Self-reported Total Sleep Time Research Articles

Treating insomnia symptoms with medicinal cannabis: a randomized, crossover trial of the efficacy of a cannabinoid medicine compared with placebo.

Study ObjectivesThis randomized, double-blind, placebo-controlled, crossover study was conducted to evaluate the safety and efficacy of 2 weeks of nightly sublingual cannabinoid extract (ZTL-101) in treating chronic insomnia (symptoms ≥3 months).MethodsCo-primary study endpoints were safety of the medication based on adverse event reporting and global insomnia symptoms (Insomnia Severity Index [ISI]). Secondary endpoints included: self-reported (sleep diary), actigraphy-derived, and polysomnography measurements of sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), sleep efficiency (SE); and self-reported assessments of sleep quality (sSQ) and feeling rested upon waking. Adjusted mean differences between placebo and ZTL-101 were calculated.ResultsTwenty-three of 24 randomized participants (n = 20 female, mean age 53 ± 9 years) completed the protocol. No serious adverse events were reported. Forty mild, nonserious, adverse events were reported (36 during ZTL-101) with all but one resolving overnight or soon after waking. Compared to placebo, ZTL-101 decreased ISI (−5.07 units [95% CI: −7.28 to −2.86]; p = 0.0001) and self-reported SOL (−8.45 min [95% CI: −16.33 to −0.57]; p = 0.04) and increased self-reported TST (64.6 min [95% CI: 41.70 to 87.46]; p < 0.0001), sSQ (0.74 units [95% CI: 0.51 to 0.97]; p < 0.0001), and feeling of being rested on waking (0.51 units [95% CI: 0.24 to 0.78]; p = 0.0007). ZTL-101 also decreased actigraphy-derived WASO (−10.2 min [95% CI: −16.2 to −4.2]; p = 0.002), and increased actigraphy-derived TST (33.4 min [95% CI: 23.07 to 43.76]; p < 0.001) and SE (2.9% [95% CI: 2.0 to 3.8]; p = 0.005).ConclusionsTwo weeks of nightly sublingual administration of a cannabinoid extract (ZTL-101) is well tolerated and improves insomnia symptoms and sleep quality in individuals with chronic insomnia symptoms.Clinical TrialANZCTR; anzctr.org.au; ACTRN12618000078257.

577 Daily facilitators and barriers to adolescent sleep: Contribution to actual sleep over 28-days of school and vacation

Abstract Introduction Little is known about what adolescents perceive as helping (facilitators) or preventing (barriers) them from getting sufficient and good quality sleep, and how these factors contribute to their actual sleep. Methods 205 (54.2% female, 64.4% non-white) Year 10–12 adolescents (Mage = 16.9 ± 0.9) completed daily morning surveys, and their sleep was measured via actigraphy over 2 school-weeks and 2 subsequent vacation-weeks. Morning surveys assessed self-reported sleep and the usage of 8 facilitators and 6 barriers of sleep from the previous night. Linear mixed-effects models were used to examine contributions of facilitators/barriers to actigraphy and self-reported total sleep time (TST) and sleep onset latency (SOL), controlling for age, sex, race, place of birth, and study day, separately for school and non-school days. Results On average, adolescents reported using 3.7 facilitators and encountering 1.5 barriers daily. Compared to school, non-school days were characterised by more frequent use of facilitators and more barriers encountered. Overall, facilitators or barriers explained an additional 1–7% (p-values &amp;lt; .01) of variance beyond the covariates. Similar facilitators and barriers contributed to actigraphy and self-reported TST and SOL, however, self-reported sleep variables were more affected. Notable facilitators that predicted longer TST and shorter SOL were: “follow body cues”, “avoid activities interfering with sleep”, “create good sleep environment”, “plan bedtime and go to bed as planned” (only TST on school days), and “manage thoughts and emotions” (only SOL). Notable barriers that predicted shorter TST and longer SOL were: “pre-bedtime thoughts and emotions”, “inconsistent routines”, “unconducive sleep environment”, “activities interfering with sleep” (only non-school) and “other household members’ activities” (only SOL). Conclusion This intense longitudinal study showed that on a daily basis, adolescents perceive a range of factors as facilitating and preventing sufficient and good quality sleep. These factors are predictive of their actual sleep duration and onset latency and need further research to understand their functions and clinical implications. Support (if any):

MRI-visible perivascular space volumes, sleep duration and daytime dysfunction in adults with cerebrovascular disease

ObjectivesRecent studies suggest that interindividual genetic differences in glial-dependent CSF flow through the brain parenchyma, known as glymphatic flow, may trigger compensatory changes in human sleep physiology. In animal models, brain perivascular spaces are a critical conduit for glymphatic flow. We tested the hypothesis that MRI-visible PVS volumes, a putative marker of perivascular dysfunction, are associated with compensatory differences in real-world human sleep behavior. MethodsWe analyzed data from 152 cerebrovascular disease patients from the Ontario Neurodegenerative Disease Research Initiative (ONDRI). PVS volumes were measured using 3T-MRI. Self-reported total sleep time, time in bed, and daytime dysfunction were extracted from the Pittsburgh Sleep Quality Index. ResultsIndividuals with greater PVS volumes reported longer time in bed (+0.85 h per log10 proportion of intracranial volume (ICV) occupied by PVS, SE = 0.30, p = 0.006) and longer total sleep times (+0.70 h per log10 proportion of ICV occupied by PVS volume, SE = 0.33, p = 0.04), independent of vascular risk factors, sleep apnea, nocturnal sleep disturbance, depression, and global cognitive status. Further analyses suggested that the positive association between PVS volumes and total sleep time was mediated by greater time in bed. Moreover, despite having on average greater total sleep times, individuals with greater basal ganglia PVS volumes were more likely to report daytime dysfunction (OR 5.63 per log10 proportion of ICV occupied by PVS, 95% CI: 1.38–22.26, p = 0.018). ConclusionsIndividuals with greater PVS volumes spend more time in bed, resulting in greater total sleep time, which may represent a behavioral compensatory response to perivascular space dysfunction.

Characterization and determinants of sleep measured by self-report and wrist actigraphy in patients with interstitial lung disease

PURPOSE The purpose of this study was to determine the association between sleep measurements by wrist actigraphy and patient self-report and assess the impact of physical activity and extrapulmonary symptoms on sleep quality in patients with fibrotic interstitial lung disease (ILD). METHODS Patients were recruited from specialized ILD clinics. Total sleep time, sleep efficiency, sleep latency and number of sleep disturbances were measured using the Pittsburgh Sleep Quality Index (PSQI) and an ActiGraph monitor worn on patients’ non-dominant wrist for seven consecutive days. Step counts were monitored over the same period using a waist monitor. Extrapulmonary symptoms were assessed with the Hospital Anxiety and Depression Scale and Brief Pain Inventory. Multivariable analyses were used to examine whether physical activity and extrapulmonary symptoms were determinants of sleep quality in fibrotic ILD. RESULTS A total of 111 patients were assessed (62% male, mean age 70 ± 9 years). Mean self-reported total sleep time was 494 ± 80mins/night. Median self-reported sleep efficiency and latency were 97% (94–98%) and 15 min (8–30 min), respectively. Poor sleep quality was reported in 61% of patients. Wrist monitors detected a mean total sleep time of 441 ± 72mins/night. Median sleep efficiency and latency measured by wrist monitors were 88% (83–91%) and 2 min (0–7 min), respectively. The PSQI was largely within limits of agreement in reference to the wrist monitor recordings. Higher pain severity was an independent predictor of reduced sleep efficiency, increased sleep latency and greater number of sleep disturbances measured by the PSQI on adjusted analyses. CONCLUSIONS The PSQI is generally in agreement with wrist actigraphy measurements. Pain is a determinant of sleep in fibrotic ILD.

Sex and race influence objective and self-report sleep and circadian measures in emerging adults independently of risk for bipolar spectrum disorder

There is a need to better understand key factors that impact sleep and circadian function for young adults of differing races and sexes. Sex and race are common factors contributing to disparities in health outcomes; however, the influence of these variables on sleep and circadian patterns for young adults are not well known. Multiple objective and self-report facets of sleep and circadian function were assessed (melatonin onset, actigraphy, and sleep diaries) in an ecological momentary assessment study of 150 emerging adults (Mage = 21.8 years; 58.7% female; 56% White, 22.7% Black, 21.3% Other ethnicity) at high or low risk for bipolar spectrum disorder (BSD). Controlling for BSD risk status, sex and race were significant predictors of objective and self-reported sleep and circadian rhythm measures. Males self-reported better sleep efficiency and exhibited later dim light melatonin onset phase than females, whereas females exhibited more actigraphy-measured sleep periods. White participants exhibited more actigraphy-measured total sleep time (TST), better sleep efficiency, and fewer sleep periods, and more self-reported TST and better sleep efficiency than Black participants. Our findings enhance the literature by utilizing robust measurement of sleep and circadian parameters to extend previous findings to a young adult sample at high or low risk for BSD.

0326 Daily Sleep and Affect in Adolescents: Differential Associations During Constrained Versus Unconstrained Sleep

Abstract Introduction Few studies have examined bi-directional associations between daily sleep and affect in adolescents, and even fewer assessed both high and low arousal affect under naturalistically-occurring constrained (school) and unconstrained (vacation) sleep opportunities. Methods 205 adolescents (54.1% females, age M±SD=16.9±0.87 years) completed daily measures of sleep and affect over 28 continuous days (2-week school and 2-week vacation). Total sleep time (TST) and sleep efficiency (SE) were measured using actigraphy and sleep diary. High- and low-arousal positive and negative affect (PA, NA) were self-reported each afternoon. Cross-lagged, multilevel models were conducted: affect predicted same-night sleep controlling for previous-night sleep; sleep predicted next-day affect controlling for previous-day affect. Day of week, study day, and sociodemographics were controlled. Results During both school and vacation, adolescents with overall higher low-arousal PA also had greater self-reported SE. Other aspects of sleep-affect associations differ between school and vacation (all p&amp;lt;.05). During school, significant associations were between, not within individuals. Bi-directional associations were found between longer actigraphy-TST and greater high-arousal PA, and between higher self-reported SE and lower low-arousal NA. High-arousal PA and NA were associated with self-reported TST (positive and negative respectively). During vacation, between-individuals, higher NA was bi-directionally associated with lower self-reported SE, regardless of arousal. Longer self-reported TST was associated with lower low-arousal NA. On the within-person level, regardless of sleep measurement, nights with longer-than-average TST were associated with lower NA the next day (high- and low- arousal). Nights with higher-than-average SE predicted lower next-day low-arousal NA. Conclusion Sleep-affect associations differed based on sleep opportunity and arousal, suggesting potentially different mechanisms of action. When sleep is typically constrained, overall levels of sleep-affect associations were stronger than daily fluctuations. When sleep is typically unconstrained, significant associations were found both between- and within- persons. In particular, daily fluctuations in sleep were predictive of next-day NA, rather than the other direction. Support Monash International Postgraduate Research Scholarship and Monash Graduate Scholarship

0825 Sleep During Pregnancy Through One Year Postpartum: Correspondence Between Actigraphy and Self-Report Measures

Abstract Introduction Disrupted sleep and shorter sleep duration is common in pregnancy, due to hormonal changes and physical discomfort, and in postpartum due to new infants. Objective data in this population studied over more than one year are lacking. The current analysis focuses on actigraphy-based and self-reported sleep. We examined the level of correspondence between these two complementary measurement modalities. Methods Pregnant women were enrolled in the Stress and Health in Pregnancy and Postpartum (SHIPP) study. Study visits were conducted from 2016-2019 during the 3rd trimester, 4-6 weeks postpartum, and 4 months, 8 months, and 12 months postpartum. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and provided wrist-actigraphy data (Actiwatch, Philips Respironics) for one week prior to each study visit. Actigraphy-based time in bed (TIB), total sleep time (TST), sleep efficiency (SE), WASO and sleep latency (SL) were calculated. Correlations were conducted between actigraphy-based and self-reported PSQI sleep measures. Results 79 women (28.9±4.6 years) provided complete actigraphy data (≥3 valid days; 6.4±1.0 days) for at least one time point. Objective TST from the 3rd trimester to 12-months postpartum was 7.19, 6.87, 6.86, 6.89, and 6.78 hours, respectively. Actigraphy-based TIB was positively correlated with self-reported TIB at all five visits (r’s: 0.37-0.62, p’s&amp;lt;0.01). Actigraphy-based TST was positively correlated with self-reported TST (r’s: 0.27-0.48, p’s&amp;lt;0.05) at all visits. Actigraphy-based SE was negatively correlated with the PSQI Global Score at 4, 8, and 12 months postpartum (r’s: -0.29 to -0.39, p’s&amp;lt;0.05). Of note, actigraphy-based WASO and SL were not consistently correlated with any self-reported PSQI sleep measures. Conclusion Ensuring collection of accurate sleep data during pregnancy and postpartum is important, as poor sleep is associated with negative health outcomes for both mother and child. Self-reported data is common in large, epidemiologic studies yet actigraphy-based measures may capture different aspects of sleep than self-report. Support This study was supported by the National Institutes of Health (R01 NR01366).

0369 Sleep Disparities are Established by the First Month of College

Abstract Introduction Short and poor quality sleep are particularly common in college students, likely impacting their ability to persist and succeed in difficult courses. In the current study, we investigated demographic-based sleep differences (sleep disparities) and demographic-based academic differences (achievement gaps) in first-semester college students, with the goal of informing whether sleep disparities contribute to achievement gaps. Methods From 2017 to 2018, first-semester undergraduate students at Baylor University completed the New2BU Survey [N=6,048, 61.9% female, 18.7% first-generation, 23.8% underrepresented racial/ethnic minority (URM)]. Data collection occurred within three to five weeks of classes beginning. The survey included self-reported weekday total sleep time (TST), which we classified as short sleep (≤6.9 hours), normal sleep (7-9 hours), or long sleep (&amp;gt;9 hours). Semester GPA data were obtained from university records for students’ first 4 semesters. Results There was evidence for both achievement gaps and sleep disparities. The risk for short sleep was increased in female students (p&amp;lt;.001; OR=1.20, 95%CI: 1.08-1.33), first-generation students (p=.02; OR=1.17, 95%CI: 1.03-1.33), and URM students (p&amp;lt;.001; OR=1.32, 95%CI: 1.16-1.50). The risk for long sleep increased substantially in first-generation students (p=.003, OR=1.92, 95%CI: 1.25-2.97) and URM students (p&amp;lt;.001; OR=2.41, 95%CI: 1.57-3.70), but not in female students (OR=0.88, 95%CI: 0.59-1.30). First-generation and URM students showed a 0.2-0.3 GPA reduction each semester relative to comparison groups (ps&amp;lt;.001), but short sleep and long sleep predicted GPA data up to four semesters later. Sleep-GPA correlations were modest in size (rs=.10-.14), but remained significant even after controlling for numerous demographic variables, high school GPA, and college entrance test scores. Conclusion Sleep disparities are noteworthy within the first month of college, and predictive of academic performance across four semesters. Addressing sleep health in all students—but particularly female, first-generation, and URM students—may increase academic success, bridge achievement gaps, and reduce health disparities. Support National Science Foundation (DRL 1920730)

0172 Blue-Light Blockers and Sleep: A Meta-Analysis of Intervention Studies

Abstract Introduction Sleep and circadian physiology are influenced by external light, particularly within the short-wavelength portion of the visible spectrum (~450–480 nm). Most personal light-emitting electronic devices (e.g., tablets, smartphones, computers) are enriched in this so-called “blue” light. Interventions to reduce short-wavelength light exposure to the eyes before bedtime may help mitigate adverse effects of light-emitting electronic devices on sleep. Methods We conducted a meta-analysis of intervention studies on the effects of wearing color-tinted lenses (e.g., orange or amber) in frames in the evening before sleep to selectively filter short-wavelength light exposure to the eyes. Outcomes were self-reported or objective (wrist-accelerometer) measures of nocturnal sleep. Databases (MEDLINE, EMBASE, Cochrane Library, PsycINFO, CINAHL, AMED) were searched from inception to November 2019. PROSPERO Registration: CRD42018105854. Results Ten studies were identified (7 randomized controlled trials; 3 before-after studies). Findings of individual studies were inconsistent, with some showing benefit and others showing no effect of intervention. For objective sleep onset latency, there was a significant modest-sized combined effect (Hedge’s g=-0.52, 95% CI: -1.27-0.24, Z=-2.94, p=0.003, I2=16.6%, k=3). There was a minor but non-statistically significant combined effect for objective sleep efficiency (Hedge’s g=0.24, 95% CI: -0.16–0.64, Z=1.69, p=0.09, I2=23.7%, k=5). There were no significant combined effects for objective measures of total sleep time and wake after sleep onset. For self-reported total sleep time, there was a statistically significant medium-sized combined effect (Hedge’s g=0.61, 95% CI: 0.14–1.09, Z=5.56, p&amp;lt;0.01, I2=0%, k=3). Conclusion There is mixed evidence that this approach can improve sleep. Relatively few studies have been conducted, and most did not assess light levels or melatonin. The “blue-blocker” intervention may be particularly useful in individuals with insomnia, delayed sleep phase syndrome, or attention-deficit hyperactive disorder. Considering the ubiquitousness of short wavelength-enriched light sources and the potential for widespread sleep disturbance, future controlled studies examining the efficacy of this approach to improve sleep are warranted. Support N/A

The influence of placebo administration on the first- night effect in patients with insomnia disorder

ObjectiveWe aimed to investigate the effects of placebo on the first-night effect (FNE) in insomniacs. MethodsIn sum, 36 patients with insomnia disorder who met the DSM-5 criteria were enrolled in this study. Sixteen patients with insomnia disorder were given two days of placebo intervention (placebo-administration group, PL). Twenty patients with insomnia disorder (drug-free group, DF) were not given any interventions. All participants underwent two consecutive nights of polysomnographic (PSG) testing in the sleep laboratory. Sleep diaries were recorded during one week at home before the PSG nights and on two subsequent nights. ResultsThe results demonstrated that compared with the DF group, sleep onset latency (SOL), time in bed (TIB) and wake after sleep onset (WASO) significantly increased and sleep efficiency (SE) significantly decreased in the first sleep lab night in the PL group (all p < 0.05). Moreover, compared with the second night, significant differences were observed in lower self-reported total sleep time (TST) and more subjective WASO during the first night in the PL group (all p < 0.05). However, no significant difference was found in the duration and percentage of N1, N2, N3 and REM between the two groups. ConclusionIn patients with insomnia disorder, placebo administration may increase the occurrence of worse sleep without causing a change in the duration and percentage of N1, N2, N3 and REM on the first sleep lab night. In some cases, a placebo may not serve as treatment but may result in a nocebo effect.

Recovery Sleep versus Emotion Regulation in Predicting Fire Service Shift Workers Stress, Fatigue and Irritability

ABSTRACT Objective/Background: Fire service shift workers are at risk of developing mental health difficulties related to sleep loss and emotion dysregulation. We aimed to clarify the relationship between off-shift recovery sleep and emotion regulation on stress, fatigue and irritability. Participants: A total of 61 fire service shift workers (e.g. firefighter, captain, engineer, paramedic) on a “5/6” shift. Methods: Following five 24-hour shifts, participants reported on emotion regulation as well as daily sleep, stress, fatigue and irritability during six consecutive off-shift recovery days. Mediation analyses examined (1) emotion regulation as a predictor and sleep as a mediator of stress, fatigue and irritability outcomes; and (2) sleep as a predictor and emotion regulation as a mediator of stress, fatigue and irritability outcomes. Results: Greater self-reported total sleep time predicted lower recovery stress, fatigue, and irritability. Greater subjective sleep efficiency predicted lower recovery stress and fatigue, but not irritability. No significant relationships emerged for objective sleep or emotion regulation variables predicting stress, fatigue or irritability. There were no significant findings with either emotion regulation or sleep variables included as mediators. Conclusions: These findings suggest that stress management programs for fire service shift workers may be most effective when targeting sleep efficiency and quantity rather than emotion regulation strategies in the off-shift recovery period.

Bi-directional relations between stress and self-reported and actigraphy-assessed sleep: a daily intensive longitudinal study.

Stress is associated with poor and short sleep, but the temporal order of these variables remains unclear. This study examined the temporal and bi-directional associations between stress and sleep and explored the moderating role of baseline sleep complaints, using daily, intensive longitudinal designs. Participants were 326 young adults (Mage = 23.24 ± 5.46), providing >2,500 nights of sleep altogether. Prospective total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE) were measured using actigraphy and sleep diaries. Perceived stress was reported three times daily between: 11:00-15:00, 15:30-19:30, and 20:00-02:00. Sleep complaints were measured at baseline using the PROMIS sleep disturbance scale. Within- and between-person sleep and stress variables were tested using cross-lagged multilevel models. Controlling for covariates and lagged outcomes, within-person effects showed that higher evening stress predicted shorter actigraphic and self-reported TST (both p < .01). Conversely, shorter actigraphic and self-reported TST predicted higher next-day stress (both p < .001). Longer self-reported SOL and WASO (both p < .001), as well as lower actigraphic (p < .01) and self-reported SE (p < .001), predicted higher next-day stress. Between-person effects emerged only for self-reported TST predicting stress (p < .01). No significant results were found for the moderating role of baseline sleep complaints. Results demonstrated bi-directional relations between stress and sleep quantity, and a consistent direction of worse sleep quantity and continuity predicting higher next-day stress. Results highlighted within-individual daily variation as being more important than between-individual differences when examining sleep and daytime functioning associations.

0343 Does Insomnia Symptom Severity Vary By Race/ethnicity?

While there is epidemiologic evidence that racial/ethnic minorities report shorter sleep duration and poorer sleep quality than whites, few studies have assessed sleep continuity (SC), variable by variable (e.g., SL, NWAK, WASO, EMA, & TST). The present analysis assesses in a quantitative way whether insomnia symptom severity varies by race/ethnicity. An archival analysis was conducted on an existing database of 4,206 individuals who completed a screening survey on-line at www.sleeplessinphilly.com. Variables collected included estimates for: sleep latency (SL), number of awakenings (NWAK), wake after sleep onset (WASO), early morning awakenings (EMA) and total sleep time (TST). The sample for the present analysis was comprised of 2,049 whites (63.4%), 1,007 blacks (31.2%), and 175 Hispanics (5.4%). The overall mean age was 39.0±14.7, 60.4% of the sample was female, and the average BMI was 28.0±7.1. For all SC variables, blacks significantly differed from whites: SL (49.2±38.3 vs. 42.8±30.5; p<.001); NWAK (2.64±1.7 vs. 2.50±1.6; p<.001); WASO (47.3±43.4 vs. 29.9±30.5; p<.000); EMA (63.4±41.8 vs. 57.2±33.0; p<.000); Hispanics did not significantly differ from whites with respect to the above measures. For self-reported TST, blacks and Hispanics significantly differed from whites (316.4±85.1; 356.2±73.7; 365.8±80.6, respectively; p<0.000). Our results suggest that blacks exhibit marginally worse sleep continuity (statistically significant owing to the large sample sizes) and shorter TSTs. Analysis is ongoing to evaluate Time in Bed [TIB], calculated TST, SE%, sleep period, sleep schedule differences, and percentage of group with Insufficient Sleep Disorder by race, in matched samples. SUPPORT:R01AG041783;K24AG055602;R01AT003332;K23HL125939

The mediating role of mood in the relationship between perseverative cognition, sleep and subjective health complaints in music students

Objective: Subjective health complaints (SHC) are frequent in musicians. These complaints may be particularly distressing in this population because they are performance relevant. This paper aims at testing a model positing that (a) perseverative cognition (PC) predicts sleep duration/quality, (b) sleep duration/quality predicts SHC and (c) mood is a mediator of these associations.Design: Participants were 72 music students (mean age (SD): 22.7 (3.0) years), and the assessment period consisted of seven consecutive days, with a solo performance on the fifth day.Main outcome measures: Self-reported total sleep time (TST) and sleep quality were assessed 30 min after wake-up, and objective TST/sleep quality were assessed with an actigraphy watch. PC and mood were measured five times a day. Daily SHC were assessed at 9 p.m.Results: PC did not significantly predict sleep duration/quality. Self-reported and objective TST and sleep quality were all significantly associated with SHC. Mood played a mediating role in each of these relationships with the exception of objective sleep quality.Conclusion: The tested model on the association among PC, sleep and SHC and the mediating role of mood received partial support, highlighting the importance of sleep and mood in the emergence of SHC among university music students.

Short Sleep Duration Is Associated With Increased Serum Homocysteine: Insights From a National Survey.

Both short sleep duration and increased serum homocysteine levels are associated with cardiovascular events. However, research on the relationship between sleep duration and serum homocysteine levels is sparse. The aim of this study is to examine the association between sleep duration and serum homocysteine levels from a national database. In total, 4,480 eligible participants older than 20 years who had serum homocysteine data and reported sleep duration were enrolled from the US National Health and Nutrition Examination Survey of 2005 to 2006. The association between sleep duration and serum homocysteine levels was analyzed using multivariate regression models for covariate adjustment. Serum homocysteine level was lowest in individuals with a sleep duration of 7 hours and increased in those with both shorter and longer self-reported total sleep time (groups were categorized into ≤ 5 hours, 6 hours, 7 hours, 8 hours, and ≥ 9 hours). After adjustment for covariates, those in the group sleeping ≤ 5 hours had significantly higher serum homocysteine levels than the reference group (sleep duration of 7 hours). In subgroup analyses by sex, body mass index (BMI), and ethnicity, the association between short sleep duration (≤ 5 hours) and higher serum homocysteine levels persisted in women, individuals with obesity (BMI ≥ 30 kg/m2), and non-Hispanic whites. This study highlighted that short sleep duration was associated with higher serum homocysteine levels in women, individuals with obesity (BMI ≥ 30 kg/m2), and non-Hispanic whites; this finding might suggest increased vulnerability to cardiovascular risk or other atherothrombotic events in these groups in the context of short sleep.

Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis.

Sleep problems are common in children and adolescents and can aggravate comorbid disorders. This meta-analysis examined the effect of cognitive and behavioral sleep interventions (with four or more treatment sessions) from randomized controlled trials on school-age children and adolescents. In a systematic literature search, six randomized controlled trials were identified (n = 528; mean age = 14.6 years; female = 63%) that reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset, and daytime sleepiness from ratings and actigraphy. After intervention, no effect was seen on self-reported TST, but when measured with actigraphy, an effect favoring the intervention group was observed (+11.47 minutes, P = .05). SOL decreased in the intervention group compared to the control group after intervention as measured by both sleep diaries (-9.31 minutes, P = .007) and actigraphy (-19.48 minutes, P < .0001). Effect sizes ranged from small to large. No effect was found for wake after sleep onset or daytime sleepiness. Short-term (4 to 8 weeks) follow-up data from four studies indicated maintained positive effects on SOL: sleep diaries -15.85 minutes (P = .01) and actigraphy -23.67 minutes (P < .0001). At follow-up, the effects on wake after sleep onset from ratings (-14.41 minutes, P = .001) and actigraphy (-7.54 minutes, P = .01) were significant, favoring the intervention group (moderate to large effect sizes). No effect on TST was indicated. Cognitive and behavioral sleep interventions are indicated to improve sleep in school-age children and adolescents. However, because treatment protocols were heterogeneous and risk of bias high, results should be interpreted with caution. Large and rigorous trials are needed.

Integrative Review of the Relationship Between Sleep Disturbances and Episodic Memory in Older Adults.

Impaired episodic memory in older adults has been linked to many factors. One of these factors is sleep disturbances, which are reported by more than 50% of older adults. The relationship between episodic memory and sleep disturbances remains unclear, however, because of the multiple types of measures of sleep and episodic memory used in previous studies. The purpose of this integrative literature review was to integrate and compare findings on this relationship in adults aged 65 years. An electronic search was conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, and Medline for material published from the inception of the databases to December 2016. The literature search produced 13 data-based, peer-reviewed, and primary research articles that met eligibility criteria. The synthesized results from these articles provide evidence that older adults with 6-8 hr of self-reported total sleep time had better episodic memory than older adults with ≤5 hr or ≥9 hr of total sleep time. Shorter length and lower percentage of slow-wave sleep were associated with reduced episodic memory in older adults, but the results were controversial. Selection of different measurements and inconsistent variables across studies increased the difficulty of synthesizing and comparing the results. The diversity of covariates controlled in the included articles raise questions regarding which covariates should be controlled in such studies of sleep and episodic memory in older adults. The numerous study limitations were thus major barriers to understanding the relationship between sleep disturbances and episodic memory.

Is subjective sleep evaluation a good predictor for obstructive sleep apnea?

OBJECTIVE:To compare subjective sleep evaluation obtained using four questionnaires with polysomnography results for individuals with and without obstructive sleep apnea.METHODS:Observational and analytical study in which individuals underwent polysomnography were studied retrospectively to investigate sleep disorders. We compared subjective data from a research database used to predict obstructive sleep apnea based on the STOP-BANG questionnaire, evaluation of excessive daytime sleepiness (Epworth Sleepiness Scale), sleep quality questionnaire (Mini Sleep Questionnaire) and Post-Sleep Data Collection Instrument with the self-reported total sleep time and sleep-onset latency for subjects with and without obstructive sleep apnea.RESULTS:The STOP-BANG questionnaire was a good predictor for the diagnosis of obstructive sleep apnea. However, the other instruments did not show a significant difference between healthy and sick individuals. Patients' perceptions of their sleep onset time were significantly lower than the polysomnographic data, but this difference remained for both subjects with and without obstructive sleep apnea. No difference was found between the subjective duration of sleep and the total sleep time assessed by polysomnography in either the healthy subjects or the patients.CONCLUSION:Except for the STOP-BANG questionnaire, subjective evaluation of sleepiness, sleep quality, perception of onset, and total sleep time are not important parameters for the diagnosis of obstructive sleep apnea, which reinforces the need for an active search for better management of these patients.

Sleep and Psychological Abuse Among Cohabiting Couples: A Pilot Study

This study explored the relationship between psychological abuse and sleep deprivation among nonclinical cohabiting couples. Thirty-one couples participated in completing a variety of sleep measures, a psychological abuse scale, and a relationship satisfaction survey. Results indicated a persistent relationship between everyday sleep deficits (sleep quality, daytime sleepiness, and self-reported total sleep time) and the perceived perpetration and felt victimization of psychological abuse. Overall, results were as hypothesized, but there were gender differences. Male psychological abuse victimization and perpetration were significantly related to sleep quality and daytime sleepiness, but for women, only sleep duration was predictive of felt victimization. The sleep variables were significantly related to women’s—but not men’s—reported relationship satisfaction. Overall, minimal sleep deprivation appears to be related to increased psychological abuse perpetration and victimization even among a normative population scoring outside the clinical range on these measures. Implications for prevention and treatment are discussed.

Validation of Nighttime Sleepability Scale Against Objective and Subjective Measures of Sleep Quality

Quick self-assessment of night sleep quality with reliable and valid instruments is often required in various fundamental and applied studies in the field of sleep medicine and chronomedicine. Individual differences in sleep quality are usually assessed with a special scale, whereas such a scale is absent in most of questionnaires for evaluation of individual differences in the domain of chronobiology. One of two exceptions is the 6-scale Sleep-Wake Pattern Assessment Questionnaire. It contains the 12-item scale S designed to self-assess nighttime sleepability. The purpose of the present report was to examine external validity of this scale by searching for correlates and predictors of S score. One hundred and sixty participants of sleep deprivation experiments self-reported their sleep latency, total sleep duration, nap frequency, and times for going to bed and awakening for one week prior to the experiment. Their objective and subjective sleepiness after sleepless night was measures in the course of experiment. Moreover, sleep latency and total sleep duration were measured by means of polysomnography in studies with 35 female participants. Other objective measurements included percentages of sleep stages, awakenings after sleep onset, and sleep efficiency. Additionally, sleep latencies were detected during 9 day- and nighttime 20-min napping attempts of 15 from 35 participants. It was found that significant correlates and predictors of S score include subjective and objective measures of sleep latency, percentage of slow wave sleep, subjectively and objectively assessed sleepiness, and self-reported total sleep time. These results provided solid evidence for external validity of scale S.