Self-reported Sleep Measures Research Articles

Investigating the relationship between objective measures of sleep and self-report sleep quality in healthy adults: a review.

Sleep is one of the most common factors related to health, yet a standard definition of sleep quality has not been identified. Polysomnography provides important information about objective sleep variables. However, the relationship between objective sleep variables and perception of sleep quality remains unclear. The purpose of this review was to (1) summarize the current methods of measuring objective sleep macrostructure and microstructure, including electroencephalography arousals, spectral frequency, cyclic alternating pattern, and self-report sleep quality, and (2) investigate the relationship between objective measures of sleep physiology and self-report sleep quality in healthy adults. A literature search was conducted using Medline, PubMed, and PsycInfo databases and cited reference searches. Eligible studies included a comparison between self-report sleep quality and polysomnography sleep measures in healthy adults. Thirteen studies were identified. Measurement of self-report sleep quality varied widely across studies. Total sleep time and sleep efficiency were most consistently related to sleep quality, while other objective sleep variables, including electroencephalography spectral analysis, were not reliably predictive of self-report sleep quality in healthy adults. There is preliminary support that microstructural sleep analysis with cyclic alternating pattern may be related to self-reported sleep quality. Further research is needed to define and standardize self-report measures of sleep quality and investigate the microstructure of sleep. Objective measures of sleep and experiences of "quality" sleep are not as closely related as one may expect in healthy individuals, and understanding this relationship further is necessary to improve the clinical utility of sleep physiology. Cudney LE, Frey BN, McCabe RE, Green SM. Investigating the relationship between objective measures of sleep and self-report sleep quality in healthy adults: a review. J Clin Sleep Med. 2022;18(3):927-936.

Sleep and health: examining the relation of sleep to burnout and well-being using a consumer fitness tracker

Sleep is an essential requirement for both physiological and psychological functioning and has an impact on various health parameters. The present study aimed to examine how quantity and quality of sleep predicts burnout and well-being by using both self-reported and objectively collected sleep data. The participants were 104 white-collar workers who wore a fitness tracker for 14 consecutive days and filled out a questionnaire about sleep, burnout, and well-being. The results showed that self-reported sleep quality predicts burnout and well-being, but neither did self-reported nor objective sleep duration. We concluded that although measuring sleep duration with a consumer fitness tracker still needs to be improved, it is a useful addition to self-reported sleep measures. The study did solidify results from previous self-reported measures and point out the prominent role of sleep quality rather than hours of sleep.

Greater time in bed and less physical activity associate with poorer cognitive functioning performance in Huntington's disease.

Objective: This study aimed to investigate how sleep and physical activity habits related to cognitive functioning, in naturalistic settings, in early Huntington's disease (HD). Method: Forty-two participants with the expanded HD repeat (20 manifest, 22 premanifest) and 29 healthy controls wore Fitbit One sleep and activity monitors for 7 days and 7 nights. They used a smartphone application to complete daily sleep and activity diaries, sleep and mood inventories, and a brief battery of cognitive tests, which were completed on Day 8 of the study. All data were collected in naturalistic home and community settings. Results: Amongst participants with the expanded HD repeat, greater time spent in bed, measured by Fitbit, was associated with poorer accuracy and response speed on a test of visual memory, whereas lower levels of physical activity, measured by Fitbit, were associated with poorer accuracy on a test involving a working memory component. Neither time in bed nor physical activity is associated with a test of psychomotor speed. Groups were mostly similar across a range of Fitbit and self-report measures of sleep and physical activity, although the Manifest-HD group spent more time in bed than the Premanifest-HD and Healthy Control groups and had better self-reported sleep quality and more self-reported time spent sitting than the Healthy Control group and the Premanifest-HD group, respectively. Conclusions: Sleep timing and physical activity relate to cognitive functioning in HD and may be important targets for management in behavioral intervention studies aimed at improving cognition in HD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Burnt out: how to help firefighters help themselves.

Burnt out: how to help firefighters help themselves.

Actigraphic and Self-reported Sleep Measures in Older Adults: Factor Analytic Study.

Actigraphy has been used to measure older adults' sleep, but few studies have evaluated the factor structure among actigraphy-measured sleep parameters. Additionally, previous studies have reported the association between actigraphy-measured and self-reported sleep parameters in older adults but have not controlled for covariates of gender, insomnia, cognitive impairment, depression, and health conditions. We therefore investigated the factor structure of actigraphy-measured sleep parameters and, controlling for covariates, the association between actigraphy-measured and self-reported sleep parameters in 62 older adults (female: 75.8%; mean age: 69.9). The factor analysis gave a three-factor solution: length of wakefulness during sleep, sleep disruption, and total sleep time. Self-reported sleep parameters and covariates explained actigraphy-measured total sleep time (explained variance: 61%) substantially more than length of wakefulness during sleep (explained variance: 14%) and sleep disruption (explained variance: 11%). Studies need to select sleep measures based on their focus to best understand sleep characteristics in healthy older adults.

Discrepancies between self-reported and device-measured sleep parameters in adults with multiple sclerosis.

Sleep problems are a common consequence of multiple sclerosis; however, there is limited evidence regarding the agreement between device-measured and self-reported sleep parameters in adults with multiple sclerosis. The present study examined the agreement between self-reported and device-measured parameters of sleep quality in a sample of adults with multiple sclerosis. Participants (n = 49) completed a 7-day sleep diary and wore a wrist-worn ActiGraph GT3×+ (ActiGraph Corp., Pensecola, FL) for seven consecutive nights to quantify self-reported and device-measured sleep parameters, respectively. There was a significant discrepancy between self-reported and device-measured parameters of total time in bed (mean difference = 19.8 [51.3] min), sleep onset latency (mean difference = 22.2 [19.5] min), and frequency of awakenings during the night (mean difference = 12.8 [6.8]). Intraclass correlation estimates indicated poor agreement between methods on most parameters, except for total time in bed (intraclass correlation = 0.80). Bland-Altman plots suggested that total time in bed and total sleep time had acceptable levels of agreement and linear regression analyses indicated that sleep onset latency (F = 113.91, B = -1.34, P < .001), number of awakenings (F = 543.34, B = 1.85, P < .001), and sleep efficiency (F = 18.39, B = -0.77, P < .001) had significant proportional bias. Our results draw attention to the discrepancies between sleep parameter measurements and highlight the importance of including both self-report and device-measured outcomes for a complete and accurate representation of sleep in adults with multiple sclerosis. Cederberg KLJ, Mathison BG, Schuetz ML, Motl RW. Discrepancies between self-reported and device-measured sleep parameters in adults with multiple sclerosis. J Clin Sleep Med. 2022;18(2):415-421.

Firefighter sleep: a pilot study of the agreement between actigraphy and self-reported sleep measures.

The aim of this study is to determine the extent of agreement between self-reported measurements of total sleep time (TST) and actigraphy in the fire and emergency services occupation. Twenty-four firefighters participated in an 18-day study. Four measurements were used to assess TST: Pittsburgh Sleep Quality Index, a newly developed habitual Extended Sleep Survey, a newly developed daily Emergency Services Sleep Diary (ESSD), and actigraphy. The Extended Sleep Survey and ESSD were constructed to address the specific job-related characteristics of fire and emergency services that other measurements cannot achieve (eg, multiple sleep episode in a single night). The Pittsburgh Sleep Quality Index TST is least accurate compared to actigraphy. The Extended Sleep Survey TST shows improvement over Pittsburgh Sleep Quality Index TST, but was statistically different from actigraphy TST. No difference in mean TST was found between ESSD TST and actigraphy TST. Furthermore, ESSD TST and actigraphy TST correlated strongly together. Without modification, traditional self-reported measures may not be appropriate in the fire and emergency service occupation. This study suggests that the ESSD may serve as a useful alternative to actigraphy to measure TST. Billings JM. Firefighter sleep: a pilot study of the agreement between actigraphy and self-reported sleep measures. J Clin Sleep Med. 2022;18(1):109-117.

Self-Reported and Objective Sleep Measures in Stroke Survivors With Incomplete Motor Recovery at the Chronic Stage

Background. Stroke survivors commonly complain of difficulty sleeping. Poor sleep is associated with reduced quality of life and more understanding of long-term consequences of stroke on sleep is needed. Objective. The primary aims were to (1) compare sleep measures between chronic stroke survivors and healthy controls and (2) test for a relationship between motor impairment, time since stroke and sleep. Secondary aims were to explore mood and inactivity as potential correlates of sleep and test the correlation between self-reported and objective sleep measures. Methods. Cross-sectional sleep measures were obtained for 69 chronic stroke survivors (mean 65 months post-stroke, 63 years old, 24 female) and 63 healthy controls (mean 61 years old, 27 female). Self-reported sleep was assessed with the sleep condition indicator (SCI) and sleep diary ratings, objective sleep with 7-nights actigraphy and mood with the Hospital Anxiety and Depression Scale. Upper extremity motor impairment was assessed with the Fugl-Meyer assessment. Results. Stroke survivors had significantly poorer SCI score (P < .001) and higher wake after sleep onset (P = .005) than controls. Neither motor impairment, nor time since stroke, explained significant variance in sleep measures for the stroke group. For all participants together, greater depression was associated with poorer SCI score (R2adj = .197, P < .001) and higher age with more fragmented sleep (R2adj = .108, P < .001). There were weak correlations between nightly sleep ratings and actigraphy sleep measures (r s = .15–.24). Conclusions. Sleep disturbance is present long-term after stroke. Depressive symptoms may present a modifiable factor which should be investigated alongside techniques to improve sleep in this population.

Sleep Habits of Women With Infertility.

Sleep plays important roles in metabolic and reproductive function, and polycystic ovary syndrome (PCOS) is associated with sleep disturbances, including increased prevalence of obstructive sleep apnea. We sought to evaluate sleep parameters in infertile women with PCOS compared with women with unexplained infertility (UI) and identify risk factors for disturbed sleep. At private and academic ambulatory gynecology and infertility practices, we evaluated a prospective cohort of women diagnosed with PCOS or UI from 2 randomized clinical trials. We included 1603 infertile women enrolled in 2 concurrent randomized clinical trials. The main outcome measures were self-reported sleep measures. Sleep duration <6 hours (6.1% vs 2.7%; P < .001), habitual snoring (37.8% vs 19.0%; P < .001), and clinical sleepiness (12.0% vs 8.6%; P < .026) were more common in women with PCOS than those with UI. After adjusting for covariates, PCOS and elevated fasting insulin were associated (P = .010) with clinical symptoms of obstructive sleep apnea (OSA) diagnosis, whereas PCOS, elevated insulin (P = .003), WC >88 cm (P = .003), and current smoking (P = .012) were associated with habitual snoring. Clinical depression score (P < .001) and PCOS diagnosis (P = .002) were associated with perceived daytime sleepiness. Short sleep duration and clinical symptoms of OSA were not associated with conception and live birth rates. Infertile women with PCOS more commonly report sleep disturbances than those with UI. Markers of insulin resistance are associated with previous diagnosis of OSA, habitual snoring, and short sleep duration. The presence of clinical symptoms of OSA or short sleep duration does not affect fertility treatment response.

Are Sweet Dreams Made of These? Understanding the Relationship Between Sleep and Cannabis Use.

Introduction: There is widespread literature on the interaction between cannabis use and sleep, yet the mechanisms that underlie this relationship are not well understood. Several factors lead to inconsistencies in this relationship suggesting a nuanced interaction between cannabis and sleep. An important question that remains to be addressed is the temporal relationship between disrupted sleep and cannabis use. This literature review summarizes the existing literature on the association between disrupted sleep and cannabis toward the goal of addressing the question of the chronology of these reported effects. Materials and Methods: We conducted a review of the literature using PubMed to summarize current knowledge on the association between cannabis use and sleep in humans. Results: We identified 31 studies on the association of cannabis use and sleep. The findings from these studies were mixed. Cannabis was associated with a variety of impacts on sleep ranging from beneficial effects, such as reduced sleep-onset latency, to negative outcomes, such as reduced sleep duration and suppressed rapid eye movement oscillations. The chronology of the interaction of cannabis and sleep was unclear, although much of the current literature focus on factors that modulate how cannabis impairs sleep after initial use. Conclusion: There was sufficient evidence to suggest that cannabis use alters circadian rhythms, and hence, negatively impacts sleep. The current literature is largely from studies utilizing self-report measures of sleep; thus, objective measures of sleep are needed. In addition, although there were no empirical studies on the temporal relationship between cannabis use and sleep, the majority of the literature focused on characterizing sleep impairment after cannabis use.

Sleep Difficulties among Mexican Adolescents: Subjective and Objective Assessments of Sleep

ABSTRACT Objective/Background Self-reported sleep difficulties, such as insomnia symptoms, have been reported among adolescents. Yet, studies of their prevalence and correlates are scarce among Latin Americans. This study sought (1) to describe associations between sociodemographic and lifestyle factors with self-reported sleep difficulties and (2) to examine associations between self-reported sleep difficulties and actigraphy-based sleep. Participants Participants included 477 Mexican adolescents from the ELEMENT cohort. Methods Over 7 days, self-reported sleep measures (hard time falling asleep, overall sleep difficulties, and specific types of sleep difficulties) were obtained from daily sleep diaries. Actigraphy-based sleep measures (duration, i.e. sleep onset to morning wake, midpoint, and fragmentation) were concurrently assessed using a wrist actigraph. Results Mean (SD) age was 15.9 (2.2) years, and 53.5% were females. Mean (SD) sleep duration was 8.5 (1.2) h/night. Half reported a hard time falling asleep at least 3 days, and 25% had sleep difficulties at least 3 days over 7 days. The 3 types of sleep difficulties commonly reported among the entire cohort were insomnia/restlessness (29%), environmental (27%), and mental/emotional difficulties (19%). Female sex, smoking behavior, and socioeconomic indicators were among the most consistent factors associated with sleep difficulties. Subjective sleep difficulties were associated with shorter sleep duration (β = −20.8 [−35.3, −6.2] min), while subjective hard time falling asleep was associated with longer sleep duration (β = 11.3 [4.6, 27.2] min). Conclusion A high proportion of Mexican adolescents in the sample reported sleep difficulties. Findings demonstrate the importance of obtaining subjective and objective sleep measures for a more comprehensive assessment of adolescent sleep.

Test-Retest Reliability and Responsiveness of PROMIS Sleep Short Forms Within an RCT in Women With Fibromyalgia.

Background: Nonrestorative sleep is commonly reported by individuals with fibromyalgia, but there is limited information on the reliability and responsiveness of self-reported sleep measures in this population.Objectives: (1) Examine the reliability and validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) sleep measures in women with fibromyalgia, and (2) Determine the responsiveness of the PROMIS sleep measures to a daily transcutaneous electrical nerve stimulation (TENS) intervention in women with fibromyalgia over 4 weeks compared with other measures of restorative sleep.Methods: In a double-blinded, dual-site clinical trial, 301 women with fibromyalgia were randomly assigned to utilize either Active-TENS, Placebo-TENS, or No-TENS at home. Measures were collected at baseline and after 4 weeks of treatment. To assess self-reported sleep, the participants completed three PROMIS short forms: Sleep Disturbance, Sleep-Related Impairment, Fatigue, and the Pittsburgh Sleep Quality Index (PSQI). To assess device-measured sleep, actigraphy was used to quantify total sleep time, wake after sleep onset, and sleep efficiency. Linear mixed models were used to examine the effects of treatment, time, and treatment*time interactions.Results: The PROMIS short forms had moderate test–retest reliability (ICC 0.62 to 0.71) and high internal consistency (Cronbach's alpha 0.89 to 0.92). The PROMIS sleep measures [mean change over 4 weeks, 95% confidence interval (CI)], Sleep Disturbance: −1.9 (−3.6 to −0.3), Sleep-Related Impairment: −3 (−4.6 to −1.4), and Fatigue: −2.4 (−3.9 to −0.9) were responsive to improvement in restorative sleep and specific to the Active-TENS group but not in the Placebo-TENS [Sleep Disturbance: −1.3 (−3 to 0.3), Sleep-Related Impairment: −1.2 (−2.8 to 0.4), Fatigue: −1.1 (−2.7 to 0.9)] or No-TENS [Sleep Disturbance: −0.1 (−1.6 to 1.5), Sleep-Related Impairment: −0.2 (−1.7 to 1.4), Fatigue: –.3 (−1.8 to 1.2)] groups. The PSQI was responsive but not specific with improvement detected in both the Active-TENS: −0.9 (−1.7 to −0.1) and Placebo-TENS: −0.9 (−1.7 to 0) groups but not in the No-TENS group: −0.3 (−1.1 to 0.5). Actigraphy was not sensitive to any changes in restorative sleep with Active-TENS [Sleep Efficiency: −1 (−2.8 to 0.9), Total Sleep Time: 3.3 (−19.8 to 26.4)].Conclusion: The PROMIS sleep measures are reliable, valid, and responsive to improvement in restorative sleep in women with fibromyalgia.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT01888640.

Profile of subjective-objective sleep discrepancy in patients with insomnia and sleep apnea.

Although subjective-objective sleep discrepancy has long been observed in patients with insomnia, the profiles of this discrepancy are poorly understood. Further, sleep discrepancy in insomnia with sleep comorbidities remains underexplored. We sought to better characterize sleep discrepancy among patient groups with and without insomnia and comorbid conditions such as obstructive sleep apnea (OSA). Using data from the Sleep Heart Health Study, we conducted a secondary analysis describing (1) the profile of self-reported and objective sleep measures in patients with insomnia (IS group; n = 73) and comorbid OSA (IS + OSA group; n = 143), compared with individuals with OSA only (OSA group; n = 296) and normal sleep control patients (NSC group; n = 126); (2) the comparative magnitude of sleep misperception between these 4 groups; and (3) the self-reported quality of life (QOL) in the 4 groups. Subjective-objective sleep discrepancy existed in all 4 groups, including the NSC group. Controlling for age, sex, mental health conditions, sleep apnea severity, and objectively measured sleep time, the presence of self-reported insomnia had the strongest association with sleep discrepancy. In patients with insomnia, sleep onset latency was overestimated (7.8 ± 36.8 min in the IS group; P < .001 when compared to the NSC and OSA groups), with the largest differences seen in the comorbid IS + OSA group (15.0 ± 56.8 min). Insomnia conferred the most negative impact on QOL, with the combined IS + OSA group reporting the lowest QOL. Self-reported insomnia is associated with sleep discrepancy and negative QOL. Those with comorbid OSA reported the greatest sleep discrepancy and the lowest QOL. Future research is warranted to further understand individual profiles of misperception and insomnia phenotypes. Ma Y, Goldstein MR, Davis RB, Yeh GY. Profile of subjective-objective sleep discrepancy in patients with insomnia and sleep apnea. J Clin Sleep Med. 2021;17(11):2155-2163.

Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes.

The purpose of this study was to describe objective sleep-wake characteristics and glycemia over 7-14 days in young adults with type 1 diabetes. In addition, person-level associations among objective sleep-wake characteristics (total sleep time, sleep variability, and sleep fragmentation index), daytime sleepiness, and glycemia (glycemic control and glucose variability) were examined. In this cross-sectional study, objective sleep-wake characteristics were measured via actigraphy and glucose variability via continuous glucose monitoring over 6-14 days. At baseline, participants completed the Psychomotor Vigilance Test, the Trail Making Test, and questionnaires on daytime sleepiness, sleep quality, and sleep disturbance including sleep diaries. Forty-six participants (mean age, 22.3 ± 3.2 years) wore a wrist actigraph and underwent continuous glucose monitoring concurrently for 6-14 days. Greater sleep variability was directly associated with greater glucose variability (mean of daily differences; r = .33, P = .036). Higher daytime sleepiness was directly associated with greater glucose variability (mean of daily differences; r = .50, P = .001). The association between sleep variability and glucose variability (mean of daily differences) was no longer significant when accounting for daytime sleepiness and controlling for type 1 diabetes duration (P > .05). A higher sleep fragmentation index was associated with greater glucose variability (B = 1.27, P = .010, pr2 = 0.40) after controlling for type 1 diabetes duration and accounting for higher daytime sleepiness. Sleep-wake variability, sleep fragmentation, daytime sleepiness, and the associations with glycemia are new dimensions to consider in young adults with type 1 diabetes. Sleep habits in this population may explain higher glucose variability, and optimizing sleep may improve overall diabetes management. Griggs S, Hickman RL Jr, Strohl KP, Redeker NS, Crawford SL, Grey M. Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes. J Clin Sleep Med. 2021;17(9):1865-1874.

545 Actigraphic sleep parameters and anxiety symptoms among community-dwelling older adults

Abstract Introduction A number of cross-sectional studies have found that elevated levels of anxiety are associated with poor sleep among healthy older adults, but most have used self-reported sleep measures. We investigated the longitudinal association between objectively measured sleep (by wrist actigraphy) and subsequent change in anxiety symptoms in this population. Methods We studied 555 community-dwelling older adults (mean age 72.52±7.35, 77.48% white, 53.15% women) in the National Social Health and Aging Project (NSHAP) study who completed 3 nights of wrist actigraphy at wave 2 (2010–2011) and the Hospital Anxiety and Depression Scale at waves 2 and 3 (2015–2016). Actigraphic sleep parameters were averaged across nights and included: total sleep time (TST; minutes), percent sleep (%), wake after sleep onset (WASO; minutes), and sleep fragmentation. Change in anxiety was calculated as the difference between anxiety scores at wave 3 and wave 2. Results After adjusting for age, race, sex, education, body mass index, number of medical conditions, depression symptoms, and anxiety scores at wave 2, we found no significant associations between any actigraphic sleep parameter and subsequent change in anxiety symptoms (all p ≥ 0.390). Additional analyses revealed no significant cross-sectional associations at wave 2 (p ≥ 0.390). Conclusion We found no evidence for an association between actigraphic sleep and anxiety symptoms, or change in anxiety symptoms, in community-dwelling older adults. Additional studies using clinical anxiety disorder diagnoses are needed to evaluate the extent to which objectively measured sleep disturbance predicts clinically significant anxiety in older adults. Support (if any) American Academy of Sleep Medicine Foundation (#223-BS-19).

538 Sleep and Self-Efficacy: The Role of Domain Specificity in Predicting Sleep

Abstract Introduction Poor sleep occurs across the lifespan and has a number of consequences across biopsychosocial life domains. As such, it is important to identify modifiable psychobehavioral mechanisms contributing to sleep disturbance as potential targets for research and intervention. Self-efficacy may play a significant role in sleep behavior outcomes. The present study aimed to determine the differential associations between general and sleep self-efficacy and sleep among a lifespan sample of adults. Methods Data from the Investigating Sleep Longitudinally Across Normal Development (ISLAND) study were utilized for the present investigation. Participants were 3,284 adults (48.5% female, 6.4% other-identifying, Mage= 43 yrs., SD=16.72 yrs.) who completed self-report sleep, general-, and sleep self-efficacy measures as part of their study involvement. A Structural Equation Model (SEM) was estimated to investigate whether general or sleep self-efficacy were significant predictors of a latent sleep disturbance variable, which was comprised of the presence of insomnia symptoms (Insomnia Severity Index) and the absence of sleep health (RU-SATED). Invariance tests were utilized to determine whether the model held across age and sex. Results The structural model evidenced good fit to the data and indicated that general self-efficacy did not have a significant, direct impact on the latent sleep construct (b=-.01, p=.33); however, sleep self-efficacy did display a significant, negative association with sleep disturbance (b=-.82, p&amp;lt;.001), whereby increased sleep self-efficacy was associated lower levels of disturbed sleep. The model was largely invariant across age and sex. Conclusion Sleep self-efficacy surfaced as an important predictor of sleep disturbance above and beyond general self-efficacy. Findings highlight the importance of domain specificity in the predicting sleep outcomes. Additionally, findings suggest the need for increased research into and application of interventions targeted toward increasing sleep self-efficacy in individuals with sleep disturbance as a potential avenue to improve sleep health. Support (if any):

Daily patterns of sedentary physical activity associated with self-reported outcomes among individuals with osteoarthritis

Purpose: To examine the relationships of hour- and day-level sedentary activity patterns with self-reported measures of pain, function, fatigue, and sleep using a multilevel functional principal component analysis technique.

Improvements in Sleep Correlate With Improvements in Clinical Outcomes Among Adolescents Undergoing Intensive Interdisciplinary Pain Treatment.

Intensive interdisciplinary pain treatment (IIPT) programs have been shown to restore function, improve coping, and reduce pain in adolescents with chronic pain. Yet, little is known about patients' sleep during IIPT and whether or not improvements in pain treatment outcomes are associated with changes in sleep pre-to-post IIPT treatment. The objectives of the current study were to describe sleep among adolescents entering IIPT and examine associations between sleep parameters and IIPT treatment effects. Self-reported sleep measures and clinical outcomes (eg, functional disability, coping, average pain), were collected from 44 adolescents (mean age=14.57, 68.2% female) at admission and discharge from an inpatient IIPT program. Wrist-worn actigraphy data and sleep diaries from participants' first week and last week in the program were analyzed to characterize sleep parameters. Participants self-reported poor sleep/wake patterns, high levels of insomnia symptoms, and subclinical problems with daytime sleepiness upon admission into IIPT, although actigraphic indices of sleep from the first week of IIPT admission were only just under clinical guidelines for healthy adolescent sleep. Better self-reported sleep quality assessed via aggregated sleep diaries from the first week was associated with improvement in average pain and disability over the course of the program. Furthermore, improvements in insomnia symptoms and daytime sleepiness throughout the program were positively correlated with concurrent improvements in functional disability and coping. Taken together, results suggest that sleep may be associated with IIPT treatment effects and pave the way for future research to continue examining these relationships.

Poorer sleep quality predicts melatonin response in patients with traumatic brain injury: findings from a randomized controlled trial.

A recent clinical trial demonstrated that melatonin treatment was effective in improving self-perceived sleep quality in patients with traumatic brain injury (TBI); however, it remains unclear which patients benefited from melatonin treatment. To that end, findings from the clinical trial were re-examined to identify possible predictors of treatment response. Hierarchical multiple regression was used to identify patient characteristics, TBI injury characteristics, and self-report measures assessing sleep, fatigue, mood, and anxiety symptomatology that may uniquely explain a change in self-reported sleep quality scores (follow-up minus baseline score) as assessed by the Pittsburgh Sleep Quality Index (PSQI). After controlling for patient demographic and TBI injury-related variables, baseline self-report measures of sleep, fatigue, mood, and anxiety explained an additional 32% of the variance in change in PSQI scores. However, only baseline PSQI score made a unique and statistically significant contribution (β = -0.56, P = .006). After controlling for patient and TBI characteristics, baseline PSQI scores further explained 27% of the variance in change in PSQI scores (R2 change = .27, F1, 27 change = 11.79, P = .002). The standardized β for baseline PSQI score revealed a statistically significant negative relationship with change in PSQI score (β = -0.54, P = .002), revealing that higher PSQI score at baseline was associated with better sleep outcomes. In a sample comprising predominantly severe TBI and comorbid insomnia, participants who report poorer sleep quality have the most to gain from melatonin treatment irrespective of time since injury, demographics, fatigue, daytimes sleepiness, mood, and anxiety symptomology. Registry: Australian New Zealand Clinical Trials Registry; Name: Efficacy of Melatonin for Sleep Disturbance Following Traumatic Brain Injury; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343083&showOriginal=true&isReview=true; Identifier: ACTRN12611000734965. Grima NA, Rajaratnam SMW, Mansfield D, McKenzie D, Ponsford JL. Poorer sleep quality predicts melatonin response in patients with traumatic brain injury: findings from a randomized controlled trial. J Clin Sleep Med. 2021;17(8):1545-1551.

Agreement between self-reported and objective measures of sleep in people with HIV and lifestyle-similar HIV-negative individuals.

The aim of this study was to evaluate the agreement between self-reported sleep measures and insomnia with objectively measured sleep parameters in people with HIV (PWH) and HIV-negative individuals. A cross-sectional analysis of PWH and lifestyle-similar HIV-negative individuals. Self-reported measures included time spent in bed, sleep onset latency and a validated insomnia questionnaire. Objective measures were assessed via 7-days/nights of actigraphy data to determine average and intra-individual variability of several sleep measures (including time spent in bed and onset latency). Spearman's correlation coefficient and Cohen's κ were used to assess the agreement between self-reported and actigraphy-assessed measures. Associations between insomnia and actigraphy-assessed sleep parameters were evaluated using partial least-square discriminant analysis (PLS-DA). We found fair correlation between self-reported and actigraphy-assessed time spent in bed in 342 PWH (rs = 0.46) and 119 HIV-negative individuals (rs = 0.48). Among PWH, the correlation did not differ by age, education, depressive symptoms and self-reported insomnia (all P > 0.05), but was stronger in men (P = 0.05) and in those with a BMI of at least 25 kg/m2 (P < 0.001). Agreement between self-reported and actigraphy-assessed sleep onset latency was poor in both PWH (κ = 0.002, P = 0.49) and HIV-negative individuals (κ = 0.009, P = 0.65). According to PLS-DA, self-reported insomnia most strongly correlated with intra-individual variability of sleep duration, movement index and efficiency. We report poor-to-fair agreement between self-reported and actigraphy-assessed sleep measures in PWH. Insomnia symptoms correlated with regularity of sleep duration, quality and efficiency. These findings highlight the importance of both patient-reported and objective measures of daily sleep variation, for better understanding sleep disorders in PWH.