underestimation of sleep duration. Compared to pretreatment, self-reported sleep efficiency increased and total wake time decreased after CBT-I, while the magnitude of changes in sleep efficiency (d = 1.40 vs d=0.81, interaction P = .016) and total wake time (d = -1.82 vs d = -0.85, interaction P < .001) were larger in the underestimation of sleep duration group . Furthermore, self-reported sleep onset latency (interaction P = .520) and wake after sleep onset (interaction P = .052) decreased in the underestimation of sleep duration group (all P < .05), but not in patients without underestimation of sleep duration. Linear regressions showed that lower sleep perception at baseline predicted greater increase in self-reported sleep efficiency (β = -0.99, P < .001) and total sleep time (β = -0.51, P = .006) and greater decrease in self-reported total wake time (β=1.22, P = .023) after CBT-I after adjusting for confounders. The current preliminary study suggests that sleep perception moderates the self-reported CBT-I effects on chronic insomnia: the phenotype of underestimation of sleep duration is associated with a better response to CBT-I, especially in self-reported sleep parameters. Sun Q, Dai Y, Chen B, etal. The underestimation of sleep duration phenotype is associated with better treatment response to cognitive behavior therapy for insomnia in patients with chronic insomnia: a preliminary study. J Clin Sleep Med. 2022;18(10):2443-2450.

Adverse childhood experiences and sleep links in a predominantly Black sample of overweight adults.

Adverse childhood experiences (ACEs) have been associated with worse sleep, but existing literature is limited by use of predominantly White samples, lack of objective sleep measurement, and use of non-standardized questionnaires. We investigated associations between retrospectively reported ACEs and sleep in adulthood in a sample of 43 adults 20-53years of age, free from chronic conditions, with a Body mass index (BMI) ≥ 25 (Mean age=33.14 [SD=10.05], 74% female, 54% Black). Sleep efficiency (SE), total sleep time (TST), wake after sleep onset (WASO), and sleep onset latency (SOL), were measured by actigraphy and daily diary. Global sleep quality and insomnia severity were measured by questionnaires. Sleepiness, fatigue, and sleep quality were also measured by daily diary. Adjusting for demographic characteristics and BMI, ACEs were significantly associated with poorer global sleep quality and diary measures of greater daytime sleepiness, fatigue, and poorer sleep quality. There were no significant associations between ACEs and SE, TST, WASO, or SOL measured by diary or actigraphy. Findings suggest that ACEs are associated with worse sleep perception and daytime functioning in adulthood. Larger prospective studies are needed to replicate these findings, examine racial/ethnic differences, and determine temporal associations between ACEs, sleep, and health (e.g., BMI).

A Study of Factors Causing Sleep State Misperception in Patients with Depression.

PurposeSleep state misperception, which is the discrepancy between subjective and objective sleep, is often observed in patients with depression. This phenomenon may delay the remission of depression. Previous studies have focused on the total sleep time (TST) misperception, with many of these studies using actigraphy. Thus, our study investigated depressed patients with the exploratory aim of clarifying factors associated with the sleep state misperception including the wake after sleep onset (WASO) misperception, with their objective sleep additionally evaluated by polysomnography (PSG).Patients and MethodsWe conducted a cross-sectional study. Before undergoing overnight PSG monitoring, 40 patients with depression completed questionnaires that included the Beck Depression Inventory (BDI), Epworth sleepiness scale, Temperament and Character Inventory, and the Pittsburgh sleep quality index. Patients were also asked to estimate their subjective sleep duration after they woke up in the morning. Based on this data, we calculated the misperception using the following formula: subjective sleep duration minus objective sleep duration. We compared each factor between negative and positive misperception groups and the multiple regression analysis was performed for TST and WASO misperception, respectively.ResultsAlthough sleep architectures, age, severity of depression and obstructive sleep apnea (OSA) exhibited differences in underestimating or overestimating the WASO, only sex differences were associated with underestimating or overestimating their total sleep time (TST). Moreover, BDI, the severity of OSA, sleep architectures (N1% and N2%), and benzodiazepine (BZD) use were significantly correlated with WASO misperception, whereas only OSA severity was significantly correlated with TST misperception. A subsequent multiple regression analysis demonstrated the BDI was independently correlated with the WASO misperception (β=0.341, p=0.049).ConclusionIn clinical practice, interventions especially for OSA, and the reduction of depressive symptoms are an important method for improving patient sleep perception. Moreover, current results suggest that BZD prescriptions should be avoided as well.

Capitalism Ate My Sleep but ASMR Brought It Back. Sleep as a Manageable Commodity in the Autonomous Sensory Meridian Response Online Community

This article focuses on the perception of sleep in the digital culture of autonomous sensory meridian response (ASMR), examining both viewer-listeners’ online discussions about the impact of ASMR videos on their sleep and the content of audiovisual materials published on YouTube. The paper posits that sleep is viewed in two ways in the ASMR community; on the one hand, in a capitalist sense as a manageable and controllable object, and, on the other, as an element that escapes this discourse. The ASMR culture, while affirming contemporary normative sleep patterns, simultaneously invites its enthusiasts to slow down, unwind, and relax, thereby aligning itself with the slow movement.

Factors Predicting Training Delays and Attrition of Recruits during Basic Military Training.

Ensuring a balance between training demands and recovery during basic military training (BMT) is necessary for avoiding maladaptive training responses (e.g., illness or injury). These can lead to delays in training completion and to training attrition. Previously identified predictors of injury and attrition during BMT include demographic and performance data, which are typically collected at a single time point. The aim of this study was to determine individual risk factors for injury and training delays from a suite of measures collected across BMT. A total of 46 male and female recruits undertaking the 12-week Australian Army BMT course consented to this study. Injury, illness, attrition, and demographic data were collected across BMT. Objective measures included salivary cortisol and testosterone, step counts, cardiorespiratory fitness, and muscular endurance. Perceptions of well-being, recovery, workload, fatigue, and sleep were assessed with questionnaires. Baseline and mean scores across BMT were evaluated as predictors of injury and attrition using generalized linear regressions, while repeated-measures ANOVA was used for the group comparisons. From the 46 recruits, 36 recruits completed BMT on time; 10 were delayed in completion or discharged. Multiple risk factors for injury during BMT included higher subjective ratings of training load, fatigue, and stress, lower sleep quality, and higher cortisol concentrations. Higher ratings of depression, anxiety, and stress, and more injuries were associated with a higher risk of delayed completion. Higher concentrations of testosterone and higher levels of fitness upon entry to BMT were associated with reduced risk of injury and delayed completion of BMT. Ongoing monitoring with a suite of easily administered measures may have utility in forewarning risk of training maladaptation in recruits and may complement strategies to address previously identified demographic and performance-based risk factors to mitigate injury, training delays, and attrition.

Prospective Associations Between Maternal Depression and Infant Sleep in Women With Gestational Diabetes Mellitus.

BackgroundWomen with gestational diabetes mellitus have higher rates of perinatal depressive symptoms, compared to healthy pregnant women. In the general population, maternal depressive symptoms have been associated with infant sleep difficulties during the first year postpartum. However, there is lack of data on infants of mothers with gestational diabetes mellitus.MethodsThis study assessed the prospective associations between maternal perinatal depressive symptoms and infant sleep outcomes. The study population consisted of 95 Swiss women with gestational diabetes mellitus and their infants, enrolled in the control group of the MySweetheart trial (NCT02890693). Perinatal depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale at the first gestational diabetes mellitus visit during pregnancy, at 6–8 weeks postpartum, and 1 year postpartum. The Brief Infant Sleep Questionnaire was used to assess infant sleep (i.e., nocturnal sleep duration, number of night waking, and maternal perception of infant sleep) at 1 year postpartum. Relevant maternal and infant measurements (e.g., infant sex or maternal age or social support) were collected or extracted from medical records as covariates.ResultsAntenatal maternal depressive symptoms at the first gestational diabetes mellitus visit were inversely associated with infant nocturnal sleep duration at 1 year postpartum (β = –5.9, p = 0.046). This association became marginally significant when covariates were added (β = –5.3, p = 0.057). Maternal depressive symptoms at 6–8 weeks postpartum were negatively and prospectively associated with infant nocturnal sleep duration (β = –9.35, p = 0.016), even when controlling for covariates (β = –7.32, p = 0.042). The association between maternal depressive symptoms and maternal perception of infant sleep as not a problem at all was significant at 1 year postpartum (β = –0.05, p = 0.006), although it became non-significant when controlling for appropriate covariates. No other significant associations were found.LimitationsThis study solely included measures derived from self-report validated questionnaires.ConclusionOur findings suggest it is of utmost importance to support women with gestational diabetes mellitus as a means to reduce the detrimental impact of maternal perinatal depressive symptoms on infant sleep, given its predictive role on infant metabolic health.

0510 Parent and Child Perception of Sleep for Children with Sensory Processing Difficulties

Abstract Introduction Roughly 5.3 million elementary children in the United States experience sensory processing (SP) difficulties, like sensitivity to touch and overstimulation with movement. These difficulties cause high levels of daytime stress and daytime dysfunction (e.g., difficulties with attention, academics, and emotional regulation). In typically developing children (without SP difficulties), high levels of daytime stress impact sleep; however, research has yet to explore sleep health in children with SP difficulties. Our study aims to use validated self- and parent-reported questionnaires to characterize differences in sleep health for children with and without SP difficulties. Methods Children (ages 6-10) with (n=22) and without (n=33) SP difficulties (per parent report; Autism and ADHD diagnosis excluded) were recruited for this convergent mixed-methods study. Sleep was assessed using validated self- and parent-report questionnaires, the Sleep Self-Report (SSR) and Children’s Sleep Habits Questionnaire (CSHQ), and through qualitative interviews with parents. Groups were compared using t-test and Mann-Whitney U tests, with significance set a priori at α=0.05. A rapid qualitative analysis produced themes and were integrated with the quantitative data. Results Parents of children with SP report significantly worse sleep quality on the CSHQ difficulties (MedianSP= 50.5, SDSP= 11.45) than parents of children without SP difficulties (MedianCON=43.0, SDCON=7.27, U= -2.92, p=.004). Children with SP deficits also report significantly worse sleep on the SSR (MSPD=42.18, SDSPD=8.26) compared to their peers (MCON=33.55, SDCON=6.71, t(53)= -4.26, p&amp;lt;.001). Qualitative themes highlight the higher prevalence of rigid, lengthy bedtime routines and adaptations within the sleep environment (e.g. specific pajamas, special bedding) to support sleep for children with SP difficulties. Parents of children with SP difficulties also report higher frequencies of an adult being in the room while the child falls asleep and co-sleeping in the middle of the night. Conclusion Parents and children both report poorer sleep in children with SP difficulties when compared to peers. Future studies should incorporate other sleep health measurement tools (e.g. actigraphy) to further understand areas to target for intervention. Support (If Any) Sensory Integration Education Network PhD Grant (PI: Hartman, 2021); University of Pittsburgh’s School of Health and Rehabilitation Science’s PhD Student Award (PI: Hartman, 2021).

0311 The day after: how does a poor sleep perception affect pain during the night?

Abstract Introduction Senescence generates repercussions on sleep, including increased difficulty to initiate and maintain sleep, more awakenings, diurnal naps, and a propensity to polyphasic sleep. These disorders might be more common in older individuals with musculoskeletal pain. In this sense, the relationship between sleep and pain is considered to be bidirectional. However, it is unclear in the literature whether feeling pain during the night could be associated with poor subjective sleep quality. Our objective was to describe a measurement model that appropriately conveys the link between sleep and feeling pain at night. Methods A cross-sectional analysis was conducted, using a dataset from the 2015 São Paulo Epidemiological Sleep Study (EPISONO), including only individuals aged 60 years or more. Two constructs were formulated: an objective sleep quality construct, based on the polysomnography (PSG) performed on all EPISONO volunteers and a subjective sleep quality construct, formed by the self-reported answers in the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI). Musculoskeletal pain was assessed by 1. Did you feel any pain during the night? 2. Did you wake up feeling pain? (Possible answers: “Yes” or “No”). We used exploratory factor analysis and structural equation modelling to identify the significant variables. Results A total of 152 older adults was analyzed in this study. The PSQI and ISI indicate poor perception of sleep or a high frequency of sleep complaints in proportion to their score, the resulting latent factor was labelled poor sleep perception. The exploratory factor analysis assessed the measurement models of the latent factors and resulted in the inclusion of sleep-related variables: wake after sleep onset, sleep efficiency, total sleep time, latency to sleep onset and amount of N1 stage in the objective sleep quality factor. However, this factor was not associated with felling pain during the night and woke up with pain. Conclusion Our findings suggest that poor sleep perception was associated with feeling pain at night in older adults. These results contribute for the improvement of future clinical evaluations of patients presenting musculoskeletal pain and sleep complaints and highlight the importance of considering both factors simultaneously during treatment. Support (If Any) The study was supported by Associação Fundo de Incentivo à Pesquisa (AFIP) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES Finance Code 001 to GLF) and Conselho Nacional de Desenvolvimento Científico Tecnológico (CNPq–Grant #133397/2017-3, #141445/2021-1 to GLF); MLA and ST are Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) fellowship recipients.

0503 The Relationships between the Impact of COVID-19 Pandemic, Parent Insomnia, Infant Temperament, and Infant Sleep: a Path Analysis

IntroductionIncreased sleep problems in adults have been repeatedly reported during the COVID-19 pandemic. However, infant sleep was understudied. We aimed to examine the relationships between the impact of the COVID-19 pandemic, parent insomnia, infant temperament, and infant sleep during the COVID-19 pandemic.MethodsParents from the Phoenix metropolitan area with a full-term healthy infant (<1 year) were recruited through social media from 2/27/2021 to 8/7/2021. A sample of 70 parents (baby age 5.5±3.5mo; parental age: 31.7±5.0y) completed the COVID-19 Exposure and Family Impact Survey Part 2 (CEFIS-Part 2, range: 12-60), a measure of the impact of the COVID-19 pandemic on families with higher scores indicating greater negative impact/distress; the Brief Infant Sleep Questionnaire-Revised (BISQ-R, range: 0-100), with higher scores indicating better sleep quality, more positive sleep perception, and parent behaviors promoting healthy sleep; and the Insomnia Severity Index (ISI, range: 0-28, cutoff: 10). Infant temperament was assessed with the Infant Behavioral Questionnaire-Revised (IBQ-R), including the subscale Negative Affect. Path analyses were conducted based on the Transactional Model of Infant Sleep to identify the direct effect of CEFIS scores, and indirect effects of parent ISI scores and infant IBQ-R Negative Affect scores on BISQ-R scores, with z scores of all variables and infant age as a covariate.ResultsThe parent sample was predominantly female (94.3%), identified as White (72.9%), had obtained a bachelor’s degree or above (71.5%), was married or in a domestic partnership (98.6%), and had household incomes > US$70,000 (57.1%). More than one third (35.7%) experienced insomnia symptoms. The means of CEFIS, ISI, IBQ-R subscale Negative Affect, and BISQ-R scores were 29.3±9.5, 8.7±5.2, 4.1±1.1, and 68.8±12.7, respectively. After adjusting for infant age, the COVID-19 related family impact was not directly associated with BISQ-R scores, whereas parent ISI scores (β=-0.11, 95%CI [-.25, -.01]) and infant IBQ-R Negative Affect scores (β=-0.10, 95%CI [-.25, -.002]) significantly mediated the relationship.ConclusionThe study highlighted the indirect effects of parent insomnia symptom severity and infant negative affect on infant sleep from the family impact of the COVID-19 pandemic. Future research should investigate how best to support healthy sleep for families during global crises.Support (If Any)

Effects of cognitive behavioral therapy for insomnia on subjective and objective measures of sleep and cognition

Study objectivesTo assess the effects of Cognitive Behavioral Therapy for insomnia (CBTi) on subjective and objective measures of sleep, sleep-state misperception and cognitive performance. MethodsWe performed a randomized-controlled trial with a treatment group and a wait-list control group to assess changes in insomnia symptoms after CBTi (8 weekly group sessions/3 months) in 62 participants with chronic insomnia. To this end, we conducted a multimodal investigation of sleep and cognition including subjective measures of sleep difficulties (Insomnia Severity Index [ISI]; sleep diaries) and cognitive functioning (Sahlgrenska Academy Self-reported Cognitive Impairment Questionnaire), objective assessments of sleep (polysomnography recording), cognition (attention and working memory tasks), and sleep-state misperception measures, collected at baseline and at 3-months post-randomization. We also assessed ISI one year after CBTi. Our main analysis investigated changes in sleep and cognition after 3 months (treatment versus wait-list). ResultsWhile insomnia severity decreased and self-reported sleep satisfaction improved after CBTi, we did not find any significant change in objective and subjective sleep measures (e.g., latency, duration). Degree of discrepancy between subjective and objective sleep (i.e., sleep misperception) in sleep latency and sleep duration decreased after CBTi suggesting a better perception of sleep after CBTi. In contrast, both objective and subjective cognitive functioning did not improve after CBTi. ConclusionsWe showed that group-CBTi has a beneficial effect on variables pertaining to the subjective perception of sleep, which is a central feature of insomnia. However, we observed no effect of CBTi on measures of cognitive functioning.

Associations Between Diaper Need and Child Sleep in Under-resourced Families.

Sleep is critical for child health, but factors related to poverty create barriers to the achievement of healthful sleep. In this study, we examined the associations of insufficient diaper supply, a measure of material hardship, with child sleep. This cross-sectional study included 129 parents of very young children. Each participant responded to an online material hardship assessment and the Brief Infant Sleep Questionnaire-Revised. Multiple linear regression was used to analyze the relationship between diaper need and sleep. Controlling for family and socioeconomic variables, diaper need was associated with disrupted, shorter sleep periods (β = -11.95, p < 0.001) and lower total sleep scores (β = -6.49, p = 0.004). High diaper need was associated with parent perception of poor sleep (β = -7.28, p = 0.017). The findings suggest that an inadequate supply of diapers adversely affects children's sleep. Further research should evaluate how screening and connecting families to resources may improve pediatric sleep.

Migraine may disturb sleep perception during sleep onset: a retrospective data analysis.

As sleep latency is an important factor in the diagnosis of many disorders, it is important to know whether the patient's self-reported evaluation of sleep latency corresponds with an objectively measured evaluation. Some studies indicate that patients usually overestimate their sleep latency. We sought to determine how comorbidities affect the patient's ability to assess their sleep latency. This was a retrospective study of 240 patients who had a polysomnography recorded at our sleep unit or at home in 2017-2020. Data on comorbidities were collected from hospital records. Mean objective sleep latency (29.5 minutes, standard deviation [SD] 35.5) was significantly lower than self-reported sleep (37.4 minutes, SD 41.6) (P < .001). The patients who overestimated their sleep latency had higher mean apnea-hypopnea index (18.8 events/h, SD 21.6, vs 13.4 events/h, SD 12.8; P = .04) and higher mean sleep efficiency (81.7%, SD 13.6%, vs 75.2%, SD 13.9%; P = .004) than those who underestimated their sleep latency. There were significantly more patients with migraine in the overestimation group than in the underestimation group (20/159 patients vs 3/81 patients; P = .035). This difference was not observed in patients with headache without migraine (P = 1.000). We hypothesize that migraine is markedly associated with overestimation of sleep latency. This overestimation was not observed in patients with other headache types. Further studies are needed to explore the relation between migraine and sleep onset misperception. Rantanen O, Hollmen M, Bachour A. Migraine may disturb sleep perception during sleep onset: a retrospective data analysis. J Clin Sleep Med. 2022;18(9):2113-2117.

Sleep disturbance in elderly patients with dementia at home and the factors associated with its identification: An observational study

The purpose of this study was to objectively quantify the sleep of elderly patients with dementia at home using a device and to investigate the factors associated with its identification. Sixteen patients (6 males [37.5%], 84.1±4.7 years old; and 10 patients with mild dementia [62.5%]) and their family caregivers who were using outpatient memory clinics and home-visiting nursing station in Japan were included. Demographic and clinical data of the patients and their family caregivers, subjective perceptions of patients' sleep, family caregivers' Zarit care burden, and whether or not they were aware of patients' sleep problems were determined. Nighttime sleep parameters were collected for one week using a non-wearable actigraph. Sleep parameters were compared with patients' subjective views and family caregivers' observations to investigate factors indicative of sleep disturbance. Nighttime sleep parameters for 1 week (mean) were follows: sleep efficiency, 77.2%±9.3%; asleep time, 442.3±99.9 minutes; sleep latency, 18.2±15.8 minutes; awake time, 105.1±69.7 minutes; and number of times leaving the bed, 4.6±3.8 (maximum of 29/night). A significant positive correlation was found between sleep efficiency and duration of dementia (r=0.53, p=0.046), while no correlation was found with dementia severity or Zarit care burden score. The agreement between the patients' complaints about sleep and sleep efficiency (75%) was 30.7%, and family caregivers' awareness of patients' nighttime awakening and bed-leaving was significantly associated with patients' incontinence (p=0.024) and a greater dementia severity (p=0.027). Elderly dementia patients experienced sleep disturbance at home, such as nighttime awakening and associated bed-leaving; however, it might be difficult to identify these patients at an early stage based on their own complaints and observations by family caregivers. Identifying sleep problems at an early stage may thus require the use of objective measurement devices.

Exclusive Breastfeeding Duration and Perceptions of Infant Sleep: The Mediating Role of Postpartum Anxiety.

(1) Background: Existing literature has identified associations between exclusive breastfeeding, maternal mental health, and infant sleep. This study aims to examine these relationships simultaneously and consider the mediating role of postpartum anxiety. (2) Methods: Participants completed validated measures of postpartum anxiety, infant sleep, and reported exclusive breastfeeding duration. Postpartum mothers with infants between six and twelve months (n = 470) were recruited to a cross-sectional online survey containing a battery of psychological measures. (3) Results: Correlation analyses examined the relationships between the predictor (exclusive breastfeeding duration), outcome (perceptions of infant sleep), and mediator (postpartum anxiety). Exclusive breastfeeding duration was significantly associated with postpartum anxiety (p < 0.05), postpartum anxiety was significantly associated with perceptions of infant sleep (p < 0.001), and exclusive breastfeeding duration was significantly associated with perceptions of infant sleep (p < 0.001). A simple mediation model was conducted, showing a significant total (B = −0.029 (0.010), p < 0.05), direct (B = −0.035 (0.009), p < 0.001), and indirect effect (B = 0.007, SE = 0.003, 95% CI = 0.000 to 0.014) of exclusive breastfeeding duration on perceptions of infant sleep via postpartum anxiety. (4) Conclusions: Associations were identified between exclusive breastfeeding duration, postpartum anxiety, and perceptions of infant sleep. The mediation model suggests postpartum anxiety may be an underlying mechanism which reduces exclusive breastfeeding duration and negatively affects maternal perceptions of infant sleep quality.

Negative and positive sleep state misperception in patients with insomnia: factors associated with sleep perception.

In the present study, factors associated with sleep perception were identified by comparing clinical characteristics and polysomnographic variables between insomnia patients with negative and positive sleep state misperception (NSSM and PSSM, respectively). Self-reported and objective sleep measures were retrospectively collected, including the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory, and a questionnaire on "morning feeling" after nocturnal polysomnography in 150 patients with insomnia. Based on the misperception index (MI), participants were classified into NSSM (MI > 0, n = 115) and PSSM (MI < 0, n = 35) groups. The PSSM group had more N3 sleep on nocturnal polysomnography than the NSSM group (P = .002). The NSSM group showed a higher PSQI score (P < .001), longer self-reported sleep-onset latency (SOL) (P = .001), and a greater SOL discrepancy (P = .001). Self-reported feelings of tiredness and morning awakenings in the morning were higher in the NSSM group (P = .029 and P = .038). The MI negatively correlated with a proportion of N3 sleep (P = .005) and positively correlated with PSQI (P < .001), morning awakenings (P = .01), self-reported SOL (P < .001), and SOL discrepancy (P < .001) in patients with insomnia. Multiple regression analysis showed that N3 sleep, PSQI, and morning awakenings were significantly associated with MI in patients with insomnia. The proportion of slow-wave sleep and self-reported measures may be associated with perception of sleep in patients with insomnia. Objective and self-reported characteristics of patients with insomnia should be carefully evaluated and managed because they may influence the perception of sleep. Yoon G, Lee MH, Oh SM, Choi J-W, Yoon SY, Lee YJ. Negative and positive sleep state misperception in patients with insomnia: factors associated with sleep perception. J Clin Sleep Med. 2022;18(7):1789-1795.

Sleep Misperception and Associated Factors in Patients With Anxiety-Related Disorders and Complaint of Insomnia: A Retrospective Study.

PurposeData on sleep parameters by polysomnography (PSG) in patients with anxiety-related disorders are limited. Although the disturbance and risk factors of sleep misperception have been implicated in psychopathology, its role in anxiety-related disorders remains unclear. This retrospective study aimed to explore the characteristics and sleep parameters in patients with anxiety-related disorders and different sleep perception types, and to explore the associated factors for sleep misperception.MethodsPatients with anxiety-related disorders who had complaint of insomnia for more than 3 months were collected at Wuhan Mental Health Center between December 2019 and July 2021. Patients underwent a two-night PSG monitoring and completed a self-reported sleep questionnaire. Behaviors were assessed using 30-item Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30). Patients were divided into normal sleep perception (NSP), positive sleep perception abnormality [PSPA; overestimation of total sleep time (TST) >60 min], and negative sleep perception abnormality (NSPA; underestimation of TST >60 min) groups. PSG indicators and NOSIE-30 scores were compared among groups using the one-way analysis of variance and the Kruskal-Wallis test. Multiple linear regression analysis was performed to determine the associated factors for misperception index.ResultsThe subjective and objective TST were 5.5 ± 1.9 h and 6.4 ± 1.7 h in 305 patients, respectively. Sixty-nine (22.6%) had PSPA, 80 (26.2%) had NSP, and 156 (51.1%) had NSPA. Subjective TST and objective sleep parameters were significantly different among groups. No statistical differences in NOSIE-30 subscale and total scores were observed among groups. Sex, rapid eye movement (REM)/TST (%), sleep efficiency, number of awakenings, Non-rapid eye movement of stage 2 sleep (NREM)/TST (%), REM spontaneous arousal times, sleep latency, diagnosis, social competence, and manifest psychosis were associated with sleep misperception.ConclusionSleep misperception is common in patients with anxiety-related disorders. Various sleep perception types have different PSG profiles, but similar personal and social behaviors. These data may be helpful to conduct personalized treatment.

A Longitudinal Study of the Effects of Bed-Sharing Experience in Infancy on Sleep Outcomes at 2 Years Old

To assess the effects of bed-sharing experiences in infancy on sleep patterns and sleep problems at 2years of age. A total of 1564 children from an ongoing Shanghai Maternal-Child Pairs Cohort were included. Bed-sharing experiences were collected when children were 2, 6, and 24months old via caregiver-completed questionnaires (whether caregivers shared a bed with children during the night), and children's bed-sharing experiences were classified as follows: no bed-sharing, early-only bed-sharing, late-onset bed-sharing, and persistent bed-sharing. Sleep outcomes at month 24 were assessed using the Brief Infant Sleep Questionnaire. Sleep patterns and problems were compared among the 4 types of bed-sharing experiences. Of the 1564 infants, 10.10% had no bed-sharing, 18.35% had early-only, 27.94% had late-onset, and43.61% had persistent bed-sharing. Compared with children with no bed-sharing, children with late-onset and persistent bed-sharing had shorter nighttime sleep durations and longer daytime sleep durations (P<.05) and were more likely to snore (aOR 1.87 [95% CI 1.25-2.79]; aOR 1.68 [95% CI 1.14-2.47]) and have sleep onset difficulty (aOR 2.06 [95% CI 1.37-3.09]; aOR 2.07 [95% CI 1.41-3.05]). However, caregivers of infants in the late-onset and persistent bed-sharing groups perceived less problematic sleep (aOR 0.38 [95% CI 0.26-0.56] and aOR 0.40 [95% CI 0.28-0.58]). Bed-sharing is a common experience among Chinese children. Although bed-sharing may reduce caregivers' perception of children's problematic sleep, late-onset or persistent bed-sharing in infancy is associated with sleep problems at 2years of age.