Self-reported Total Sleep Time Research Articles

Reciprocal dynamics between self-rated sleep and symptoms of depression and anxiety in young adult women: a 14-day diary study

ObjectivesThe objective of this study was to characterize the day-to-day associations among sleep disturbance, depression, and anxiety in a sample of young adult women. MethodsOne hundred and seventy-one women (20.1 ± 3.3 years) completed in-laboratory baseline assessment followed by daily online surveys across a two-week period. Daily measures included the Mood and Anxiety Symptom Questionnaire-Short Form to assess shared and disorder-specific symptoms of depression and anxiety (general distress, anhedonic depression, and anxious arousal), as well as self-reported total sleep time (TST), sleep-onset latency (SOL), and sleep quality (SQ). ResultsFindings supported bidirectional day-to-day relationships between sleep and affective symptoms. When women felt greater general distress (shared features of anxiety and depression), they experienced longer SOL and worse SQ at night. Specificity among depression, anxiety, and sleep disturbance was observed such that higher levels of depression-specific anhedonia presaged longer SOL, shorter TST, and poorer SQ. In the other direction, when women had poor-quality sleep, they later experienced greater anhedonic depression and anxious arousal. The influence of TST on anhedonia was complex such that a single night of short sleep led to less anhedonic depression the next day, whereas women who obtained shorter sleep across the two-week period reported greater anhedonia. ConclusionsReciprocal dynamics between nightly sleep disturbance and daily experiences of depression and anxiety may serve as a process by which insomnia, depression, and anxiety develop into comorbid clinical states over time in women. The associations of anhedonic depression with nightly sleep disturbance and chronic short sleep were especially toxic, offering insight into daily mechanisms driving the most prevalent phenotype of comorbid insomnia.

Sleep and 24-h activity rhythms in relation to cortisol change after a very low-dose of dexamethasone

The hypothalamic-pituitary-adrenal (HPA) axis plays an important role in sleep. Nevertheless, the association of sleep and its 24-h organization with negative feedback control of the HPA axis has received limited attention in population-based studies. We explored this association in 493 middle-aged persons of the Rotterdam Study, a large population-based study (mean age 56 years, standard deviation: 5.3 years; 57% female). The negative feedback of the HPA axis was measured as the change in morning saliva cortisol after the intake of 0.25mg dexamethasone the night before. Actigraphy allowed us to measure the stability and fragmentation of the activity rhythm and to estimate total sleep time, sleep onset latency and wake after sleep onset. A sleep diary kept during the week of actigraphy was used to assess self-reported total sleep time, sleep onset latency, number of awakenings and perceived sleep quality. In our study, enhanced negative feedback of the HPA axis was found in association with unstable activity rhythms (B=0.106, 95% confidence interval (CI): 0.002; 0.210), total sleep time (B=0.108, 95%CI: 0.001; 0.215) and poor subjective sleep quality (B=0.107, 95%CI: 0.009; 0.206) after multivariate adjustment. These results indicated that the 24-h organization, duration and experience of sleep are all associated with the negative feedback control of the HPA axis.

Nurses working on fast rotating shifts overestimate cognitive function and the capacity of maintaining wakefulness during the daytime after a rotating shift

The objective of our study was to explore changes in cognitive functions, sleep propensity, and sleep-related hormones (growth hormone [GH], cortisol, prolactin [PRL], thyrotropin [TSH]) in the daytime of nurses working on fast rotating shifts. Twenty nurses who worked two consecutive night shifts and 23 off-duty nurses were recruited from an acute psychiatric ward. The maintenance of wakefulness test (MWT), Stanford sleepiness scale (SSS), visual attention tasks, Wisconsin card sorting test (WCST), multiple sleep latency test (MSLT), and measuring hormones were administered four times throughout the daytime at 2-hour intervals. The subjects in the off-duty group were more able to maintain wakefulness than those in the night-shift group; however, there were no differences in self-reported total sleep time or sleep latency on the MSLT and SSS scores between the two groups. The subjects in the night-shift group had poorer performances on visual attentive tasks and higher levels of TSH than those in the off-duty group, and this resulted in a lack of a learning effect on the tasks that required a high attentive load. Nurses working on fast rotating shifts overestimate the cognitive functions and capacity of maintaining wakefulness following daytime sleep restriction. Attention performance depended on the attentive load requirement and was possibly related to TSH level.

Extreme Sleep Durations and Increased C-Reactive Protein: Effects of Sex and Ethnoracial Group

We hypothesize that extremes of sleep duration are associated with elevated C-reactive protein (CRP), a pro-inflammatory marker for cardiovascular disease risk. Cross-sectional. Population-based research. Nationally representative sample of 2007-2008 National Health and Nutrition Examination Survey participants (n = 5,587 adults). None. Associations between CRP and self-reported total sleep time (TST) were examined. Explanatory models considered contributions of sex, age, race/ethnicity, body mass index (BMI), and BMI squared (BMI2). Models also explored the role of insomnia symptoms, sleep apnea, active medical illness, and antidiabetic/antihypertensive treatment. Differential patterns among race/ethnicity groups were examined using interactions and stratified analyses. Nonlinear relationships between CRP and TST were assessed using polynomial and multinomial regression models (< 5, 5, 6, 7, 8, 9, and > 9 h). Linear and squared terms were significant in all models in the complete sample, with notable differences by sex and ethnoracial group. Overall, in models adjusted for sociodemographics and BMI, different patterns were observed for non-Hispanic white (elevated CRP for < 5 h and > 9 h), black/African-American (elevated CRP for < 5 h and 8 h), Hispanic/Latino (elevated CRP for > 9 h), and Asian/ Other (higher in 9 and > 9 h and lower in 5 h and 6 h) groups. Ethnoracial groups also demonstrated patterning by sex. In a representative sample of American adults, elevated CRP was associated with extreme sleep durations. Sex, race/ethnicity, sleep disorders, and medical comorbidity influenced these associations. Differences in CRP along these dimensions should be considered in future research on sleep related disparities influencing cardiometabolic disease risk.

Sleep duration and weight loss among overweight/obese women enrolled in a behavioral weight loss program

Objective:The purpose of this study was to examine whether baseline sleep duration predicts weight loss outcomes in a randomized controlled trial examining a behavioral weight loss (BWL) intervention among overweight and obese (OW/OB) women with urinary incontinence; and whether participation in the BWL intervention is associated with changes in sleep duration.Design:Longitudinal, clinical intervention study of a 6-month BWL program.Subjects:Three hundred sixteen OW/OB women, with urinary incontinence (age: 30–81 years, body mass index (BMI; 25–50 kg m−2) enrolled from July 2004–April 2006.Measurements:Measured height and weight, self-report measures of demographics, sleep and physical activity.Results:Neither self-reported total sleep time (TST) nor time in bed (TIB) at baseline significantly predicted weight loss outcomes among OW/OB women in a BWL treatment. BWL treatment was successful regardless of how much subjects reported sleeping at baseline, with an average weight loss of 8.19 kg for OW/OB women receiving BWL treatment, versus a weight loss of 1.44 kg in the control condition. Similarly, changes in weight, BMI and incontinence episodes did not significantly predict changes in sleep duration or TIB across the treatment period.Conclusion:Although epidemiological and cross-sectional studies support a relationship between short sleep and increased BMI, the present study found no significant relationship between TST or TIB and weight loss for OW/OB women participating in a BWL treatment.

Enhanced slow wave sleep and improved sleep maintenance after gaboxadol administration during seven nights of exposure to a traffic noise model of transient insomnia

Slow wave sleep (SWS) has been reported to correlate with sleep maintenance, but whether pharmacological enhancement of SWS also leads to improved sleep maintenance is not known. Here we evaluate the time-course of the effects of gaboxadol, an extra-synaptic gamma-aminobutyric acid (GABA) agonist, on SWS, sleep maintenance, and other sleep measures in a traffic noise model of transient insomnia. After a placebo run-in, 101 healthy subjects (20-78 y) were randomized to gaboxadol (n = 50; 15 mg in subjects <65 y and 10 mg in subjects ≥65 y) or placebo (n = 51) for 7 nights (N1-N7). The model caused some disruption of sleep initiation and maintenance, with greatest effects on N1. Compared with placebo, gaboxadol increased SWS and slow wave activity throughout N1 to N7 (p < 0.05). Gaboxadol reduced latency to persistent sleep overall (N1-N7) by 4.5 min and on N1 by 11 min (both p < 0.05). Gaboxadol increased total sleep time (TST) overall by 16 min (p < 0.001) and on N1 by 38 min (p < 0.0001). Under gaboxadol, wakefulness after sleep onset was reduced by 11 min overall (p < 0.01) and by 29 min on N1 (p < 0.0001), and poly-somnographic awakenings were reduced on N1 (p < 0.05). Gaboxadol reduced self-reported sleep onset latency overall and on N1 (both p < 0.05) and increased self-reported TST overall (p < 0.05) and on N1 (p < 0.01). Subjective sleep quality improved overall (p < 0.01) and on N1 (p < 0.0001). Increases in SWS correlated with objective and subjective measures of sleep maintenance and subjective sleep quality under placebo and gaboxadol (p < 0.05). Gaboxadol enhanced SWS and reduced the disruptive effects of noise on sleep initiation and maintenance.

Dissection of the factors driving the placebo effect in hypnotic treatment of depressed insomniacs.

Our prior work has shown that there is improvement in self-reported sleep in persons receiving placebo in hypnotic clinical trials. We examined the components of the "placebo response" in a hypnotic clinical trial. This was an exploratory analysis of a randomized, double-blind clinical trial of eszopiclone versus placebo in the treatment of persons with depression and insomnia who were also receiving fluoxetine at a clinic of a teaching hospital. Sixty adults with both depression and insomnia symptoms, who were free of significant primary sleep disorders, received open-label fluoxetine for 9weeks. Patients were further randomized 1:1 to receive either masked eszopiclone 3mg or placebo at bedtime after the first week of fluoxetine. We examined the respective contributions of three factors associated with the "placebo effect": (1) regression to the mean, (2) expectancy, and (3) social desirability. There was evidence for regression to the mean for the continuous measurement of the Insomnia Severity Index (ISI) and the Hamilton Depression Rating Scale. There was evidence for expectancy in self-reported Wake After Sleep Onset, continuous measurement of ISI, and dichotomous remission/non-remitter measurement of ISI. There was evidence of social desirability affecting self-reported Total Sleep Time. Factors that have been associated with the "placebo effect" are operating in hypnotic clinical trials. However, the role of each factor differs depending upon which self-reported variable is being considered. The findings have implications for clinical trial design in insomnia.

Adolescent sleep and working memory performance

Several studies have reported a link between poor adolescent sleep and academic achievement. Evidence suggests that particular intellectual abilities that are integral in academic achievement may be susceptible to sleep loss. One such ability is working memory. The aim of the present study was to investigate the link between adolescent sleep loss and working memory performance. A total of 143 adolescents (aged 13–18 years, mean age = 14.9 ± 1.4 years, 43% boys) volunteered for the study. All participants completed an online sleep questionnaire and the working memory tasks of letter-number sequencing and operation span task. Participants were grouped into sufficient sleepers (i.e. more than 9 h; n = 43), borderline sleepers (8 to 9 h; n = 57) and insufficient sleepers (less than 8 h sleep; n = 43), based on their self-reported total sleep time on school nights. The adolescents reporting insufficient sleep performed worse on both letter-number sequencing and operation span task (both P = 0.03; medium to large effect sizes) compared with borderline sleepers, but not compared with sufficient sleepers. No other significant differences between groups were found. Compared to the other groups, insufficient sleepers reported going to bed later (P < 0.0001), taking longer to fall asleep (P < 0.0001) and experiencing greater daytime sleepiness (P < 0.05). These findings suggest between 8 to 9 h of sleep on school nights is sufficient for optimum working memory performance. Future experimental studies are needed to support the current study’s findings.

Efficacy of the selective extrasynaptic GABA A agonist, gaboxadol, in a model of transient insomnia: A randomized, controlled clinical trial

Objective The hypnotic efficacy of gaboxadol, a selective extrasynaptic GABA A agonist (SEGA), was evaluated in a phase-advance model of transient insomnia. Methods Healthy subjects (18–64 years) completed a randomized, double-blind, parallel group study in which the sleep period was advanced 4 h from habitual sleep time. Polysomnographic (PSG) and self-reported sleep measures were used to compare gaboxadol 10 mg ( N = 271) and 15 mg ( N = 274) versus placebo ( N = 277). Results In the placebo group, the phase-advance procedure disrupted sleep maintenance as measured by PSG wakefulness after sleep onset (WASO) and self-reported WASO (sWASO), and also, to a lesser extent, disrupted sleep onset as measured by PSG latency to persistent sleep (LPS) and self-reported time to sleep onset (sTSO). Both doses of gaboxadol decreased WASO and sWASO versus placebo ( p ⩽ 0.05). Gaboxadol 15 mg also reduced LPS versus placebo ( p ⩽ 0.01) and both doses reduced sTSO versus placebo ( p ⩽ 0.01). PSG and self-reported total sleep time as well as ratings of sleep quality were improved with both gaboxadol doses relative to placebo (all p ⩽ 0.01 or better). The amount of slow wave sleep (SWS) was greater with both doses of gaboxadol than with placebo ( p ⩽ 0.001). No group differences in the amount of rapid eye movement sleep were found. Most PSG and self-report measures indicated a mild dose response. The percentage of subjects with adverse events was low (<10% in any treatment group) and all were mild or moderate; none were serious and gaboxadol did not impact morning gait or coordination. Conclusions Gaboxadol 10 and 15 mg were efficacious in significantly reducing the sleep maintenance and sleep onset disruption produced by this model of transient insomnia, with effects generally being most pronounced for the 15 mg dose. Gaboxadol also enhanced SWS.