Self-reported Sleep Questionnaires Research Articles

The Relationships of Specific Cognitive Control Abilities with Objective and Subjective Sleep Parameters in Mild Cognitive Impairment: Revealing the Association between Cognitive Planning and Sleep Duration.

This study aimed to examine the associations between specific sleep parameters and specific aspects of cognitive functioning in individuals diagnosed with mild cognitive impairment (MCI), compared with healthy controls (HCs) by using cognitive, subjective, and objective sleep measures. A total of 179 participants were enrolled, all aged ≥ 65 years (mean age = 70.23; SD = 4.74) and with a minimum of six years of education (mean = 12.35; SD = 3.22). The sample included 46 HCs (36 females), 75 individuals with amnestic MCI (aMCI) (51 females), and 58 individuals with non-amnestic MCI (naMCI) (39 females). Inhibition, cognitive flexibility as a combined application of inhibitory control and set shifting or task/rule switching, and planning were examined. The following D-KEFS subtests were administered for their evaluation: Verbal Fluency Test, Color-Word Interference Test, and Tower Test. Self-reported sleep questionnaires (Athens Insomnia Scale, Stop-Bang questionnaire, and Pittsburg Sleep Quality Index) were used for subjective sleep assessments. Actigraphy was used for objective sleep measurements. Mixed-measures ANOVA, MANOVA, and one-way ANOVA, as well as the Scheffe post hoc test, were applied to the data. The results showed that the three groups exhibited statistically significant differences in the Tower Test (total achievement score, total number of administered problems, and total rule violations). As regards objective sleep measurements, the total sleep time (TST) was measured using actigraphy, and indicated that there are significant differences, with the HC group having a significantly higher mean TST compared to the naMCI group. The relationships evaluated in the TST Tower Test were found to be statistically significant. The findings are discussed in the context of potential parameters that can support the connection between sleep duration, measured as TST, and cognitive planning, as measured using the Tower Test.

Psychometric properties of the Brief Version of Pittsburgh Sleep Quality Index (B-PSQI) among Chinese male sailors on 18-hr rotating shift schedule.

Sleep problems among shift workers have emerged as a public health concern in recent years. However, few validation studies of self-reported sleep quality questionnaires were performed among shift workers. The present study aimed to examine the psychometric properties of the Brief Version of Pittsburgh Sleep Quality Index (B-PSQI) in a shift workers sample. In total, 443 Chinese male sailors were recruited, of whom 46.95% (n = 208) were watchstanding sailors on 18-hr working schedule at sea. All participants completed the B-PSQI, the Insomnia Severity Index (ISI), the Self-Rating Depression Scale, and Self-Rating Anxiety Scale before and after a 30-day saling. Forty watchstanding sailors were selected to wear wrist actigraphy throughout the sailing. The results showed that the B-PSQI had acceptable internal consistency reliability in different sailor groups. Confirmatory factor analysis showed optimal fit of the single-factor model of the B-PSQI in different sailor groups. Furthermore, scalar invariance between watchstanding and day-working sailors was supported, as well as longitudinal scalar invariance across time. In addition, receiver operating characteristic analysis showed that the B-PSQI yields high discrimination power to detect poor sleep quality using ISI ≥ 8 criterion. However, a lack of intermethod agreement across the B-PSQI and actigraphy was found in this study. Moreover, the total scores of B-PSQI were positively related to depression and anxiety symptoms in the present sample. The B-PSQI is a reliable and valid sleep quality measure and a useful screening tool for sleep disorders among Chinese male sailors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

P111 Validity and Reliability of Sleep Questionnaires in Adults: A Systematic Review

Abstract Introduction Sleep plays an important role in maintaining overall health and well-being. It has been well-established that poor sleep is linked to several negative health consequences. Therefore, the use of appropriate sleep measures in national surveillance systems is essential to understand the impact that poor sleep has on population health. The aim of this systematic review is to evaluate the validity and reliability of self-reported sleep questionnaires. Method Electronic database searches were performed on PubMed, EMBASE, and PsycINFO, focusing on studies of adults aged 18 and above that validated sleep questionnaires against objective sleep measurements or compared them with other subjective sleep instruments. Search terms were grouped into three categories: sleep health, assessment instrument type, and psychometric properties. Progress to Date A total of 5,071 abstracts across the three electronic databases were retrieved from the general search and screening is currently being undertaken. Relevant studies meeting the inclusion criteria will be analysed, and data will be extracted using a predefined form, which includes study characteristics, sleep measures, validated objective and/or subjective instruments, and psychometric properties. Intended Outcome and Impact The systematic review is expected to provide a summary of the psychometric properties of sleep questionnaires that have potential use in population health surveys as part of routine health monitoring. The findings will contribute to the identification of any gaps in the current sleep questionnaires to help enable more comprehensive monitoring and understanding of population sleep habits and associated health outcomes.

Relationship of Sleep Health and Endoscopic Disease Activity in Inflammatory Bowel Disease: Endoscopic Disease Activity and Sleep.

Among adults with inflammatory bowel disease (IBD), self-reported sleep disturbances are associated with active symptoms, but the association between sleep measures and endoscopic disease activity is unknown. This study aimed to (1) compare sleep-wake behaviors among IBD patients based on endoscopic and clinical disease activity and (2) describe associations between actigraphy, self-reported sleep measures, and symptoms of fatigue, anxiety, and depression. Participants wore a wrist actigraph for 10 consecutive days and completed self-reported sleep questionnaires (Pittsburgh Sleep Quality Index [PSQI] and Patient-Reported Outcome Measures System [PROMIS] Sleep Disturbance and Sleep Interference questionnaires). Clinical and endoscopic disease activity were assessed. Based on actigraphic recordings ( n = 26), average total nighttime sleep was 437 minutes and sleep efficiency was 84%. Objective sleep measures did not differ based on endoscopic or clinical disease activity. Individuals with active clinical disease had higher PROMIS Sleep Disturbance (57.3 vs. 49.7, d = 1.28) and PROMIS Sleep-Related Impairment (58.1 vs. 52.8, d = 0.51) compared with those with inactive clinical disease. Self-reported sleep was significantly associated with anxiety, depression, and fatigue. Further research is needed to better characterize the relationship between sleep and endoscopic disease activity, and determine underlying mechanisms related to poor sleep in the IBD population.

Sleep disturbance in schizophrenia spectrum disorders: more than just a symptom?

Sleep disturbance is commonly reported in patients with schizophrenia spectrum disorder (SSD) in the clinical setting. Sleep features can be assessed subjectively, with self-report sleep questionnaires, and objectively with actigraphy and electroencephalogram recordings. Traditionally, electroencephalogram studies have focused on sleep architecture. More recently, numerous studies have investigated alterations in sleep-specific rhythms, including electroencephalogram oscillations, such as sleep spindles and slow waves, in patients with SSD compared with control subjects. Here, I briefly discuss how sleep disturbance is highly prevalent in patients with SSD and I present findings from studies demonstrating abnormalities in sleep architecture and sleep-oscillatory rhythms, with an emphasis on sleep spindles and slow-wave deficits, in these patients. This increasing body of evidence highlights the importance of sleep disturbance in SSD and points to several future research directions with related clinical implications, thus showing that sleep disturbance is more than just a symptom in these patients.

Systematic Item Content and Overlap Analysis of Self-Reported Multiple Sleep Disorder Screening Questionnaires in Adults.

Sleep disorders are defined on the basis of diagnostic criteria presented in medical classifications. However, no consensus has emerged on the exact list of operational symptoms that should be systematically investigated in the field of sleep medicine. We propose a systematic analysis of sleep symptoms that figure in a set of self-reported multiple sleep disorder screening questionnaires for adult populations, to identify the content overlap of symptoms that probe the presence of central sleep symptoms, and to highlight the potential level of heterogeneity among sleep disorder questionnaires. The method comprises three steps: (i) the selection of self-reported multiple sleep disorder screening questionnaires; (ii) item extraction and selection; (iii) the extraction of symptoms from items. Frequency of sleep symptoms and content overlap (Jaccard Index) are analyzed. We extracted 469 items that provide 60 different symptoms from 12 questionnaires. Insomnia, somnolence, and sleep-related breathing symptoms were found in all the questionnaires. The mean overlap among all questionnaires evaluated with the Jaccard Index is 0.44, i.e., moderate similarity. Despite limitations related to the selection of questionnaires and the symptom extraction and harmonization, this study underlines the need to standardize sleep symptom contents for sleep medicine in order to enhance the practicability, reliability, and validity of sleep disorder diagnoses.

Comparison of Sleep, Perceived Health, and Job Stress According to Symptoms of Shift Work Disorder in Shift Nurses

Objectives: This study aimed to investigate the prevalence of symptoms of shift work disorder (SSWD) and its related factors in rapidly rotating three-shift nurses. Methods: We enrolled 344 nurses (mean age, 28.7 years) without prior history of sleep disturbance before starting shift work in a university-affiliated hospital. SSWD were defined using self-reported sleep questionnaires (insomnia severity index >14 and/or Epworth Sleepiness Scale ≥10) and without any sleep problem before shift work. Sleep pattern in each of the three shifts was measured using the Munich Chronotype Questionnaire for Shift-Workers. Mood (anxiety, depression) and job stress were also measured using self-reported questionnaires. Results: Our results showed that 62.2% of the participants presented SSWD. Compared to the non-SWD group, the SSWD group showed worse sleep hygiene, lower total sleep time (TST) during workdays, higher anxiety and depressive mood, and higher job stress. In the SSWD group, the evening chronotype individuals presented the shortest TST during day shifts, while the morning chronotype individuals presented the shortest TST during evening shifts. Conclusions: SSWD is highly prevalent in fast rotating three-shift nurses. This study suggests that intensive education on sleep hygiene and appropriate scheduling of shift work while considering individual chronotypes may improve sleep patterns and sleep quality of shift workers and minimize SSWD.

Sleep architecture in patients with frontal brain tumor

IntroductionThe aim of the study was to characterize sleep architecture and self-reported sleep questionnaires in patients with frontal brain tumor. MethodsEight patients with frontal brain tumor underwent polysomnographic testing and completed self-report questionnaires on sleep quality, insomnia, drowsiness and risk of obstructive sleep apnea, in addition to depression and anxiety inventories. ResultsPatients with frontal brain tumor exhibited a disruption of the sleep architecture, characterized by changes in the pattern and in the time they spend asleep. It was found that objective values (polysomnographic variables) do not necessarily correspond to the perception of alteration through subjective methods (self-reported questionnaires). ConclusionsChanges in the architecture of sleep in patients with frontal tumors allow us to understand the organization of the brain during this state in the presence of this type of pathology, which causes structural and functional changes.

Relationship Between Social Capital and Depressive Symptoms Among Type 2 Diabetes Mellitus Patients in Northwest China: A Mediating Role of Sleep Quality.

Objective: There are few studies about the relationship between social capital (SC) and depression among type 2 diabetes mellitus (T2DM) patients, and the mechanism explaining how SC leads to decreased depression is unclear. The current study aims to explore the relationship between SC and depressive symptoms among the T2DM patients in northwest China, with a particular focus on the mediating role of sleep quality.Methods: A cross-sectional study of 1,761 T2DM patients from Ningxia Province was conducted. The Center for Epidemiological Survey Depression Scale (CES-D) and self-report sleep quality questionnaire coupled with the SC scales were administered during the face-to-face survey. The Bootstrap methods PROCESS program is employed to test the mediation model.Results: The prevalence of depressive symptoms among T2DM patients was 24.8%. After controlling for covariates, the SC (r = −0.23, p < 0.001) was negatively correlated with CES-D score; the sleep quality was also negatively correlated with CES-D score (r = −0.31, p < 0.001); and the SC was positively correlated with sleep quality (r = 0.10, p < 0.001). Logistic regression analysis showed that SC was inversely related to the risk of depressive symptoms. Meanwhile, sleep quality was negatively associated with depressive symptoms. Sleep quality has mediated the relationship between SC and depressive symptoms among T2DM patients (explaining 12.6% of the total variance).Conclusions: We elucidated how SC interacted with depressive symptoms through the mediation pathway of sleep quality using a representative sample of the Chinese diabetes patients. The findings indicate that the improvement of SC and sleep quality may help in maintaining mental health among T2DM patients. Hence, clinicians can suggest that patients communicate more with others to improve the SC and, in turn, maintain their health.

197 Refining the Subjective Assessment of Sleep: An SEM Approach

Abstract Introduction Given that sleep is multidimensional, the assessment of sleep requires an examination of a number of different domains. Accordingly, there is an abundance of self-report sleep questionnaires that are widely used for both research and clinical use. The surplus of available measures can be problematic, as it often leads to difficulties in selecting the best measure for a given purpose/context. In addition, the use of multiple measures to assess sleep may be an inefficient use of time and resources if they are not measuring unique constructs. The purpose of the current study is to evaluate the factor structure of five sleep measures. A confirmatory factor analysis (CFA) was initially used to evaluate whether each of these scales are measuring different factors of sleep, with follow-up exploratory factor analysis (EFA) as needed. Methods An archival analysis was performed using data from an online study, Investigating Sleep Across Normal Development (ISLAND Study). The sample consisted of 3,284 adults aged 18+. The following measures were utilized: RU SATED, PROMIS Sleep-Related Impairment, Sleep Self-Efficacy, Insomnia Severity Index, and the Sleep Regularity Questionnaire. Results As expected, the CFA model fit was determined to be poor and an EFA was then conducted to assess the factor structure of these scales. The EFA revealed a four-factor structure comprised of 25 items: Sleep-Related Daytime Impairment, Sleep Regularity, Sleep Disturbance, and Sleep-Related Daytime Enhancement. Conclusion The findings from the current study add to the literature supporting the multidimensionality of sleep, as well as the continued need to assess the various facets that comprise this construct. Although the literature supports the utility of these five measures, the present study found that within a community sample, these measures are not entirely unique. Further, the present study extends our knowledge and the literature by revealing a novel factor of sleep – Sleep-Related Daytime Enhancement. It may be worthwhile for researchers and clinicians to consider latent sleep factors that contribute to sleep disturbance and sleep health. Future work is needed to further confirm the observed factor structure and assess the psychometrics of this new scale. Support (if any) National Institute on Aging (K23AG049955, PI: Dzierzewski).

Preliminary Validation of the Sleep and Concussion Questionnaire as an Outcome Measure for Sleep Following Brain Injury

ABSTRACT Background Sleep and wakefulness disturbances are common with traumatic brain injury (TBI); however, there are no condition-specific measures to evaluate sleep following TBI. Objective To assess the convergent validity of the Sleep and Concussion Questionnaire (SCQ), a condition-specific (TBI) measure is compared to polysomnography and existing self-report sleep questionnaires. Participants Included Thirty-two adults diagnosed with mild TBI, 3–24 months post-injury, average age, 38.9 years, predominantly female (63%) and with symptoms of chronic insomnia. Methods Participants underwent polysomnographic evaluation of sleep and completed the SCQ, Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and the Fatigue Severity Scale (FSS). Correlations were assessed using Pearson’s correlations. The sample was sufficiently powered (0.85) to detect a moderate to strong correlation of 0.5 or greater. Results SCQ sub-questions were meaningfully correlated with corresponding objective sleep parameters (time awake, number of awakenings, sleep efficiency, sleep onset latency, wake after sleep onset) as measured with polysomnography. Additional significant correlations were seen between total scores on the SCQ and ISI and between SCQ sub questions and total ESS scores. Conclusions This work provides initial evidence of the convergent validity of the SCQ with objective sleep parameters and existing self-report measures in patients after mild TBI.

Agreement analysis of sleep patterns between self-reported questionnaires and actigraphy in adults.

To investigate the agreement in sleep pattern recording by self-reported sleep questionnaires and actigraphy in adults. This is a cross-sectional study. Men and women who metinclusion criteria were recruited for this study. The inclusion criteria were apparently healthy Omani nationalsages 19 to 50 years. Sleep questionnaires were randomly distributed in Muscat either directly or via electronic and paper announcements. Data were collected from the participants using the self-reported questionnaires with four piloted questions for sleep pattern identification and through the actigraphy wristband given to subjects to wear for a week. Cohen's kappa test was performed for agreement analysis. A total of 964 Omani subjects between ages 18 and 59 years of both genders were recruited and completed the questionnaires successfully. Out of these, only 321 subjects wore the actigraphy wristband for 1 week (response rate = 33%). Agreement analysis reported a mild level of agreement for the monophasic (41%), moderate level for biphasic (59%), and good level for polyphasic (70%) sleep patterns. The overall agreement level of sleep patterns between the two methods was 57%. There is a low specificity of self-reported assessment in reporting sleep pattern. The average agreement level of subjective versus objective assessments of sleep patterns was moderate at 57% and self-reported sleep pattern is not specific. The study recommends the use of actigraphy along with sleep questionnaires for accurate assessment of sleep patterns in cohort studies.

Objective and subjective sleep measures are associated with neurocognition in aging adults with and without HIV

Objective: Poor sleep quality is related to worse neurocognition in older adults and in people with HIV (PWH); however, many previous studies have relied only on self-report sleep questionnaires, which are inconsistently correlated with objective sleep measures. We examined relationships between objective and subjective sleep quality and neurocognition in persons with and without HIV, aged 50 and older. Method: Eighty-five adults (PWH n = 52, HIV-negative n = 32) completed comprehensive neuropsychological testing to assess global and domain-specific neurocognition. Objective sleep quality was assessed with wrist actigraphy (total sleep time, efficiency, sleep fragmentation) for five to 14 nights. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index. Results: Objective and subjective sleep measures were unrelated (p’s > 0.30). Compared to HIV-negative participants, PWH had greater sleep efficiency (80% vs. 75%, p = 0.05) and were more likely to be using prescription and/or over the counter sleep medication (p = 0.04). In the whole sample, better sleep efficiency (p < 0.01) and greater total sleep time (p = 0.05) were associated with better learning. Less sleep fragmentation was associated with better learning (p < 0.01) and recall (p = 0.04). While PWH had slightly stronger relationships between total sleep time and sleep fragmentation, it is not clear if these differences are clinically meaningful. Better subjective sleep quality was associated with better executive function (p < 0.01) and working memory (p = 0.05); this relationship was primarily driven by the HIV-negative group. Conclusions: Objective sleep quality was associated with learning and recall whereas subjective sleep quality was associated with executive function and working memory. Therefore, assessing objective and subjective sleep quality could be clinically useful, as they are both related to important domains of cognition frequently impacted in HIV-associated neurocognitive disorders as well as neurodegenerative disorders associated with aging. Future studies should evaluate if behavioral sleep interventions can improve neurocognition.

Sleep in New Zealand children aged 7-9: associations with ethnicity, socioeconomic status, and achievement in reading and mathematics.

The aims were (1) to investigate differences by ethnicity and socioeconomic status (SES) in objective measures of sleep in children aged 7-9 years and (2) determine whether measures of sleep predict child achievement in reading or mathematics after controlling for ethnicity and SES. Four groups of parent-child dyads were recruited: Māori, low-SES schools (n = 18); Māori, high-SES schools (n = 17); New Zealand European, low-SES schools (n = 18); New Zealand European, high-SES schools (n = 17). Child sleep was measured by actigraphy. Parents and teachers reported child daytime sleepiness and behavior, and children completed a self-report of anxiety symptoms. Teachers also reported on child achievement in reading and mathematics. Children from low-SES schools went to bed later on school nights (F[1,68] = 12.150, P = .001) and woke later (F[1,68] = 15.978, P < .001) than children from high-SES schools but had similar sleep duration. There were no differences related to ethnicity. Children from low-SES schools were almost 3 times more likely to be below national standards for mathematics. Children not meeting academic standards in mathematics had a later sleep start time, lower sleep period efficiency, and a decreased total sleep time. However, when SES and sleep period efficiency were modeled together neither were found to significantly influence achievement in mathematics. In this study, SES influenced sleep timing but not the quality and quantity of sleep in 7- to 9-year-old children, and a significant independent effect of sleep efficiency on learning could not be demonstrated.

B-24 Objective and Subjective Sleep Measures are Associated with Neurocognition in Middle-Aged and Older Adults With and Without HIV

Abstract Objective Poorer sleep quality is related to worse cognitive functioning in the general population and people living with HIV; however, many studies use self-report sleep questionnaires that rely on retrospective recall. This study aimed to examine the relationship between objective (wrist actigraphy) and subjective sleep quality with neurocognitive functioning. Method Eighty-five adults aged 50-74 years with and without HIV (HIV+ n = 53, HIV- n = 32) were recruited from the community and ongoing studies at UC San Diego. Participants completed comprehensive neuropsychological testing assessing global and domain-specific cognition. Participants wore actigraphy watches for 14 nights after neuropsychological testing to objectively assess sleep quality (i.e., total sleep time (TST), efficiency, wake after sleep onset, and sleep fragmentation). The Pittsburgh Sleep Quality Index assessed subjective sleep quality. Results After adjusting for demographic variables and use of sleep medications, there were no differences in any sleep quality measures by HIV status (p’s&gt;0.05). In separate adjusted linear regression models, lower sleep efficiency (p = 0.02; 95% CI: -9.5, -1.1) and greater sleep fragmentation (p = 0.02; 95% CI: -0.82, -0.09) were associated with worse learning. Less TST was associated with worse working memory (p = 0.02; 95% CI: -9.2, -0.8). In contrast, worse subjective sleep quality was associated with worse executive function (p &lt; 0.01; 95% CI: -1.18, -0.23) and working memory (p = 0.03; 95% CI: -1.22, -0.07). Conclusion Both objective and subjective sleep quality were associated with cognition in both persons with and without HIV; however, subjective and objective sleep quality were associated with different cognitive domains. Therefore, both objective and subjective sleep quality are important health behaviors to assess.

The interactive effect of habitual midday napping and nighttime sleep duration on impaired fasting glucose risk in healthy adolescents

ObjectivesTo investigate the association between habitual midday napping and impaired fasting glucose (IFG), and the interactive effect of napping and time in bed (TIB) at night on IFG among healthy adolescents. MethodsThe sample comprised 625 early adolescents (12.26 ± 0.63 years old) who self-reported good health status from Jintan, China. Midday napping and nighttime sleep were measured using the Youth Self-report Sleep Questionnaire. Fasting plasma glucose was dichotomized into normal (<5.6 mmol/L) and impaired (≥5.6 mmol/L) levels. The multivariate random-effect logistic regression examined the nap-glucose relationship and the interaction between nap and TIB. Marginal effects of napping were calculated when TIB was held constant at different values. ResultsOf the participants, 83.20% (n = 520) took naps and 62.28% reported average nap durations ≥31 min in the past month. Moreover, 16% (n = 101) of participants had IFG. After adjusting for covariates, early adolescents who napped 3–4 days/week (OR = 1.72, p < 0.001), 5–7 days/week (OR = 1.34, p = 0.02) or ≥31 min/nap (OR = 1.52, 1.56, p's < 0.05) were associated with increased likelihoods of IFG compared to non-nappers. There was an inverse relationship between TIB and IFG among non-nappers (OR = 0.45, p = 0.03). Interaction analyses also showed significantly increased likelihoods of IFG only among nappers with TIB ≥9 hours. ConclusionThe relationship between midday napping and IFG is dependent on TIB. Midday naps may increase the risk for IFG among early adolescents who have sufficient nighttime sleep. However, further research is needed to confirm our preliminary findings.

Agreement between parent-reports and child self-reports of sleep problems in Chinese children.

Sleep problems are major concerns for parents, health professionals, and children and youths themselves. For assessing sleep problems, both parent and child reports are important, with each having its unique features. However, little is known about the correlates of the agreement between parent and child self-reports. This study evaluated the agreement between the youth self-report sleep questionnaire (YSRSQ) and the parent-reported children's sleep habits questionnaire (CSHQ) and assessed the associated sociodemographic factors, as well as the underlying discrepancies. The participants included 3143 pairs of Chinese preadolescents (mean age = 11.03, SD = 0.98) and parents. Sleep-disordered breathing (SDB), daytime sleepiness, and parasomnia were assessed by both the YSRSQ and CSHQ. Significant but low correlations were present between parent report and preadolescent self-report items on SDB problems, daytime sleepiness, and parasomnias. Although the agreement between SDB symptoms and parasomnias was stronger for girls than for boys, the degree of concordance between SDB symptoms and parasomnia increased with preadolescent age, with the highest agreement achieved among preadolescents aged 12 years or older for SDB problems and 11 years or older for parasomnias. Findings underscore the importance of utilizing both parental and preadolescent self-reports in accurately assessing and diagnosing sleep impairment in pediatric samples.

Examining stress: an investigation of stress, mood and exercise in medical students.

Stress is an event that threatens homoeostasis and thus causes physiological and behavioural responses to reinstate equilibrium. Excessive and/or chronic stress can be psychologically and physiologically detrimental. Examinations can represent a significant source of stress for students. The hypothalamic-pituitary-adrenal axis (HPA) is the core endocrine stress system. Investigations into the HPA response to examinations have yielded inconsistent results. The aim of this study is to further explore the relationship between examination stress, HPA axis activity, mood, sleep and exercise in students undergoing a naturalistic examination period stressor. In total, 16 medical students participated. Students completed self-reported stress, anxiety, mood, sleep and physical activity questionnaires, and provided saliva samples during an examination-free period and an examination period 1 month later. The cortisol awakening response, representative of HPA activity, was determined from saliva samples by enzyme-linked immunosorbent assay. Anxiety levels increased (p=0.04) and mood decreased (p=0.05) during the examination period. There was concomitant decease in physical activity levels (p=0.02). There was no significant increase in HPA activity during the examination period (p=0.29). Sleep quality did not significantly worsen (p=0.55) during the examination period. Examination periods are associated with increased anxiety levels, lower mood and decreased physical activity. Future studies incorporating examination results and cognitive function may help to identify potential protective interventional strategies, while optimising performance.

P.2.d.015 - Is cognitive dysfunction in bipolar disorder related to sleep abnormalities?

Sleep disturbance is common in chronic post-traumatic stress disorder (PTSD). However, prior work has demonstrated that there are inconsistencies between subjective and objective assessments of sleep disturbance in PTSD. Therefore, we investigated whether subjective or objective sleep assessment has greater clinical utility to differentiate PTSD patients from healthy subjects. Further, we evaluated whether the combination of subjective and objective methods improves the accuracy of classification into patient versus healthy groups, which has important diagnostic implications. We recruited 32 chronic war-induced PTSD patients and 32 age- and gender-matched healthy subjects to participate in this study. Subjective (i.e. from three self-reported sleep questionnaires) and objective sleep-related data (i.e. from actigraphy scores) were collected from each participant. Subjective, objective, and combined (subjective and objective) sleep data were then analyzed using support vector machine classification. The classification accuracy, sensitivity, and specificity for subjective variables were 89.2%, 89.3%, and 89%, respectively. The classification accuracy, sensitivity, and specificity for objective variables were 65%, 62.3%, and 67.8%, respectively. The classification accuracy, sensitivity, and specificity for the aggregate variables (combination of subjective and objective variables) were 91.6%, 93.0%, and 90.3%, respectively. Our findings indicate that classification accuracy using subjective measurements is superior to objective measurements and the combination of both assessments appears to improve the classification accuracy for differentiating PTSD patients from healthy individuals.

Differentiation chronic post traumatic stress disorder patients from healthy subjects using objective and subjective sleep-related parameters

Sleep disturbance is common in chronic post-traumatic stress disorder (PTSD). However, prior work has demonstrated that there are inconsistencies between subjective and objective assessments of sleep disturbance in PTSD. Therefore, we investigated whether subjective or objective sleep assessment has greater clinical utility to differentiate PTSD patients from healthy subjects. Further, we evaluated whether the combination of subjective and objective methods improves the accuracy of classification into patient versus healthy groups, which has important diagnostic implications. We recruited 32 chronic war-induced PTSD patients and 32 age- and gender-matched healthy subjects to participate in this study. Subjective (i.e. from three self-reported sleep questionnaires) and objective sleep-related data (i.e. from actigraphy scores) were collected from each participant. Subjective, objective, and combined (subjective and objective) sleep data were then analyzed using support vector machine classification. The classification accuracy, sensitivity, and specificity for subjective variables were 89.2%, 89.3%, and 89%, respectively. The classification accuracy, sensitivity, and specificity for objective variables were 65%, 62.3%, and 67.8%, respectively. The classification accuracy, sensitivity, and specificity for the aggregate variables (combination of subjective and objective variables) were 91.6%, 93.0%, and 90.3%, respectively. Our findings indicate that classification accuracy using subjective measurements is superior to objective measurements and the combination of both assessments appears to improve the classification accuracy for differentiating PTSD patients from healthy individuals.