Sleep Self-assessment Research Articles

P-457 The overlooked side of sleep quality; can self-reported sleep quality have an impact on the quality of oocytes and embryos in women undergoing IVF treatment?

Abstract Study question Does sleep quality affect oocyte and embryo quality in women undergoing in vitro fertilization (IVF) treatment? Summary answer Sleep quality and number of mature oocytes retrieved were negatively correlated, but not significantly so. In addition, embryo grading was not associated with sleep quality. What is known already Some studies have found associations between sleep disturbances or disruption of circadian rhythms and decreased ovarian reserve, menstrual cycle irregularity, and infertility. The literature on the positive effects of quality sleep on oocyte health is growing in importance. Especially sleep hormone melatonin regulates biological rhythms through various receptors and also has strong antioxidant activities to scavenge reactive oxygen species in the ovaries. Taken together, the available evidence on sleep quality during fertility treatment is limited, and our objective was to explore self-reported sleep quality on oocyte and embryo quality in women undergoing IVF treatment. Study design, size, duration 105 eligible patients who underwent IVF treatment with fresh embryos at an infertility clinic in Izmir between January 2020 and December 2023 were included. However, women with psychiatric disorders, cycles with frozen embryos, and those with low ovarian reserve were excluded. Data were collected through participants’ self-assessment of sleep and embryologists’ assessment of oocyte and embryo quality in a laboratory setting. Participants/materials, setting, methods “Pittsburg Sleep Quality Index” (PSQI) was used to assess the sleep quality and “The Balaban and Veeck/Gardner Classification Assessment Form” was used to evaluate oocyte and embryo quality. Sleep quality data were collected face-to-face in a private, quiet and isolated patient room after oocyte pick-up (OPU). Oocytes and embryos were evaluated 2-4 hours and 48-72-96 (Day 2, Day 3, or Day 5) hours after the OPU for quality and development, respectively. Main results and the role of chance After the OPU, there were approximately 5.35 (SD:4.24) oocytes which reached at least 16 mm. OPU duration was 11.42 (SD:4.53) minutes and number of oocytes retrieved was 9.02 (SD:7.30). According to Balaban category, 64.8% of the oocytes were grade 4 and 18.1% were grade 2. The number of fertilized oocytes was approximately 4.54 (SD:4.52) and transferred in 2.76 (SD:1.70) days. Of the embryos, 71.9% were grade 1 and 39.0% were grade 2. In addition, sleep quality was found to be above the cut-off score of 5 in all women. A higher score indicated poorer sleep quality. The mean on the PSQI scale was 12.58 (SD: 2.33). Showering, dark and quiet environment, were reported as sleep facilitators and stress, light, and noise as disturbances. 66.7% of the women felt that they had a good quality of sleep. There was a non-significant but negative corelation between sleep quality and the number of mature oocytes retrieved (t=-7.662, p = 0.939). Therefore, as sleep quality deteriorates, oocyte retrieval decreases. According to the result of linear regression analysis, it is difficult to associate the effectiveness of Balaban categorization with sleep quality, and Pearson’s correlation test showed that embryo grades were not associated with sleep quality (p = 0.917). Limitations, reasons for caution The inclusion of objective measures such as actigraphy or polysomnography, which are practically challenging, could have validated the PSQI results and provided additional data on the sleep characteristics of women. Secondly, all participants were recruited from single infertility centers; therefore, our results may not apply to all infertile women. Wider implications of the findings Our study sheds light on measuring sleep with a self-reported index that can be used in the clinical setting and assessing its impact on oocyte quality. This study could be extended over years to study the long-term effects. The high prevalence of poor sleep quality calls for further research. Trial registration number not applicable

Web survey during COVID-19 pandemic in São Paulo state: how are medical students sleeping and living?

This study aimed at characterizing medical students' sleep and life quality during the COVID-19 pandemic in São Paulo (SP) state. All public higher education institutions (HEIs) of SP state were invited to participate. From a list of 56 private HEIs, 16 were randomly selected. The web survey collected: sociodemographic data; factors related to COVID-19; sleep self-assessment; scores in the Epworth sleepiness scale, Pittsburgh sleep quality index, and student and resident life in the health area - questionnaire. The HEIs' acceptance rate was 25% (8), resulting in 200 participants (response rate 5.04%), aged ≥18 years, 60.5% females. Concerning COVID-19, 89.00% never showed symptoms and/or tested positive, 82.00% declared full adherence to epidemiological measures to prevent the infection's spread, and 45.00% completed the vaccination schedule against SARS-CoV-2. Sleep deprivation was accompanied by a drop of self-perceived sleep quality from 8 to 6 (in a Likert scale) during COVID-19 pandemics (p≤0.0001), 76.50% were poor sleepers, and 40.00% had drowsiness, especially women (p≤0.05). They also had lower quality of life and unfavorable psychological and physical outcomes than men (p≤0.05). Internship students had a more negative perception of the educational environment (p≤0.05), characterized by an excessive workload. Women and internship students are a representative fraction that requires special attention and focused strategies to cope with sleep problems and medical education during COVID-19 pandemics.

730 Prevalence and impact of sleep problems in active duty military personnel receiving Cognitive Processing Therapy for PTSD

Abstract Introduction Sleep disturbances are common in active duty military personnel and play a key role in the development and maintenance of posttraumatic stress disorder (PTSD). Research indicates that although insomnia and nightmares improve with successful PTSD treatment, they may remain clinically significant. Few previous PTSD studies have assessed sleep disorder constructs using validated instruments. The objectives of this study were to examine the proportion of active duty military personnel seeking treatment for PTSD who reported clinically significant insomnia, nightmares, sleep duration, and excessive daytime sleepiness and to examine the impact PTSD treatment had on these sleep constructs using validated self-report questionnaires. Methods Sleep was evaluated in 223 active duty service members participating in a randomized clinical trial comparing group and individual Cognitive Processing Therapy (CPT) for PTSD. Sleep constructs were assessed using the Insomnia Severity Index (ISI), Trauma-Related Nightmare Survey (TRNS), Self-Assessment of Sleep (SAS), and Epworth Sleepiness Scale (ESS) at baseline and 2 weeks posttreatment. Results At baseline, 82% of participants reported clinically significant insomnia and 75% reported at least 1 moderately severe nightmare per week. Participants reported averaging 4.76 hours of sleep per night, and 65% reported excessive daytime sleepiness. Over the course of PTSD treatment, there were statistically significant improvements in insomnia, nightmares, and excessive daytime sleepiness, but scores remained in clinically significant ranges. Minimal increases were seen in sleep duration. Of the participants who no longer met criteria for PTSD at posttreatment, 50% continued to report clinically significant insomnia, 52% continued to report clinically significant nightmares, and 44% continued to report excessive daytime sleepiness. Conclusion Consistent with previous research, sleep problems persisted for a significant number of service members who completed treatment for PTSD. Insomnia, nightmare, and sleep extension interventions are likely an important part of comprehensive PTSD treatment plans. Support (if any) Funding for this work was made possible by the U.S. Department of Defense through the U.S. Army Medical Research and Materiel Command, Congressionally Directed Medical Research Programs, Psychological Health and Traumatic Brain Injury Research Program awards W81XWH-08-02-109 (Alan Peterson), W81XWH-08-02-0116 (Patricia Resick), W81XWH-10-1-0828 (Daniel Taylor), and W81XWH-08-02-0114 (Brett Litz).

Study Protocol on the Validation of the Quality of Sleep Data from Xiaomi Domestic Wristbands.

(1) Background: Sleep disorders are a common problem for public health since they are considered potential triggers and predictors of some mental and physical diseases. Evaluating the sleep quality of a person may be a first step to prevent further health issues that diminish their independence and quality of life. Polysomnography (PSG) is the “gold standard” for sleep studies, but this technique presents some drawbacks. Thus, this study intends to assess the capability of the new Xiaomi Mi Smart Band 5 to be used as a tool for sleep self-assessment. (2) Methods: This study will be an observational and prospective study set at the sleep unit of a hospital in A Coruña, Spain. Forty-three participants who meet the inclusion criteria will be asked to participate. Specific statistical methods will be used to analyze the data collected using the Xiaomi Mi Smart Band 5 and PSG. (3) Discussion: This study offers a promising approach to assess whether the Xiaomi Mi Smart Band 5 correctly records our sleep. Even though these devices are not expected to replace PSG, they may be used as an initial evaluation tool for users to manage their own sleep quality and, if necessary, consult a health professional. Further, the device may help users make simple changes to their habits to improve other health issues as well. Trial registration: NCT04568408 (Registered 23 September 2020).

Eating behavior, sleep self-assessment and personality traits of students with extreme chronotypes

To identify the differences in eating behavior, sleep self-assessment and personality traits in students with extreme chronotypes. Students (n=350), aged 17 to 23 years, with extreme chronotypes (owls/larks) were studied. Eating behavior was assessed with the Three-Factor Eating Questionnaire (TFEQ-R18). Evaluation of the condition of the cycle sleep-wakefulness (sleep quality, sleep hygiene, daytime sleepiness) and psychophysiological differences (Eysenck Personality Questionnaire, Spielberger-Khanin anxiety inventory and the Taylor Manifest Anxiety Scale (TMAS); the Stress test) was performed. Higher neuroticism, psychoticism and anxiety, low resistance to stress, reduced quality and hygiene of sleep with increased daytime sleepiness are found in people with evening preferences in comparison with the morning chronotype. Eating behavior according to TFEQ-R18 is characterized by a lack of cognitive restraint. The results may indicate preclinical health disorders, which are affected by lifestyle factors. The number of alcohol consumers and smokers is two and more than three times higher, respectively, among students with evening chronotype. The changes identified in people with evening chronotype require additional attention to student's health.

Anxiety, sleep self-assessment, cortisol and saliva antioxidants in students with occasional experience of shift work

To study the anxiety level, sleep self-assessment and indicators of morning and evening levels of cortisol and saliva antioxidants in students with experience of occasional shift work. University students (n=159) with experience of shift work were examined. Psychoemotional status was assessed using the Eysenck personality questionnaire (EPQ), Spielberger-Khanin anxiety inventory, The Taylor Manifest Anxiety Scale (Nemchin's modification). The express-questionnaire The Quality of Sleep Hygiene, the Sleep Quality scale and the scale of drowsiness were used to assess sleep. Saliva morning and evening cortisol levels (ELISA) and the total antioxidant activity (amperometric method) were determined. There was an increase in the number of respondents with higher anxiety, higher scores of psychoticism and neuroticism. According to the self-assessment of sleep, a statistically significant decrease in the quality of sleep hygiene was shown. Biochemical parameters of the saliva differed significantly only in the morning hours: the increase in cortisol and decrease in the antioxidant activity were observed. The results suggest the possibility of asymptomatic development of emotional disorders and metabolic disorders in people with occasional night shift work.

The Influence of Sleep Disorders on Voice Quality

To verify the influence of sleep quality on the voice. Descriptive and analytical cross-sectional study. Data were collected by an online or printed survey divided in three parts: (1) demographic data and vocal health aspects; (2) self-assessment of sleep and vocal quality, and the influence that sleep has on voice; and (3) sleep and voice self-assessment inventories-the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), and the Voice Handicap Index reduced version (VHI-10). A total of 862 people were included (493 women, 369 men), with a mean age of 32 years old (maximum age of 79 and minimum age of 18 years old). The perception of the influence that sleep has on voice showed a difference (P < 0.050) between measures of sleep quality and vocal self-assessment. There were higher scores on the ESS, PSQI, and VHI-10 protocols if sleep and vocal self-assessment were poor. The results indicate that the greater the effect that sleep has on voice, the greater the perceived voice handicap. The aspects that influence a voice handicap are vocal self-assessment, ESS total score, and self-assessment of the influence that sleep has on voice. The absence of daytime sleepiness is a protective factor (odds ratio [OR] > 1) against perceived voice handicap; the presence of daytime sleepiness is a damaging factor (OR < 1). Sleep quality influences voice. Perceived poor sleep quality is related to perceived poor vocal quality. Individuals with a voice handicap observe a greater influence of sleep on voice than those without.

Sleep quality and hormone levels in the morning and evening hours under chemical pollution

To evaluate self-assessment of sleep and the level of hormones in the morning and evening in chemical pollution conditions. Three hundred adolescent and adult men living in the regions with low and high levels of chemical pollution were examined using questionnaires for self-assessment of quality of sleep, sleep hygiene, daytime sleepiness. Levels of cortisol and testosterone in the saliva were determined in the morning and evening hours by ELISA. In areas with low pollution level, there were normal changes in hormone levels with an increase in the morning and decrease in the evening. In high pollution conditions, the average levels of hormones increased, the morning-evening gradient disappeared. These conditions were also associated with an increase in daytime sleepiness and disturbances in the sleep-wake cycle and the endocrine regulation system that indicate the possibility of the development of internal desynchronosis.

Does Subjective Sleep Affect Bone Mineral Density in Older People with Minimal Health Disorders? The PROOF Cohort.

Clinical and epidemiological studies suggest a relation between bone mineral density (BMD) and self-assessment of sleep with an effect on bone formation and osteoporosis (OS) risk in short and long sleepers. This study explores this association in a large sample of older subjects. We examined 500 participants without insomnia complaints aged 65.7 ± 0.8 y. Each participant had a full evaluation including anthropometric measurement, clinical examination and measurements of BMD at the lumbar spine and femoral sites by dual-energy X-ray absorptiometry. The daily energy expenditure (DEE) was measured by the Population Physical Activity Questionnaire. Sleep duration and quality were evaluated by the Pittsburgh Sleep Quality Index. The subjects were stratified into three groups according to sleep duration, i.e., short (< 6 h), normal (6-8 h), and long (≥ 8 h) sleepers. Osteopenia was found in 40% of the subjects at the femoral level and 43% at the vertebral level. The prevalence of OS was lower both at femoral (8%) and vertebral (12%) levels. Short, normal, and long sleepers accounted for 29%, 40%, and 31% of subjects, respectively. After adjustments for metabolic, anthropometric, and DEE, multinomial logistic regression analysis indicated that long sleepers were more likely to have femoral neck OS with a slight effect of DEE at vertebral spine. In a sample of older subjects, self-reported long sleep was the best predictor of OS risk at the femoral level. This finding suggests an association between OS and self-reported sleep duration in older subjects. NCT 00759304 and NCT 00766584.

Sleep and delirium in the intensive care: A prospective cohort study of nurses documentation and patients insights

Sleep disruption is common in intensive care unit (ICU) patients, with reduced quality and quantity of sleep in many patients. Sleep in this setting may be related to the prevalence of delirium. The aim of this study was to describe ICU patients’ self-reported assessment of sleep, examine the relationship between patients’ self-reported sleep and associated nurses’ assessment of sleep and delirium status, and describe the sleep promotion strategies suggested by patients. A prospective cohort study was undertaken with communicative adult patients recruited in 2014–2015. Patients reported sleep using the Richards–Campbell Sleep Questionnaire (range 0–100; higher score indicates better sleep quality), with nursing assessment of sleep documented into categories. Delirium was assessed using the Confusion Assessment Method – ICU. Participants were asked daily to describe strategies that helped or hindered their sleep. Ethics approval for the study was gained. Descriptive statistics are provided as median (inter-quartile range); differences were assessed using the Kruskal–Wallis test (p < 0.05). Participants (n = 151) provided 355 reports of sleep [age: 60 (46–71) years; ICU length of stay 4 (2–9) days]. Average perceived sleep quality was 46 (26–65). Patients’ self-assessment of sleep varied widely across categories of sleep documented by nurses (see below table). Using the latest sleep assessment patients provided in ICU there was no difference in sleep for those who were delirious or not (p = 0.35). Strategies identified by patients to improve sleep included pain relief and sedation, peaceful and comfortable environment and physical interventions, e.g. clustering care, ear plugs.

P0009 Sleep self-assessment by visual analogue scales (VASs) in a 6-week European trial of pramipexole for restless legs syndrome (RLS)

P0009 Sleep self-assessment by visual analogue scales (VASs) in a 6-week European trial of pramipexole for restless legs syndrome (RLS)

P0010 Sleep self-assessment by visual analogue scales (VASs) in a 12-week US trial of pramipexole for restless legs syndrome (RLS)

P0010 Sleep self-assessment by visual analogue scales (VASs) in a 12-week US trial of pramipexole for restless legs syndrome (RLS)

Insomnia in depression: Differences in objective and subjective sleep and awakening quality to normal controls and acute effects of trazodone

Utilizing polysomnography (PSG) and psychometry, objective and subjective sleep and awakening quality was investigated in 11 drug-free patients (five females, six males) aged 35–75 years (mean age 54.1±11.4) suffering from nonorganic insomnia ( F 51.0) related to a depressive episode ( F 32) or recurrent depressive disorder ( F 33), as compared with 11 age- and sex-matched normal controls (five females, six males) aged 36–75 years (mean age 53.0±13.5). PSG demonstrated decreased sleep efficiency, total sleep time (TST), total sleep period (TSP) and sleep stage S2, as well as increased wakefulness during TSP, early morning awakening, sleep latency to S1, S2, S3 and sleep stage S1 in depressed patients. Subjective sleep quality and the total score of the Self-Assessment of Sleep and Awakening Quality Scale (SSA) were deteriorated as were morning and evening well being, drive, mood and fine motor activity right. Evening and morning blood pressure, the O 2 desaturation index and periodic leg movement (PLM) index were increased. In a subsequent acute, placebo-controlled cross-over design study, the acute effects of 100 mg of trazodone, a serotonin reuptake inhibitor with a sedative action due to 5-HT 2 and α 1 receptor blockade, were investigated in the patients. As compared with placebo, trazodone induced an increase in sleep efficiency (primary target variable), TST, TSP and SWS (S3+S4), as well as a decrease in wakefulness during the TSP, early morning awakening and S2. There was no change in rapid eye movement (REM) sleep with the exception of an increase in the REM duration in minutes. Trazodone also caused an improvement in subjective sleep quality, affectivity, numerical memory and somatic complaints. All respiratory variables remained within normal limits. Critical flicker frequency and morning diastolic blood pressure were decreased. The present study demonstrated that depression induced significant changes in objective and subjective sleep and awakening quality, which were counteracted by 100 mg of trazodone, thus suggesting a key-lock principle in the treatment of depression.

Predictors of restful sleep in a rehabilitation hospital.

The effect of hypnotic use on self-rated quality of sleep and therapist-rated level of alertness was examined in an inpatient rehabilitation setting. We examined what other factors were predictive of a restful sleep in this population. Seventy-five inpatients at the Jewish Rehabilitation Hospital in Montreal were included. Patients were asked to rate the quality of their own sleep on a given night. Night nurses recorded whether sleeping pills had been used and rated patients' sleep and number of awakenings during the same night. Patients were evaluated by their physiotherapists and occupational therapists the next day regarding how well rested they seemed according to three parameters: alertness, fatigue, and level of participation in therapy. Thirty-three percent of the patients received sleeping pills on the study night. Sleeping pill use did not predict patient perception of getting a good night of sleep or the somewhat more objective sleep rating by the night nurse. Whether a sleeping pill was taken was also found not to be predictive of restful sleep as estimated by the physical and occupational therapists. Variables significantly associated with therapists' ratings of apparently restful sleep included number of comorbidities, the nurses' rating of how well the patient had slept, the patients' self-assessment of sleep, and whether the patient felt well rested the morning after sleep. However, the patients' own assessment of sleep quality was negatively related to their performance in rehabilitation therapy. This suggests that patient self-report of sleeping difficulty may not be the best or only guideline to follow when considering intervention such as prescribing sleeping pills, particularly because sleeping pill use seems not to influence either patient perception of sleep or how well rested they seem in therapy.

Wrist actigraphic assessment of sleep in 116 community based subjects suspected of obstructive sleep apnoea syndrome.

The combined use of wrist actigraphic assessment and self assessment of sleep in the screening of obstructive sleep apnoea syndrome was evaluated in a community based sample. One hundred and sixteen community based subjects clinically suspected of having obstructive sleep apnoea (syndrome) were evaluated by means of simultaneous ambulatory recording of respiration (oronasal flow thermistry), motor activity (wrist actigraphy), and subjective sleep (sleep log) during one night of sleep. The subjects were distributed according to their apnoea index (AI); AI < 1 (non-apnoeic snorers) 44%; AI 1- < 5 39%; and AI > or = 5 17%. High apnoea index values were associated with self reported disturbed sleep initiation and more fragmented and increased levels of motor activity and decreased duration of immobility periods, particularly in those with an apnoea index of > or = 5. Across subjects the duration of immobility periods was the only predictor of the apnoea index, explaining 11% of its variance. Use of the multiple regression equation to discriminate retrospectively between those with an apnoea index of < 1 and > or = 5 resulted in sensitivity and specificity values of 75% and 43%, and 5% and 100%, respectively. The combined use of a sleep log and actigraphic assessment of sleep failed to identify reliably those subjects who suffered from obstructive sleep apnoea (syndrome) in a sample of community based subjects reporting habitual snoring combined with excessive daytime sleepiness and/or nocturnal respiratory arrests.