Sleep Measures Research Articles

Practical Resources for Effective Postpartum Parenting (PREPP): a randomized controlled trial of a novel parent-infant dyadic intervention to reduce symptoms of postpartum depression: RCT of the PREPP intervention for postpartum depression

BackgroundThere is little known about the effectiveness of psychological interventions to prevent postpartum depression that focus on the birthing parent and infant dyad. Risk factors for PPD include depression during pregnancy, low parenting self-efficacy, and disrupted parental nocturnal sleep. The brief Practical Resources for Effective Postpartum Parenting (PREPP) intervention is designed for pregnant individuals at-risk for postpartum depression, providing them with 1) caregiving strategies aimed at reducing infant fuss and cry behavior and increasing infant sleep, 2) self-reflection and mindfulness skills and 3) psychoeducation about the postpartum period and infant behavior. The aims are to set more realistic postpartum expectations, enhance parenting confidence and sleep via supporting infant regulatory behavior, improve parental affect regulation and ultimately reduce the risk of postpartum depression. ObjectivesAssess the effectiveness of PREPP compared to enhanced treatment as usual in reducing symptoms of depression and anxiety and episodes of infant fuss and cry behavior and improving parental and infant sleep in the early postpartum. Study designA randomized controlled trial was conducted of 175 pregnant individuals. Inclusion criteria were standard prenatal care for a singleton pregnancy, aged 18 to 45 and at increased risk of PPD as determined by a score of ≥19 on the Predictive Index of Postnatal Depression or ≥7 on the Edinburgh Postnatal Depression Scale. Participants assigned to the PREPP group (n=88) received three coaching sessions and two phone check-ins. Participants assigned to the enhanced treatment as usual group (n=87) received three sessions which included psychoeducation, mood assessments, and clinical referral and follow-up as indicated. Assessments were conducted at 28 to 32 weeks and 34 to 39 weeks gestation, and at six, 12 and 16 weeks postpartum and included measures of parental depression, anxiety and sleep (Edinburgh Postnatal Depression Scale, Patient Health Questionnaire (PHQ-9), Hamilton Rating Scales of Depression and Anxiety and Pittsburgh Sleep Quality Index) and infant sleep and fuss and cry behavior (Baby Day Diary). ResultsCompared to enhanced treatment as usual, PREPP significantly reduced depressive symptoms at six, 12 and 16 weeks postpartum with medium to large effect sizes (d=0.7-0.98). Compared to enhanced treatment as usual, participants receiving PREPP reported less of a decline in sleep quality at six weeks postpartum (p=0.035) and the effect size was large (d=0.83). Moreover, parents receiving the PREPP intervention reported less infant fussing and crying, with the largest effect for morning crying (p<0.001; d=-1.48). ConclusionsThe results provide evidence that PREPP, initiated during pregnancy, reduced symptoms of parental depression and infant fuss and cry behavior in the early postpartum, compared to enhanced treatment as usual, in a sample at-risk for postpartum depression.

Self-report Internal Load Measures Of Readiness, Fatigue, Sleep, And Stress In Women’s Collegiate Volleyball

Self-report Internal Load Measures Of Readiness, Fatigue, Sleep, And Stress In Women’s Collegiate Volleyball

A routine within a routine: Can bedtime yoga improve sleep for the whole family?

Parents often point to bedtime as a source of frustration, yet early bedtimes and sufficient sleep are important for children's development, learning, and behavior. ObjectivesThis pilot study aimed to assess the feasibility and preliminary effectiveness of a yoga-based bedtime routine in a sample of parent-child dyads from a rural community. MethodsUsing a waitlist control study design, children aged 2–5 years and their parent were randomized to either intervention (yoga) or control (bedtime story) groups. Pre- and post-intervention measures included the CHAOS, CSHQ, and FNPA scales. Height, weight, and waist circumference were measured by trained staff, while sleep and physical activity were tracked using accelerometry. ResultsOf the 15 dyads that completed all assessments, 13 (81.2%) completed at least 16 yoga sessions. CSHQ scores improved in both groups (Cohen's d 0.42 vs. 0.52 for intervention and control, respectively), and FNPA scores improved in the intervention group (Cohen's d = 0.4). The number of sessions completed was inversely correlated with changes in CHAOS score (r = −0.74, p = 0.003). DiscussionThese findings suggest that a yoga-based bedtime routine is feasible for families with 2-5-year-old children, with good adoption and adherence. Improvements in sleep and household chaos measures indicate that a yoga routine may be slightly more effective than a story-based one. This study provides preliminary support for further research on a yoga-based bedtime routine in a larger sample.

The Relationship Between Sleep And Health Measures In College Students

The Relationship Between Sleep And Health Measures In College Students

Assessing the Reliability and Validity of Sleep Assessments in Patients Seeking Metabolic and Bariatric Surgery

BackgroundMore than 80% of patients seeking metabolic and bariatric surgery (MBS) report disturbance in sleep function. No studies have assessed the psychometric properties of sleep measures in MBS samples. ObjectivesThis study assessed the reliability and validity of the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI) in a large sample of patients seeking MBS. SettingTwo academic medical centers. MethodsMeasures of sleep (PSQI & ISI) and psychological functioning, including the Quick Inventory of Depressive Symptomatology (QIDS), were administered pre-surgically. Internal consistency was assessed with mean inter-item correlations and item-total correlations. Construct validity was assessed using confirmatory factor analyses (CFAs) based on models identified in the literature and by measuring convergent and discriminant validity. ResultsParticipants (N = 939) were primarily female (83.4%) with a mean age of 41.7 (SD=11.5) years and mean BMI of 47.5 kg/m2 (SD = 8.5). CFAs indicated excellent fit for two-factor solutions for the PSQI and ISI. Internal consistency for the PSQI and ISI were acceptable. Convergent validity was demonstrated by large correlations between the PSQI and ISI (r = .80, p < .001), and moderate correlation between the PSQI, ISI, and QIDS (rs > .50, ps < .001). The PSQI and ISI were moderately correlated with QIDS items assessing sleep function (p < .001), but correlations with items assessing appetite change were small (r < .10), demonstrating good discriminant validity. ConclusionsResults support the reliability and validity of the PSQI and ISI for patients undergoing MBS.

Investigation of the influence of 45-minute pre-sleep social media use on sleep quality and memory consolidation in adolescents

Adolescents devote a significant portion of their time to smartphone usage, often engaging in social media activities. Social media use has previously been linked to diminished sleep quality and reduced sleep durations in correlational studies. In this experimental study, we aimed to investigate the influence of pre-sleep social media use on memory consolidation, subjective arousal and objectively assessed sleep quality in adolescents. We compared the social media condition to two reading conditions, one involving reading a book on a smartphone and the other reading from a physical book in a within-subjects design. Twenty participants between 12 and 14 years engaged in these activities for 45 min before bedtime. Contrary to our expectations, the results indicated that pre-sleep social media use did not have a discernible impact on sleep quality, pre-sleep arousal or memory consolidation. All assessed sleep measures remained consistent across the three conditions. Subjectively, the social media condition was rated less thrilling than the reading conditions. This suggests that, within the confines of this experiment, pre-sleep social media exposure did not significantly disrupt adolescents' sleep or their ability to consolidate memories during sleep. This deviation from previous correlational studies might be explained by a possible impact of mental health factors on media consumption and sleep or the fact that contrary to their daily routines participants had to sleep after our intervention and could not continue to engage in their activities. This highlights the need for further investigations into the complexities of this interaction.

Effects of night-to-night variations in objectively measured sleep on blood glucose in healthy university students.

We examined associations between daily variations in objectively measured sleep and blood glucose in a sample of non-diabetic young adults to complement laboratory studies on how sleep affects blood glucose levels. 119 university students underwent sleep measurement using an Oura Ring 2 and continuous glucose monitoring (CGM) for up to 14 days. In 69 individuals who consumed a standardised diet across the study, multilevel models examined associations between sleep duration, timing and efficiency and daily CGM profiles. Separately, in 58 individuals, multilevel models were used to evaluate postprandial glycaemic responses to a test meal challenge on 7 days. Participants also underwent oral glucose tolerance testing once after a night of ad libitum sleep, and again following a night of sleep restriction by 1-2 hours relative to that individual's habitual sleep duration. Between-condition glucose and insulin excursions, HOMA-IR and Matsuda index were compared. Nocturnal sleep did not significantly influence following-day CGM profiles, postprandial glucose, or nocturnal mean glucose levels (all Ps>0.05). Longer sleep durations were associated with lower same-night glucose variability (all Ps<0.001). However, the range of variation of sugar levels was small and unlikely to be of functional significance. Considering naps in the analysis did not alter the findings. Sleep restriction by an average of 1.73 hours (SD=0.97) did not significantly impact excursions in glucose or insulin or insulin sensitivity the following morning (all Ps>0.05). Glucose handling in young, healthy adults may be more resilient to real-life fluctuations in sleep patterns than previously thought.

Supplemental ambient lighting intervention to improve sleep in Parkinson's disease: A pilot trial

ImportanceSleep disturbances in Parkinson's disease (PD) are common and often adversely affect quality of life. Light therapy has benefited sleep quality and mood outcomes in various populations but results to date with conventional light therapy boxes in PD patients have been mixed. We hypothesized that a passive lighting intervention, applied in the morning and designed to maximally affect the circadian system, would improve measures of sleep and mood in PD patients. MethodsIn this single-arm, within-subjects intervention study, baseline objective sleep (actigraphy), subjective sleep quality (questionnaires), and subjective mood (questionnaires) data were collected for 1 week. Lighting was then administered to participants via table/floor lamps installed in the home or via personal light therapy glasses for 2 h in the morning, 7 days per week, over the following 4-week period. Post-intervention data for the same outcomes were collected during the final week of the intervention period. ResultsAmong 20 participants (12 women, 8 men; mean [SD] age 72.1 [9.5] years, disease duration 9.0 [5.2] years), objective sleep duration increased significantly by 28.5 min (p = 0.029) and objective sleep time increased significantly by 19.9 min (p = 0.026). ConclusionPassive and easily administered lighting interventions for improving sleep in PD patients hold promise as a treatment for mitigating symptoms and improving quality of life in PD.

Sleep Health among Community-Recruited Opioid-Using People Who Inject Drugs in Los Angeles, CA and Denver, CO.

Chronic insufficient and poor-quality sleep are linked to hypertension, diabetes, depression, heart attack, and stroke. While studies on substance use and sleep typically focus on people in or entering treatment, there is a lack of research on sleep health among community-recruited people who inject drugs (PWID). To address this literature gap, we examined factors associated with insufficient and poor-quality sleep among community-recruited PWID. We recruited and interviewed 472 active opioid-using PWID (injected within the last 30days) in Los Angeles, CA and Denver, CO between 2021 and 2022. Participants completed computer-assisted interviews covering demographics, subsistence measures, drug use patterns, injection-related behaviors, health risks, and sleep duration and quality in the last 3months. Descriptive statistics were used to analyze all variables for subjects with complete responses to sleep items (n = 464). Bivariate analyses determined factors associated with sleep measures using chi-square and t-tests. Collinear variables were removed, and binomial linear multivariable regression calculated risk ratios (RR) for insufficient and poor-quality sleep in the last 3months. Participants exhibited low sleep duration (mean = 4.99, standard deviation (SD) = 2.70), with 76% reporting insufficient sleep and 62% poor-quality sleep. Bivariate analyses associated both sleep measures with drug use, high subsistence scores, violent victimization, and poor health outcomes. Multivariable analyses showed a high subsistence score predicting insufficient (RR = 1.31) and poor-quality sleep (RR = 1.69) compared to low subsistence. Poor sleep health is common among structurally vulnerablecommunity-recruited PWID, asmeasured by subsistence index associated with adverse sleep outcomes. Further research on structural interventions to address sleep and subsequent health outcomes among PWID is imperative.

Personalized sleep and nutritional strategies to combat adverse effects of night shift work: a controlled intervention protocol

Abstract Background Working during the night interferes with the timing of normal daily activities and is associated with an increased risk of chronic diseases. Under controlled experimental conditions, interventions focusing on sleep and nutrition can mitigate the short-term adverse effects of shift work. However, it is unclear how these results translate to real-life, how they can be targeted to individual conditions, and how they relate to long-term health. Therefore, the current study aims to implement a personalized sleep and nutritional intervention among night shift workers in the field. Methods A non-blinded controlled intervention study is used, consisting of a run-in period, an intervention of 3 months, post-intervention measurements, and a follow-up after 12 months. Three study arms are included: sleep intervention, nutritional intervention, and control group (n = 25 each). Participants are healthy 18–60-year male night shift workers, with at least one year of experience in night shift work. Information from the run-in period will be used to personalize the interventions. The main outcomes are sleep measurements and continuous interstitial glucose levels. Furthermore, general health biomarkers and parameters will be determined to further evaluate effects on long-term health. Discussion This study aims to mitigate negative health consequences associated with night shift work by introducing two personalized preventive interventions. If proven effective, the personalized interventions may serve as practical solutions that can have a meaningful impact on the sustainable health and employability of night shift workers. This study will thereby contribute to the current need for high–quality data on preventative strategies for night shift work in a real-life context. Trial registration This trial has been registered under ClinicalTrials.gov Identifier NCT06147089. Registered 27 November 2023.

Immediate Effect of Continuous Positive Airway Pressure Therapy on Sleep and Respiration in Patients with Multiple System Atrophy and Sleep-Disordered Breathing.

Sleep-disordered breathing (SDB; including stridor and sleep apnea syndromes) is frequent in multiple system atrophy (MSA), but the immediate effect of continuous positive airway pressure (CPAP) therapy is incompletely determined. We sought to evaluate the acute effect and safety of CPAP therapy on SDB and sleep architecture, as well as the clinical characteristics of nonresponders to CPAP therapy. The measures of 63 consecutive patients with MSA who underwent a video-polysomnography during two consecutive nights (a first night in ambient air, a second night with or without CPAP, depending on the presence of SDB and availability of CPAP) in routine care were retrospectively collected. Linear mixed models assessed the two-night change in sleep and respiratory measures, comparing those with and without the CPAP therapy on the second night. SDB was frequent and mainly associated with the cerebellar phenotype. The introduction of CPAP had immediate benefits, including the normalization of the apnea-hypopnea index and a resolution of stridor in more than two-thirds of the cases, decreased arousal index, and increased rapid eye movement sleep. CPAP therapy was well tolerated, and only two patients had emergent central apneas. Nonresponse to CPAP was generally associated with more severe motor disease. CPAP seems a well-tolerated and effective therapy in patients with MSA and SDB in the short term. This treatment shows remarkable immediate benefits by objectively improving both respiratory disturbances and sleep architecture. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

A Meta-Regression of psychosocial factors associated with sleep outcomes in mindfulness-based intervention trials.

In this meta-regression, we aimed to explore associations between changes in psychosocial factors and changes in sleep disturbance during mindfulness-based interventions (MBIs). We also investigated participant-specific and methodological factors associated with sleep disturbance during MBIs. We utilized data from a published meta-analysis of 40 randomized controlled trials of MBIs (published from inception to 2020) with a sleep disturbance outcome measure in healthy and clinical adult populations. We conducted meta-regressions to test associations between sleep improvements following MBIs and psychosocial factors, as well as demographic and methodological factors. MBIs were associated with significant reductions in sleep disturbance (SMD = -0.523; 95% CI = -0.678 to -0.368) and psychosocial factors (SMD = -0.213 - -0.894). Reductions in sleep disturbance were associated with reductions in stress (r = 0.74, p = .02) and depression (r = 0.90, p < .001). MBIs improve sleep disturbance across a wide range of healthy and clinical populations. Stress and depression may be important psychosocial factors associated with sleep disturbance. Future RCTs should include measures of additional factors and should investigate longitudinal associations between psychosocial, demographic, and methodological factors with changes in sleep disturbance to test mechanisms and to identify "active ingredients" of MBIs.

Psychometric Examination of the PROMIS Parent Proxy Pediatric Sleep Measures from Early Childhood to Adolescence in a Nationally Representative Spanish Sample.

To use a nationally representative sample to (1) evaluate the factor structure of the PROMIS parent proxy pediatric sleep scales (Spanish translation), (2) examine the invariance of these scales across sex and across different developmental periods of childhood and adolescence, (3) confirm the information and precision of the scales using item response theory (IRT), and (4) provide age-based normative information. Parents of a nationally representative sample of 5,525 Spanish children and adolescents ages 5-16 years (56.1% boys) completed the Spanish translation parent proxy short versions of the Sleep Disturbance and Sleep-Related Impairment scales. We conducted confirmatory factor analyses (CFA), invariance analyses, and graded response IRT analyses. CFAs conducted separately on males and females within three age groups (early childhood: ages 5-8 years; middle childhood: ages 9-12 years; adolescence: ages 13-16 years) indicated all items had a substantial loading with one exception (the sleep continuity item ["my child slept through the night"] had a substantially lower loading and was removed for subsequent analyses). The scores on the two scales demonstrated invariance across sex within each age group. Using IRT analyses, both scales showed a high degree of information and precision from slightly below the trait means to slightly above two standard deviations above the trait means. The strong psychometric properties of the short versions of the parent proxy PROMIS pediatric sleep disturbance and sleep-related impairment scales, coupled with age-based norms, suggests these scales are likely to be useful for research and clinical applications.

Cognitive performance, neuropsychiatric symptoms, and cerebrospinal fluid viral control following programmatic switch from efavirenz-based to dolutegravir-based antiretroviral therapy in South Africa (CONNECT): a prospective cohort study

Both efavirenz and dolutegravir have been associated with neuropsychiatric side-effects and cognitive impairment. Furthermore, cerebrospinal fluid (CSF) HIV RNA escape has not been comprehensively studied in African populations. We aimed to examine changes in cognition, neuropsychiatric symptoms, and CSF viral control associated with the widespread switch from efavirenz-based to dolutegravir-based antiretroviral therapy (ART). This prospective cohort study of people with HIV and people without HIV recruited adults with HIV (aged 18-55 years) from the Gugulethu Community Health Centre in a low-income periurban area of Cape Town, South Africa. Eligible participants had been receiving efavirenz-based ART for at least 1 year and were identified by the clinic to switch to dolutegravir-based ART as part of the national programmatic switch. Participants were studied at baseline and followed up at 1 year after switch to dolutegravir. People without HIV were recruited from the same area, matched for age and gender, and followed up at the same time interval. People with HIV and people without HIV underwent comprehensive cognitive testing over seven domains and measures of functioning, mood, anxiety, and sleep. People with HIV had CSF sampling for HIV RNA quantification. Between Aug 12, 2019, and Sept 16, 2022, we recruited 178 people with HIV and 95 people without HIV. 145 (81%) of 178 people with HIV and 40 (66%) of 60 people without HIV who were offered underwent follow-up. Global cognitive performance was 2·57 T score points lower in people with HIV than in people without HIV at baseline (p=0·0008). At follow-up, cognition in people with HIV improved more than practice effects observed in people without HIV (coefficient 1·40, 95% CI 0·48-2·32, p=0·0028) and no significant difference in cognitive performance between groups was apparent (51·43 vs 52·73; p=0·22). Sleep quality improved following the switch (risk ratio 0·90, 95% CI 0·84-0·95; p=0·0002), driven mainly by indicators of disturbed sleep. There were nine incident cases of depression, although baseline differences were present. There was one case (1%) of CSF escape at baseline and three cases (4%) at follow-up; all were at low levels or resolved with repeated sampling. Improvements in cognition and sleep are probably related to switching from efavirenz. However, the possible increase in depression warrants further examination. Cognitive performance in virally supressed African people with HIV receiving dolutegravir-based therapy is similar to people without HIV. CSF escape is uncommon on both efavirenz-based and dolutegravir-based therapy. South African Medical Research Council and UK Medical Research Council, Newton Fund.

Respiratory safety of lemborexant in adult and elderly subjects with moderate-to-severe chronic obstructive pulmonary disease.

Because some hypnotics worsen respiratory conditions, it was important to determine the respiratory safety of lemborexant, a competitive dual orexin-receptor antagonist approved to treat adults with insomnia, in subjects with moderate-to-severe chronic obstructive pulmonary disease. E2006-A001-113 (Study 113; NCT04647383) was a multicentre, multiple-dose, randomised, double-blind, placebo-controlled, two-period crossover study in adult subjects with moderate or severe chronic obstructive pulmonary disease (per spirometry-based Global Initiative for Chronic Obstructive Lung Disease [GOLD] criteria). Subjects (N = 30) were randomised to two treatment sequences comprising 8-night treatment periods (washout ≥ 14 days) with lemborexant 10 mg or placebo. Peripheral oxygen saturation (SpO2; primary endpoint), apnea-hypopnea index, objective sleep parameters and sleep architecture measures were assessed after single (Day 1) and multiple (Day 8) doses. There was no significant difference in least-squares mean SpO2 after a single dose of lemborexant (91.1%) versus placebo (91.5%). Although a statistically significant difference in SpO2 was observed after multiple doses (least-squares mean: lemborexant, 91.3%; placebo, 90.8%) favouring lemborexant, this was not considered clinically meaningful. Apnea-hypopnea index was not significantly different between treatments after single or multiple doses. Total sleep time and total rapid eye movement sleep were significantly greater on Days 1 and 8 with lemborexant versus placebo. Treatment-emergent adverse events were reported in five (16.7%) subjects when taking lemborexant and four (13.3%) subjects when taking placebo; treatment-emergent adverse events were mostly mild. Lemborexant was well tolerated and did not adversely impact SpO2 or apnea-hypopnea index after single and multiple doses relative to placebo in subjects with moderate-to-severe chronic obstructive pulmonary disease.

A - 14 Sleep and Tauopathies: a Review

Abstract Objective This project highlights a narrative review investigating the relation between sleep and tauopathies (a disease which reflects the pathological changes in the brain’s tau protein). Tauopathies are often associated with aging disorders and causes of dementia, including Alzheimer’s disease. Sleep is a behavioral modifiable risk factor that has been implicated in many of these disorders, but the process, relationship, and mechanisms remain largely unknown. Understanding relationships between behaviors and disease pathology is crucial to furthering our understanding of causes of disorders, as there are no known cures for neurodegenerative tauopathies. Data Selection This review was registered with Prospero, a database of potential systematic reviews, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. The search took place between August and November 2023. Databases included PubMed, APA PsycInfo, MEDLINE, and Cochrane Library. Key words included “sleep,” “tau,” and “dementia.” Study requirements included a measure of sleep and tau, and a human sample that had been diagnosed with a tauopathy. Data Synthesis The search yielded 319 unique results. A three-person team independently reviewed titles for relativity and inclusion first, then reviewed abstracts to determine eligibility. A total of 22 papers were found to meet review criteria. Conclusion A majority of studies (n = 21) found correlations between impaired sleep and increased tau pathology. A subset analysis that reviewed studies with neuropsychological testing (n = 6) found increased cognitive impairment with poorer sleep and increased tau pathology. There is a continued need for longitudinal studies to understand the impacts of lifestyle behaviors on pathology development.

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.

Music listening for improvement of sleep in post-acute rehabilitation of adults with acquired brain injury: A feasibility study

ABSTRACT Introduction Acquired brain injury (ABI) often leads to sleep disturbances impacting recovery. Previous research has shown that listening to music at bedtime can have a beneficial effect on sleep quality in various populations, but the impact of bedtime music on sleep problems related to ABI has not been studied. This feasibility study investigates the acceptability and effectiveness of music listening for sleep improvement in ABI patients. Methods In a within-subjects crossover design with repeated measures for 28 days, ABI patients with sleep disturbance were allocated to a control or music condition, switching conditions after 14 days. Acceptability was assessed with questionnaires on compliance and attrition. The effect was evaluated with the Pittsburgh Sleep Quality Index (PSQI) at baseline, day 14 and 28, daily sleep ratings, and actigraphy. Results The intervention was well-liked, and participants listened to the music most of the intervention nights. A descriptive statistical comparison of outcome data on PSQI and daily sleep ratings regarding how well participants slept indicated that participants (n = 4) experienced better sleep with the music intervention. The objective sleep measures reflected a slightly longer time to fall asleep with the music intervention. Discussion The results suggest good acceptability and a potential beneficial effect of the intervention. Music listening may be a safe and effective tool, and a full RCT is recommended to evaluate the efficacy of music listening for sleep improvement in ABI patients. https://www.clinicaltrials.gov, Identification number: NCT05620069.

Associations between obstructive sleep apnea and sleep characteristics with chronic kidney disease in rural Pennsylvania

Study objectivesTo examine the association between moderate-severe obstructive sleep apnea (msOSA) and sleep characteristics with chronic kidney disease (CKD) in a population of rural and urban adults in Pennsylvania. MethodsA cross-sectional study of 23,643 adults who underwent polysomnography (PSG) at a rural healthcare system in Pennsylvania between 2009 and 2019. Serum creatinine was abstracted from electronic health records to calculate estimated glomerular filtration rate (eGFR). CKD was defined as an eGFR <60 mL/min/1.73 m2. msOSA was defined as an apnea-hypoxia index (AHI) ≥15 events/hour. Poisson regression was performed to estimate the prevalence ratio (PR) of CKD for various sleep measures while adjusting for age, sex, race, smoking (never, former, current), body mass index, diabetes, and hypertension at time of PSG. ResultsIn this clinically-referred sample comprised of over one-third (35 %) rural individuals, the prevalence of CKD and msOSA was 9.4 % and 32.1 %, respectively. Patients with CKD had more severe OSA based on AHI and intermittent hypoxia profile and presented worse sleep quality across all studied measures. Having OSA was associated with a 13 % higher prevalence of CKD (95%CI: 1.04, 1.22). In addition, for every 5 % increment in sleep efficiency, the prevalence of CKD was 3 % lower (PR = 0.97, 95%CI: 0.96, 0.98). Significant associations that were in the expected direction were observed across most sleep characteristics in adjusted models. ConclusionsModerate-severe OSA, nocturnal hypoxemia, and disruptions to normal sleep duration, continuity, and architecture are associated with increased CKD prevalence in Pennsylvania adults. Management of OSA and/or sleep disturbances may be an opportunity to improve CKD outcomes. The unique health disparities among vulnerable rural populations are deserving of future study.

Improvement in self-reported, but not actigraphic, sleep measures with suvorexant in people with well-controlled Restless Legs Syndrome and persistent insomnia

BackgroundSleep disturbance remains common in people with Restless Legs Syndrome (RLS), even after RLS symptoms are sufficiently controlled with medication. We conducted a placebo-controlled crossover trial to examine the efficacy of suvorexant in improving sleep quality and quantity in people with well-controlled RLS and persistent insomnia. MethodsIn this double-blind, randomized, placebo-controlled crossover trial, 34 participants (70.6 % female, mean age = 62.7) with well-controlled RLS were randomized to placebo or suvorexant (10–20 mg) for 6 weeks, followed by a 2-week washout and then the opposite treatment. Study inclusion required an IRLS score <15, insomnia diagnosis per DSM-5, and a diary-reported combined Sleep Onset Latency (SOL) and Wake After Sleep Onset (WASO) > 45 min and a Total Sleep Time (TST) < 7 h on 7/14 baseline nights. The primary outcome was actigraphically-derived TST, and secondary outcomes were Insomnia Severity Index (ISI) score and actigraphically-derived WASO. Data for all sleep metrics were collected at baseline and for the last two weeks of each treatment period. ResultsThere were no significant improvements in actigraphically-derived TST (p = 0.58) or WASO (p = 0.99) while taking suvorexant compared to placebo. However, there were significant reductions in insomnia symptoms, measured by the ISI, as well as increases in diary-reported TST (p = 0.01) while taking suvorexant compared to placebo. The most commonly reported side effect of suvorexant was fatigue (29.4 %). ConclusionsWe observed no significant differences between treatments in actigraphically-derived sleep measures, but support for suvorexant's benefit for overall insomnia and self-reported quantity of sleep in people with well-controlled RLS who continue to suffer from insomnia. Clinical trials registration numberNCT04706091.