Sleep Efficiency Research Articles

Evaluation of automated pediatric sleep stage classification using U-Sleep: a convolutional neural network.

U-Sleep is a publicly available automated sleep stager, but has not been independently validated using pediatric data. We aimed to a) test the hypothesis that U-Sleep performance is equivalent to trained humans, using a concordance dataset of 50 pediatric polysomnogram excerpts scored by multiple trained scorers, and b) identify clinical and demographic characteristics that impact U-Sleep accuracy, using a clinical dataset of 3114 polysomnograms from a tertiary center. Agreement between U-Sleep and 'gold' 30-second epoch sleep staging was determined across both datasets. Utilizing the concordance dataset, the hypothesis of equivalence between human scorers and U-Sleep was tested using a Wilcoxon two one-sided test (TOST). Multivariable regression and generalized additive modelling were used on the clinical dataset to estimate the effects of age, comorbidities and polysomnographic findings on U-Sleep performance. The median (interquartile range) Cohen's kappa agreement of U-Sleep and individual trained humans relative to "gold" scoring for 5-stage sleep staging in the concordance dataset were similar, kappa=0.79 (0.19) vs 0.78 (0.13) respectively, and satisfied statistical equivalence (TOST p < 0.01). Median (interquartile range) kappa agreement between U-Sleep 2.0 and clinical sleep-staging was kappa=0.69 (0.22). Modelling indicated lower performance for children < 2 years, those with medical comorbidities possibly altering sleep electroencephalography (kappa reduction=0.07-0.15) and those with decreased sleep efficiency or sleep-disordered breathing (kappa reduction=0.1). While U-Sleep algorithms showed statistically equivalent performance to trained scorers, accuracy was lower in children < 2 years and those with sleep-disordered breathing or comorbidities affecting electroencephalography. U-Sleep is suitable for pediatric clinical utilization provided automated staging is followed by expert clinician review.

Voice-Activated Cognitive Behavioral Therapy for Insomnia

Insomnia symptoms affect an estimated 30% to 50% of the 4 million US breast cancer survivors. Previous studies have shown the effectiveness of cognitive behavioral therapy for insomnia (CBT-I), but high insomnia prevalence suggests continued opportunities for delivery via new modalities. To determine the efficacy of a CBT-I-informed, voice-activated, internet-delivered program for improving insomnia symptoms among breast cancer survivors. In this randomized clinical trial, breast cancer survivors with insomnia (Insomnia Severity Index [ISI] score >7) were recruited from advocacy and survivorship groups and an oncology clinic. Eligible patients were females aged 18 years or older who had completed curative treatment more than 3 months before enrollment and had not undergone other behavioral sleep treatments in the prior year. Individuals were assessed for eligibility and randomized between March 2022 and October 2023, with data collection completed by December 2023. Participants were randomized 1:1 to a smart speaker with a voice-interactive CBT-I program or educational control for 6 weeks. Linear mixed models and Cohen d estimates were used to evaluate the primary outcome of changes in ISI scores and secondary outcomes of sleep quality, wake after sleep onset, sleep onset latency, total sleep time, and sleep efficiency. Of 76 women enrolled (38 each in the intervention and control groups), 70 (92.1%) completed the study. Mean (SD) age was 61.2 (9.3) years; 49 (64.5%) were married or partnered, and participants were a mean (SD) of 9.6 (6.8) years from diagnosis. From baseline to follow-up, ISI scores changed by a mean (SD) of -8.4 (4.7) points in the intervention group compared with -2.6 (3.5) in the control group (P < .001) (Cohen d, 1.41; 95% CI, 0.87-1.94). Sleep diary data showed statistically significant improvements in the intervention group compared with the control group for sleep quality (0.56; 95% CI, 0.39-0.74), wake after sleep onset (9.54 minutes; 95% CI, 1.93-17.10 minutes), sleep onset latency (8.32 minutes; 95% CI, 1.91-14.70 minutes), and sleep efficiency (-0.04%; 95% CI, -0.07% to -0.01%) but not for total sleep time (0.01 hours; 95% CI, -0.27 to 0.29 hours). This randomized clinical trial of an in-home, voice-activated CBT-I program among breast cancer survivors found that the intervention improved insomnia symptoms. Future studies may explore how this program can be taken to scale and integrated into ambulatory care. ClinicalTrials.gov Identifier: NCT05233800.

Sleep dysfunction and gut dysbiosis related amino acids metabolism disorders in cynomolgus monkeys after middle cerebral artery occlusion

IntroductionThis study aimed to explore the characteristics of post-stroke sleep dysfunction and verify their association with gut dysbiosis and the related amino acid metabolism disorders. This was achieved by using fecal microbiota transplantation (FMT) in a non-human primate stroke model. MethodsTwenty adult male cynomolgus monkeys were divided into the sham (n = 4), middle cerebral artery occlusion (MCAO, n = 5), MCAO + FMT (n = 3), and donor (n = 8) groups. The MCAO+FMT group received FMT at post-MCAO week 4. Sleep parameters, gut microbiota, gamma-aminobutyric acid (GABA), and glutamine (Gln) in the cerebrospinal fluid (CSF) were measured at baseline and postoperative weeks 4, 8, and 12. ResultsAt postoperative weeks 4, 8, and 12, the MCAO group showed decreased sleep efficiency, measured as the percentage of sleep during the whole night (82.3 ± 3.2 % vs 91.3 ± 2.5 %, 79.0 ± 3.75 % vs 90.8 ± 3.2 %, and 69.5 ± 4.8 % vs 90.5 ± 2.7 %; all P < 0.05), lower relative abundance of Lactobacillus (all P < 0.05), and reduced GABA concentrations in the CSF (317.3 ± 30.6 nmol/L vs 437.7 ± 25.6 nmol/L, 303.1 ± 48.9 nmol/L vs 4 40.9 ± 37.8 nmol/L, and 337.9 ± 49.4 nmol/L vs 457.4 ± 39.2 nmol/L; all P < 0.05) compared with the sham group. Sleep efficiency at post-FMT weeks 4 and 8 (84.7 ± 1.1 % vs 79.0 ± 3.75 %, and 84.1 ± 2.0 % vs 69.5 ± 4.8 %; both P < 0.05) and GABA concentration in the CSF at post-FMT week 4 (403.1 ± 25.4 nmol/L vs 303.1 ± 48.9 nmol/L, P < 0.05) was higher in the MCAO+FMT group than in the MCAO group. ConclusionsPost-stroke sleep dysfunction in monkeys is characterized by impaired sleep coherence, associated with decreased levels of probiotics such as Lactobacillus, GABA, and Gln in the CSF and can be ameliorated using FMT.

Sleep Habits and Academic Performance of Grade 3 Learners

This study explores the critical relationship between sleep habits and academic performance among Grade 3 learners. With a sample of 100 students, a descriptive correlational research design was employed to investigate various dimensions of sleep habits, including sleep duration, quality, onset latency, efficiency, and continuity. The results revealed that Grade 3 learners exhibited very extensive sleep habits, particularly in terms of sleep duration and quality. Moreover, the study identified specific sleep habit indicators, such as sleep efficiency and continuity, which significantly influenced academic performance. Notably, a significant positive correlation (R = 0.709) between sleep habits and academic performance was observed, underscoring the pivotal role of sleep in students' educational achievements. This study underscores the critical influence of specific sleep habit indicators, particularly sleep efficiency and continuity, on academic performance, highlighting the undeniable significance of sleep in the educational achievements of students. These findings provide valuable insights for educators, parents, and policymakers, emphasizing the need to prioritize strategies that promote healthy sleep habits among young learners. By integrating sleep education into the curriculum and fostering a conducive sleep environment, stakeholders can contribute to enhancing both the well-being and academic success of Grade 3 learners.

Sleep actigraphy results and HIV health outcomes in an urban HIV clinic sample

ABSTRACT Sleep disorders are prevalent and interfering conditions that affect people living with HIV (PLWH) at higher rates than the general population. Lower quality sleep has been associated with poorer health-related quality of life and immune function in PWH, though sleep is typically assessed subjectively. The current study aimed to examine the association between objective sleep/wake patterns measured via actigraphy with HIV outcomes. Participants (N = 87) were recruited from a public, urban HIV clinic located in the Southeastern United States. Participants were instructed to wear actigraphy monitors for one week (Range: 5–8 days). Log viral load and absolute CD4 were obtained via medical chart review. Linear regression analyses predicting HIV RNA Viral Load (log transformed) and CD4 Count were employed with three actigraphy sleep variables: sleep efficiency, wake after sleep onset (WASO), and sleep quantity. Backward entry regression with both significant actigraphy predictors, sleep efficiency and WASO, included as predictors resulted in sleep efficiency remaining in the model and WASO being removed. Separate models revealed that each one-unit increase in sleep efficiency was associated with a b = 0.032-point decrease in the log-transformed HIV RNA viral load (p = 0.03) and for each one-unit increase in wake after sleep onset (WASO) was associated with a b = 0.35-point increase in the log-transformed HIV RNA viral load (p = 0.04). Sleep quantity, however, was not, and none were associated with absolute CD4 count. The findings add to the evidence for an association of objectively measured poorer sleep efficiency being associated with higher HIV RNA viral load. Implications for clinical practice include assessing and addressing sleep efficiency as part of comprehensive clinical HIV care.

Effect of exercise versus mandibular advancement device in moderate obstructive sleep apnea patients with mandibular retrognathia: A randomized clinical trial

ABSTRACT Objective The aim of this study was to investigate the effects of exercise and mandibular advancement device (MAD) on severity of Obstructive sleep apnea syndrome (OSAS) with mandibular retrognathia. Methods Patients were randomly allocated into either exercise group or MAD group. All patients underwent blood tests, polysomnography studies and questionnaires studies at enrollment and at the 12-week’s follow-up. Results Our study showed MAD was superior to exercise in improving polysomnographic outcomes and Snore Scale (SS) score. No significant difference was observed between the two treatments in terms of Epworth Sleepiness Scale (ESS) score. Moreover, in the exercise group, improvements were also observed in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C). Conclusion MAD was more effective than exercise in improving sleep efficiency. Exercise can improve daytime sleepiness and lipid metabolism, independent of the effects on BMI. Trial registration ChiCTR2000034188

Napping during cognitive behavioural therapy for insomnia: Friends or foes?

SummaryCognitive and Behavioural Therapy for Insomnia (CBT‐I) is the gold standard treatment for chronic insomnia, with one crucial step being the restriction of time spent in bed. This restriction often intensifies early afternoon sleepiness, leading to a natural gateway for a short recuperative nap, which might foster adherence to CBT‐I over time. In practice, mental health professionals providing CBT‐I lack consensus on whether or not to tolerate short naps during the CBT‐I period for requesting patients. In this pilot study, we examined the effects of authorised napping on CBT‐I efficiency in patients with insomnia (a napping group was compared with a matched non‐napping group, n = 108). We report that napping enhanced early afternoon alertness and importantly did not affect CBT‐I‐mediated improvements in the Insomnia Severity Index and Beck Depression Inventory‐2 and in self‐reported sleep efficiency, latency, and wake after sleep onset (assessed by the sleep diaries). Further investigations using objective methods of sleep assessments are now needed to confirm that napping behaviour does not compromise the improvements enabled by CBT‐I and may even strengthen adherence to the treatment.

The role of sleep in links between daily interpersonal stress and internalizing and externalizing symptoms during middle childhood

BackgroundInterpersonal stress has been consistently linked with poorer adjustment, and healthy sleep may play a promotive or protective role in this relation. However, little is known regarding such associations among children. The current study examined longitudinal associations between daily interpersonal stress, sleep, and internalizing/externalizing symptoms during middle childhood. MethodsAt age 8 years, participants wore actigraphy watches for 7 days to capture sleep, and primary caregivers reported on children's daily interpersonal stress, internalizing/externalizing symptoms, and sleep problems. At age 9 years, children self-reported symptoms. ResultsGreater daily interpersonal stress at age 8 years predicted greater internalizing/externalizing symptoms at age 9 years. Higher sleep efficiency predicted fewer externalizing symptoms. Sleep duration moderated links between interpersonal stress and internalizing/externalizing symptoms, but associations were positive and significant for children with average and high duration only. ConclusionFindings advance our understanding of links between interpersonal stress, sleep, and child adjustment and can inform targeted family and school interventions.

Predicting sleep based on physical activity, light exposure, and Heart rate variability data using wearable devices

Objective We aimed to improve the performance of sleep prediction algorithms by increasing the data amount, adding variables reflecting psychological state, and adjusting the data length. Materials and Methods We used ActiGraph GT3X+® and Galaxy Watch Active2™ to collect physical activity and light exposure data. We collected heart rate variability (HRV) data with the Galaxy Watch. We evaluated the performance of sleep prediction algorithms based on different data sources (wearable devices only, sleep diary only, or both), data lengths (1, 2, or 3 days), and analysis methods. We defined the target outcome, ‘good sleep’, as ≥90% sleep efficiency. Results Among 278 participants who denied having sleep disturbance, we used data including 2136 total days and nights from 230 participants. The performance of the sleep prediction algorithms improved with an increased amount of data and added HRV data. The model with the best performance was the extreme gradient boosting model; XGBoost, using both sources combined data with HRV, and 2-day data (accuracy=.85, area under the curve =.80). Conclusions The results show that the performance of the sleep prediction models improved by increasing the data amount and adding HRV data. Further studies targeting insomnia patients and applied researches on non-pharmacological insomnia treatment are needed.

Exploring Sleep Architecture in Polish Patients with Multiple Sclerosis: A Polysomnography Study.

Sleep disturbances are a prevalent phenomenon in patients with multiple sclerosis (PwMS). The present study employs polysomnography (PSG) to quantify sleep efficiency and architecture in PwMS, aiming to elucidate the relationships between PSG parameters and factors including gender, disability level, brain lesion location, and subjective measures of insomnia, excessive daytime sleepiness (EDS), fatigue, pain, and mood disorders. The study cohort comprised 51 adult PwMS, of whom 31 underwent overnight PSG. The demographic and clinical characteristics, including age, gender, and Expanded Disability Status Scale (EDSS), were collated. The Athens Insomnia Scale, the Epworth Sleepiness Scale, the Fatigue Severity Scale, the Modified Fatigue Impact Scale (MFIS), the Numerical Pain Rating Scale, and the Hospital Anxiety and Depression Scale were employed for the assessment of insomnia, EDS, fatigue, pain, and mood disorders. The brain and spinal cord magnetic resonance imaging (MRI) were evaluated. A reduced sleep efficiency was observed among 30 PwMS (aged 38.9 ± 12.9), with a mean of 80 ± 12%, especially in those with brainstem demyelinating lesions. In those PwMS aberrant sleep onset latency (SOL) and wake after sleep onset were also noted (p < 0.05). The prevalence of sleep fragmentation, as measured by the total arousal index, was greater in male PwMS than in female (p < 0.05). Higher disability according to the EDSS correlated with longer SOL (ρ = 0.48, p < 0.05), and reduced N2 sleep stage correlated with cognitive fatigue according to MFIS (ρ = -0.46, p < 0.05). Age, disease duration, insomnia, EDS, physical fatigue, and mood disorders did not impact PSG parameters. The study demonstrated the disruption of sleep architecture in PwMS, and highlighted the importance of a comprehensive PSG assessment of sleep disturbances in this population.

Patient Self-Guided Interventions to Reduce Sedative Use and Improve Sleep

Direct-to-patient interventions enabling transitions from long-term benzodiazepine receptor agonist (BZRA) use to cognitive behavioral therapy for insomnia (CBTI) by older adults has the potential to reduce BZRA use and related harms while improving sleep outcomes without requiring prearranged clinician involvement. To compare 2 direct-to-patient behavior change interventions with treatment as usual (TAU) on BZRA use, sleep, and other health outcomes, and uptake of CBTI techniques. The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study was a 3-arm, pragmatic, open-label, minimum-contact, randomized clinical trial. The study began November 2020 and ended June 2022. Participants were randomly allocated to 1 of 3 groups, including 2 different mailed behavior change interventions or no intervention (TAU). Participants were from communities across the province of New Brunswick, Canada, and included adults 65 years and older living independently with long-term use of BZRAs and current or past insomnia. The Sleepwell package (YAWNS-1) consisted of a cover letter and 2 booklets ("How to Stop Sleeping Pills" and "How to Get Your Sleep Back"). The other package (YAWNS-2) included updated versions of the 2 booklets ("You May Be at Risk" and "How to Get a Good Night's Sleep Without Medication") used in the Eliminating Medications Through Patient Ownership of End Results (EMPOWER) study. BZRA use at 6 months was the primary measure. Secondary measures included CBTI use, sleep, insomnia, daytime sleepiness, safety, anxiety, frailty, and quality of life. A total of 1295 individuals expressed interest in the study, and 565 (43.6%) completed a baseline assessment. Participants had a mean (SD) age of 72.1 (5.7) years, a mean (SD) BZRA use duration of 11.4 (9.1) years, and 362 (64.1%) were female. Discontinuations and dose reductions of 25% or greater were highest with YAWNS-1 (50 of 191 [26.2%]; 39 of 191 [20.4%]; total, 46.6%) compared with YAWNS-2 (38 of 187 [20.3%]; 27 of 187 [14.4%]; total, 34.8%, P = .02) and TAU (14 of 187 [7.5%]; 24 of 187 [12.8%]; total, 20.3%, P < .001). YAWNS-1 also demonstrated better uptake of CBTI techniques and sleep outcomes compared with YAWNS-2 (new CBTI techniques: 3.1 vs 2.4; P =.03; sleep efficiency change: 4.1% vs -1.7%; P =.001) and reduced insomnia severity and daytime sleepiness compared with TAU (insomnia severity index change: -2.0 vs 0.3; P <.001; Epworth Sleepiness Scale change: -0.8 vs 0.3; P =.001). Results of the YAWNS NB randomized clinical trial show that, as a simple, scalable, direct-to-patient intervention, YAWNS-1 substantially reduced BZRA use and improved sleep outcomes. It could be implemented to transform insomnia care for older adults at the population level. ClinicalTrials.gov Identifier: NCT04406103.

Depressive symptoms' trajectories since adolescence and sleep quality in early adulthood: results from the EPITeen cohort.

We aimed to estimate the association between depressive symptoms' trajectories during adolescence and young adulthood and sleep quality in early adulthood. Data from 802 participants of the EPITeen study, evaluated at 13, 17 and 21 years of age, were analysed. Depressive symptoms were assessed using the Beck Depression Inventory-II and three trajectory classes from adolescence to adulthood were previously identified (High, Moderate, Low). The prevalences of poor sleep quality, overall (score>5) and in its specific dimensions: subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep drugs and daytime dysfunction (score≥2), at 21 years of age were evaluated using the Pittsburgh Sleep Quality Index. Associations were estimated using adjusted odds ratio (OR) and the respective 95 % confidence intervals (CI). At 21 years of age, 29.8 % young adults presented poor sleep quality, which was significantly different between those in the Low and High depressive trajectories (14.3 and 53.1 %, respectively, p<0.001). Compared with participants in the Low trajectory, those in the High trajectory were more likely to present poorer sleep quality at 21 years of age (OR=6.34 95 % CI: 3.94-10.21), particularly worse levels of sleep disturbance (OR=5.89 95 % CI: 2.84-12.21), daytime dysfunction (OR=7.63 95 % CI: 3.63-16.06) and subjective sleep quality (OR=6.61 95 % CI: 3.69-11.85). Poor sleep quality in early adulthood was more frequent among individuals who had high levels of depressive symptoms since adolescence. Monitoring depression until adulthood may help to identify those at higher risk of sleep problems which, in turn, can lead to worse health outcomes over time.

The effects of alternate-day fasting on sleep and physical activity in poor sleeping adults: A randomized control trial.

Utilizing a randomized control design, 42 healthy adults (22.5 ± 2.8 years) participated in alternate-day modified fasting over a 12-day treatment period. Assessments of sleep included sleep time, efficiency, latency and wake after sleep onset, and assessments of physical activity included steps, energy expenditure, sedentary time, time spent in light physical activity and time spent in moderate-to-vigorous activity. Additional measurements included body composition and mood. The alternate-day modified fasting group consumed 25.8% ± 0.3% fewer calories compared with the control group (p = 0.03). There were no differences between groups for change in body mass index (p = 0.87), total fat mass (p = 0.91) or total lean mass (p = 0.88). Daily energy expenditure did not differ between groups (p = 0.11). On fast days, participants spent 34.5 ± 12.7 more minutes sedentary (p = 0.01), took 1100 ± 362 fewer steps (p < 0.01), and engaged in 27.2 ± 8.4 fewer minutes of moderate-to-vigorous physical activity (p = 0.00) compared with non-fasting days. Sleep duration, efficiency, latency or wake after sleep onset were not different between conditions (p = 0.92, p = 0.10, p = 0.09 and p = 0.66, respectively). We conclude that alternate-day modified fasting does not alter sleep time, efficiency, latency or wake after sleep onset in people reporting poor sleep quality, and does not alter overall physical activity. Although average daily physical activity is not altered, fasting in this manner does tend to result in more sedentary time and less physical activity with compensation on non-fasting days.

Deep behavioural representation learning reveals risk profiles for malignant ventricular arrhythmias

We aimed to identify and characterise behavioural profiles in patients at high risk of SCD, by using deep representation learning of day-to-day behavioural recordings. We present a pipeline that employed unsupervised clustering on low-dimensional representations of behavioural time-series data learned by a convolutional residual variational neural network (ResNet-VAE). Data from the prospective, observational SafeHeart study conducted at two large tertiary university centers in the Netherlands and Denmark were used. Patients received an implantable cardioverter-defibrillator (ICD) between May 2021 and September 2022 and wore wearable devices using accelerometer technology during 180 consecutive days. A total of 272 patients (mean age of 63.1 ± 10.2 years, 81% male) were eligible with a total sampling of 37,478 days of behavioural data (138 ± 47 days per patient). Deep representation learning identified five distinct behavioural profiles: Cluster A (n = 46) had very low physical activity levels and a disturbed sleep pattern. Cluster B (n = 70) had high activity levels, mainly at light-to-moderate intensity. Cluster C (n = 63) exhibited a high-intensity activity profile. Cluster D (n = 51) showed above-average sleep efficiency. Cluster E (n = 42) had frequent waking episodes and poor sleep. Annual risks of malignant ventricular arrhythmias ranged from 30.4% in Cluster A to 9.8% and 9.5% for Clusters D-E, respectively. Compared to low-risk profiles (D-E), Cluster A demonstrated a three-to-four fold increased risk of malignant ventricular arrhythmias adjusted for clinical covariates (adjusted HR 3.63, 95% CI 1.54–8.53, p < 0.001). These behavioural profiles may guide more personalised approaches to ventricular arrhythmia and SCD prevention.

Menopausal stage transitions and their associations with overall and individual sleep quality in middle-aged Korean women

BackgroundUnderstanding the association between the menopausal transition and declining sleep quality can guide optimal timing for preventive interventions in transitioning women. However, studies lack representation of Asian women and sufficient data on the progression of menopausal stages and sleep quality changes over time in this population. MethodsThis study included 3305 women in the pre-menopause stage at baseline. The sleep quality and its components were assessed using the Pittsburgh Sleep Quality Index (PSQI). Menopausal stages were classified as pre-menopause, early transition, late transition, and post-menopause according to the Stages of Reproductive Aging Workshop+10 (STRAW+10) criteria. We estimated the longitudinal association between menopausal stage changes over time and the PSQI score, and examined the effect of being overweight. ResultsThe trends in the PSQI scores and its components according to the menopausal stage changes over time showed that with the exception of sleep duration and habitual sleep efficiency, an overall decline was noted in sleep health during late transition and post-menopause compared to pre-menopause. These associations were independent of time-variant annual chronological aging, which was not significantly associated with sleep deterioration. Additionally, although the associations between menopausal stages and sleep quality did not significantly differ by adiposity level, the overweight group exhibited worse PSQI scores and components than did the non-overweight group. LimitationSleep quality and menopausal stage were assessed using self-reported questionnaires without objective measures. ConclusionOur study underscores the importance of screening for sleep quality deterioration and implementing appropriate measures for women experiencing menopausal transition.

Daily Associations Between Sleep Parameters and Depressive Symptoms in Individuals with Insomnia: Investigating Emotional Reactivity and Regulation as Mediators

ABSTRACT Objectives Previous research suggests that insomnia and depressive symptoms might be causally related. Emotional reactivity and regulation have been proposed to explain the potential causal relationship between insomnia and depression. However, longitudinal evaluations of their mediating effects are limited. Hence, the current study aimed to examine the mediating effects of emotional reactivity and regulation on the longitudinal associations between daily sleep parameters and depressive symptoms over 14 days in individuals with insomnia. Methods Participants were sixty adults aged 18–65 who had clinically significant insomnia. They filled out a survey each morning and evening and wore actigraphy watches for 14 consecutive days. The five sleep parameters were measured by sleep diary in the morning survey (subjective total sleep time, subjective sleep efficiency, and sleep quality) and actigraphy watches (objective total sleep time and objective sleep efficiency). Emotional reactivity and emotion regulation strategy use during the day were assessed in the evening survey using the International Positive and Negative Affect Schedule Short Form, Emotion Regulation Questionnaire, and Cognitive Emotion Regulation Questionnaire. Depressive symptoms of the day were evaluated in the evening survey with the Center for Epidemiologic Studies Depression Scale. Results Results showed that sleep quality and depressive symptoms, as well as actigraphy-measured sleep efficiency and depressive symptoms, predicted each other in individuals with insomnia, mediated by negative reactivity but not emotion regulation. Conclusions The present findings support the mediating role of negative emotional reactivity in the bidirectional, daily relationship between sleep parameters and depression in individuals with insomnia.

Device-based 24-hour movement behaviours in adult phase III cardiac rehabilitation service-users during the COVID-19 pandemic: a mixed-methods prospective observational study

Purpose To examine changes in device-based 24-hour movement behaviours (MB), and facilitators and barriers to physical activity (PA) and exercise, during remotely-delivered cardiac rehabilitation (RDCR). Materials and methods This prospective observational study used wrist-worn GENEActiv accelerometers to assess MB of 10 service-users (63 ± 10 years) at the start, middle, and end of three-months of RDCR. Barriers and facilitators to PA and exercise were explored through self-report diaries and analysed using content analysis. Results At start, service-users were sedentary for 12.6 ± 0.7 h · day−1 and accumulated most PA at a light-intensity (133.52 ± 28.57 min · day−1) – neither changed significantly during RDCR. Sleep efficiency significantly reduced from start (88.80 ± 4.2%) to the end (86.1 ± 4.76%) of CR, with values meeting health-based recommendations (≥85%). Barriers to RDCR exercise included exertional discomfort and cardiac symptoms, and reduced confidence when exercising alone. Setting meaningful PA goals, self-monitoring health targets, and having social support, facilitated PA and exercise during RDCR. Conclusions Our RDCR programme failed to elicit significant changes in MB or sleep. To increase the likelihood of successful RDCR, it is important to promote a variety of exercise and PA options, target sedentary time, and apply theory to RDCR design, delivery, and support strategies.

Dream habits in a large cohort of preteens and their relation to sleep and nocturnal awakenings.

The present study examined dream habits, and their relation to sleep patterns, in 1151 preteens (597 boys; 554 girls; 11.31 ± 0.62 years old). Dream questionnaires assessed the frequency of dream recall, nightmare, and lucid dream, as well as the intensity of emotions experienced in dreams. Sleep variables included sleep duration and efficiency, but also different measurements of nocturnal awakenings. Among the preteens, 49.21% of them reported that they recalled dreams several times a week or almost every morning over the past few months. In addition, 52.00% of the preteens reported that they experienced nightmares, and 45.48% lucid dreams, less than once a month or never over the past few months. No gender differences were observed in dream variables. Nocturnal awakenings were linked to all dream variables, while sleep duration and sleep efficiency were related to nightmare frequency and emotions in dreams. Importantly, sleep duration and sleep efficiency were not associated with dream recall nor lucid dream frequency, with Bayesian analyses supporting the null hypothesis. These findings offer a comprehensive understanding of preteens' dreams and their connection to key sleep aspects.

Mental health, substance use, and a composite of sleep health in adults, 2018 Ohio behavioral risk factor surveillance system

ObjectivesVarious factors impact sleep health including mental health and substance use. Mental health issues and substance use continue to rise in the United States. Yet, the association between mental health, substance use and sleep health in adults remains unclear. MethodsWe used multivariable linear regression models to examine the associations between mental health (poor mental health days in the past 30 days) and substance use (marijuana, tobacco, alcohol) with sleep health (individual dimensions of sleep: alertness, sleep efficiency, duration, and sleep health composite score) in 4333 participants from the 2018 Ohio Behavioral Risk Factor Surveillance System Survey. ResultsBetter mental health was associated with higher alertness, higher sleep efficiency, longer sleep duration and a higher sleep health composite score even after controlling for covariates (individual: sex at birth, age, body mass index, race, education, sleep disordered breathing, and area-level: socioeconomic deprivation) (all p < .001). Higher marijuana and tobacco use were associated with lower individual sleep health dimensions (marijuana with sleep efficiency and duration and tobacco use with lower efficiency) and a lower sleep health composite score even after controlling for covariates for tobacco use (p < .001). Contrary to the hypothesis, higher alcohol use was associated with higher alertness and a higher sleep health composite score (p < .001), however after adjusting for covariates these associations were no longer significant. ConclusionsThe implications of these trends on sleep health are important to address as mental health and substance use are modifiable targets to consider when addressing sleep health.

Restoration of abnormal sleep EEG power in patients with insomnia disorder after 1Hz rTMS over left DLPFC.

Hyperarousal has been a significant pathophysiological theory related to insomnia disorder (ID), characterized by excessive cortical activation and abnormal electroencephalogram (EEG) power during daytime or sleep. However, there is currently insufficient attention to the EEG power during rapid eye movement (REM) sleep and different stages of non-rapid eye movement (NREM) sleep. Additionally, whether the abnormal sleep EEG power in ID patients can be restored by repetitive transcranial magnetic stimulation (rTMS) remains unclear. Data of 26 ID patients and 26 healthy controls (HCs) were included in the current observational study. The comparisons of relative power between patients and HCs at baseline in each band of each sleep stage and the changes in patients before and after rTMS treatment were performed. The correlations between relative power and behavioral measures of the patients were also investigated. Abnormalities in sleep EEG relative power in the delta, beta and gamma bands of the patients were observed in NREM2, NREM3 and REM sleep. Correlations were identified between relative power and behavioral measures in ID group, primarily encompassing sleep efficiency, sleep onset latency and depression scores. Post-treatment improvements in relative power of the delta and beta band were observed in NREM2 sleep. The relative power of sleep EEG exhibited a significant correlation with sleep measures in ID patients, and demonstrated notable differences from HCs across the delta, beta, and gamma frequency bands. Furthermore, our findings suggest that rTMS treatment may partially ameliorate relative power abnormalities in patients with ID.