Subjective Daytime Research Articles

The impact of subjective excessive daytime sleepiness on cognition in parkinson disease

The impact of subjective excessive daytime sleepiness on cognition in parkinson disease

The effect of the long-term treatment with vagus nerve stimulation on objective respiratory patterns and subjective sleep quality and daytime sleepiness in korean patients with drug-resistant epilepsy

The effect of the long-term treatment with vagus nerve stimulation on objective respiratory patterns and subjective sleep quality and daytime sleepiness in korean patients with drug-resistant epilepsy

P.672 Physical, physiological and biochemical parameters of adults with schizophrenia: Data from cognitive rehabilitation and training with exercise for schizophrenia study

Exercise training has been shown to improve learning and memory, and to protect against the negative impact of sleep deprivation. The aim of this study was to investigate the effects of seven weeks of moderate- and high-intensity interval exercise training on vigilance/sustained attention, inhibition processes and working memory during 40-h total sleep deprivation (TSD) in 16 healthy young men.The subjects were evaluated before (Baseline, BAS) and during TSD, and the day after a night of recovery sleep (Recovery, REC).Exercise training significantly decreased errors and increased speed assessed by the psychomotor vigilance task (PVT) during TSD and REC while no difference was found in executive inhibition (Go–noGo task) and working memory (2-Back task) performances. The multiple sleep latency test results were higher during BAS and REC at Post-exercise training, and no difference occurred in subjective sleepiness and daytime microsleeps over the 40-h TSD. The PVT speed was positively correlated with maximal oxygen consumption and maximal aerobic power measured before entry in the in-laboratory TSD protocol, and stage 3 sleep duration measured during the first night in the in-laboratory TSD protocol (N-1). Exercise training effects on sleep were found during the night recovery with lower stage-3 sleep and higher rapid eye movement (REM) sleep durations. An exercise training effect was also found on free insulin-like growth factor I levels with lower levels during TSD at Post-exercise training.In healthy young men, exercise training reduced sleep pressure at baseline and protected against sustained attention deficits induced by TSD with persistent effect after one night of recovery sleep. Nevertheless, exercise training was not effective in reducing deficits in executive inhibition and working memory induced by TSD.

Increased high-frequency EEG activity during nerm sleep mediates the association between subjective daytime sleepiness and sustained attention in sleep apnea patients

Increased high-frequency EEG activity during nerm sleep mediates the association between subjective daytime sleepiness and sustained attention in sleep apnea patients

Profiles of Subjective Daytime Sleepiness through Cluster Analysis.

Sleepiness propensity and sleepiness perception are two relevant dimensions of the general multidimensional sleepiness construct. In the current study, the aim was to identify eventual homogeneous subgroups when sleepiness propensity and sleepiness perception measures are combined. Data from 678 undergraduate students (aged 17 to 24years) from a medical school were analyzed. A Two-Step Cluster Analysis was performed taken into consideration sleepiness propensity and sleepiness perception measures as clustering variables. Four different clusters were identified. Additionally, the two groups comprising higher levels of sleepiness perception (i.e., "high perception, low propensity" and "high subjective daytime sleepiness" clusters) had the most compromised results in some of the sleep-related variables examined - sleep needs, sleep latency, sleep quality, sleep sufficiency, self-reported insomnia, sleep reactivity to stress, and cognitive arousal - and in some of non-sleep related variables, such as neuroticism and affect. As to non-sleep variables, those groups reported higher scores in neuroticism, arousability, self-reported mental health and affective states. The identification of distinct groups concerning self-reported sleepiness may bring new avenues for research and understanding of the specific and differential role of sleepiness and its dimensions in sleep health and sleep disturbances, in particular, insomnia disorder.

The estimation of excessive daytime sleepiness in post-stroke patients - a polysomnographic study

Abstract Excessive daytime sleepiness (EDS) has been reported in stroke patients. EDS in acute stroke was studied repeatedly, but there is a modest amount of data in post-stroke patients. The aim of this study was to assess the frequency of EDS and characterize sleep architecture in patients >3 months after stroke and identify factors which may affect EDS. 66 patients were enrolled, of which 33 had experienced stroke. All underwent a standardized overnight, diagnostic single night polysomnography, including electrocephalogram (EEG) leads, electrooculograms (EOG), chin electromyogram (EMG), and electrocardiogram (ECG). Epworth Sleepiness Scale (ESS) was used to measure subjects’ level of daytime sleepiness. We observed similar total ESS score, total sleep time (TST), sleep efficiency, as well as respiratory disturbance index /apnea-hypopnea index (RDI/AHI), oxygen desaturation index (ODI) and mean heart rate in both groups. We observed positive linear correlation between EDS and mean heart rate in the stroke group (r = 0.46, p In summary, in stroke patients subjective daytime sleepiness is associated with heart rate, but not with the severity of OSA. Thus ESS (Epworth Scale Score) may be not as useful as a marker of obstructive sleep apnea (OSA) presence or severity in post stroke patient as in the general population.

Qualidade do sono e sonolência em estudantes do ensino superior

Objetivos: O sono ao demonstrar-se fundamental para o desenvolvimento do indivíduo, despertando o interesse em investigar qualidade do sono em estudantes do ensino superior. Assim, pretendeu-se com o presente estudo, caracterizar as componentes da qualidade subjetiva do sono e sonolência excessiva diurna numa amostra de estudantes do ensino superior. Método: Aplicaram-se as versões portuguesas do Índice da qualidade do sono (PSQI-PT) e da Escala de Sonolência excessiva diurna (ESS), em 257 estudantes do ensino superior distribuídos por sete instituições de ensino superior. Resultados: A maioria dos participantes revelou subjetivamente uma má qualidade do sono e referiu dormir mais de sete horas durante a semana, sendo este número maior durante o fim de semana. A perceção da Latência do Sono e da Disfunção Durante o Dia diferiu em função do sexo dos participantes. Os trabalhadores-estudantes mostraram percecionar uma fraca Qualidade Subjetiva do Sono e uma menor Duração do Sono. Encontrou-se uma correlação baixa com significância estatística entre o PSQI-PT e a ESS. Apesar da maioria dos participantes da amostra percecionar uma má qualidade do sono, também a maioria revelou uma eficiência subjetiva do sono superior a 85,0%. Conclusões: Verificou-se que os participantes em estudo avaliaram subjetivamente a qualidade do sono como sendo pobre. Estudos futuros devem explorar possíveis programas de prevenção (i.e., alimentação, TIC, exercício físico) que melhorem a qualidade subjetiva do sono.

Remotely controlled mandibular positioning of oral appliance therapy during polysomnography and drug-induced sleep endoscopy compared with conventional subjective titration in patients with obstructive sleep apnea: protocol for a randomized crossover trial

BackgroundThe amount of mandibular protrusion is a key factor in optimizing the efficacy of mandibular advancement device (MAD) therapy in an individual patient diagnosed with obstructive sleep apnea. This process is called titration and is generally based on resolution of subjective symptoms like snoring and/or daytime sleepiness as a function of protrusion. An objective approach uses a remotely controlled mandibular positioner (RCMP) during a full-night polysomnography (PSG), in analogy with continuous positive airway pressure (CPAP) titration. More recently, the feasibility of RCMP use during drug-induced sleep endoscopy (DISE) titration was reported.MethodsThis randomized crossover trial will compare DISE-assisted titration to PSG-guided titration, as well as with the conventional subjective titration method. The primary outcome is the actual mandibular protrusive position found to be the most optimal for each tested titration procedure. Furthermore, the therapeutic efficacy will be compared among the different titration modalities using level 1 sleep studies.DiscussionCurrently, the optimal titration of MAD therapy is most often based on ‘trial and error’. The conventional method relies on subjective improvement in symptoms, although this may not provide the most accurate indicator for efficient titration. Therefore, relying on objective criteria in the titration process should be advantageous. In analogy with CPAP, titration of the most optimal mandibular protrusion could be performed using RCMP during an overnight titration PSG. Recently, it was shown that titration under direct visualization of upper airway patency and collapsibility is feasible using the RCMP during DISE. However, no clinical results for such a procedure are as yet available. This study is the first to compare the most optimal mandibular protrusive position according to three titration procedures, as well as to compare the therapeutic efficacy of these titration methods.Trial registrationClinicalTrials.gov, NCT03716648. Registered on 23 October 2018.

The impact of depression, self-esteem, and body image on sleep quality in patients with PCOS: a cross-sectional study.

To date, some factors associated with quality of sleep in patients with PCOS have been identified. Previous studies have mainly focused on limited psychological variables related to sleep disorder without evaluating them in a comprehensive framework. The aim of the present study was to evaluate the impact of predictive factors on the sleep quality of PCOS patients using structural equation modeling (SEM). The present study is a case control that is done in an infertility clinic in Hormozgan, Iran. The case group (n = 201) consisted of women with PCOS and the control group (n = 199) was healthy women whose partners had male infertility. All the women recruited to the study completed the Hospital Anxiety and Depression Scale, the Body Image Concern Investigation, the Rosenberg Self-esteem Scale, and the Pittsburgh Sleep Quality Index on attendance at the Hormozgan Infertility Clinic. Direct and indirect relationship between clinical signs, psychological situation, self-esteem, and body image was studied as independent predictors of sleep quality using structural equation modeling. Compared with the control group, there was a lower sleep quality in women with PCOS in all fields, especially subjective sleep quality (P < 0.05), daytime function (P = 0.001), and use of sleep medication (P = 0.003). The strongest effect from a psychological variable on sleep quality was body image which had negative impact on sleep quality of patients with PCOS. Our study showed that body image plays an important role in the sleep quality of women with PCOS.

Association of severity of depressive symptoms with sleep quality, social support and stress among Pakistani medical and dental students: A cross-sectional study

Abstract Objectives This study has been designed to elucidate the prevalence of stress, depression and poor sleep among medical students in a Pakistani medical school. There is a paucity of data on social support among medical students in Pakistan; an important predictor of depressive symptoms. Therefore, this study was also aimed to demonstrate the direct and indirect impact of social support in alleviating depressive symptoms in the study sample. Methods This observational cross-sectional study was conducted in Lahore, Pakistan, where a total of 400 students at a medical school were approached between 1st January to 31st March 2018 to participate in the study. The study sample comprised of medical and dental students enrolled at a privately financed Pakistani medical and dental school. The participants responded to a self-administered survey comprising of five parts: a) demographics, b) Pittsburgh Sleep Quality Index (PSQI), c) Patient Health Questionnaire-9 (PHQ-9), d) Multidimensional Scale of Perceived Social Support (MSPSS) and e) Perceived Stress Scale-4 (PSS-4). All data were analysed using SPSS v. 20. Linear regression analysis was used to reveal the predictors of depression. Results In total, 353 medical students participated, yielding a response rate of 88.25%. Overall, poor sleep quality was experienced by 205 (58.1%) students. Mild to severe depression was reported by 83% of the respondents: mild depression by 104 (29.5%), moderate depression by 104 (29.5%), moderately severe depression by 54 (15.3%) and severe depression by 31 (8.8%) respondents. Subjective sleep quality, sleep latency, daytime dysfunction and stress levels were significantly associated with depression symptoms. Social support was not significantly associated with depressive symptoms in the regression model (Beta = -0.08, P &lt; 0.09); however, it acted as a significant mediator, reducing the strength of the relationship between depressive symptoms and sleep quality and stress. Conclusions According to our study, a large proportion of healthcare (medical and dental) students were found to be suffering from mild to moderate depression and experienced poor sleep quality. It is concluded that social support is an important variable in predicting depressive symptomatology by ameliorating the effects of poor sleep quality and high stress levels.

Cross-Sectional Survey on the Relationship Between Occupational Stress, Hormone Levels, and the Sleep Quality of Oilfield Workers in Xinjiang, China.

The impact of psychosocial factors on health has received increased attention. This study employed a multi-stage hierarchical cluster sampling method and a cross-sectional survey was conducted from March to August 2017. By studying 2116 oilfield workers based in Karamay, Xinjiang, the relationship between occupational stress, blood hormone levels, and sleep was analyzed. Occupational stress was measured using the internationally accepted Occupational Stress Inventory Revised Edition (OSI-R) questionnaire and sleep disorders were measured using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The study found that the sleep quality of respondents was not high and the incidence of sleep disorders was 36.67%. The higher the level of occupational stress, the higher the incidence of sleep disorders. Irregular shifts can affect sleep quality and individuals with high-level professional titles experience a higher incidence of sleep disorders than those with low-level titles. The total score of the PSQI was different among the low, medium, and high stress groups. The higher the level of stress, the higher the scores of subjective sleep quality, sleep disorder, and daytime dysfunction. The scores of the PSQI, subjective sleep quality, sleep time, sleep disturbance, and daytime dysfunction in the high-stress group were higher than those in the low stress group. A case-control study found that the concentration of glucocorticoids in the sleep disorder positive group was lower than that in the sleep disorder negative group. The results of the regression analysis showed that glucocorticoid is a protective factor for sleep disorders (OR = 0.989, 95% CI: 0.983–0.995), suggesting that the higher the level of glycosaminoglycan, the less likely the subject is to have sleep disorders. For example, in the case of high occupational stress, the interaction between low and moderate occupational stress levels and glucocorticoids is a protective factor for sleep disorders.

Morningness–eveningness and affect: the mediating roles of sleep quality and metacognitive beliefs

Morningness (a preference for earlier rise and bed times) is associated with well-being, better sleep quality, and positive affect, while eveningness is associated with poor sleep quality, negative mood, maladaptive behaviours, and psychological disorder. The current study investigated: (1) whether eveningness is associated with more maladaptive metacognitive beliefs; (2) whether maladaptive metacognitive beliefs and sleep quality are related to associations between morningness–eveningness and affect. An online survey with questionnaire measures of morningness–eveningness, affect, sleep quality, and metacognitive beliefs was completed by 591 undergraduate students. More morningness correlated with more positive affect, while more eveningness correlated with more negative affect and poor sleep quality. Eveningness also showed small correlations with having less cognitive confidence and with metacognitive beliefs about uncontrollable thoughts. Mediation analysis showed that cognitive confidence and beliefs about uncontrollable thoughts, together with poor sleep quality (especially subjective sleep quality and daytime dysfunction), were mediators in the relationships between morningness–eveningness and both negative affect and positive affect. These findings suggest that metacognitive beliefs may be an important consideration in understanding the associations between morningness–eveningness and well-being.

Beneficial effects of exercise training on cognitive performances during total sleep deprivation in healthy subjects

ObjectiveExercise training has been shown to improve learning and memory, and to protect against the negative impact of sleep deprivation. The aim of this study was to investigate the effects of seven weeks of moderate- and high-intensity interval exercise training on vigilance/sustained attention, inhibition processes and working memory during 40-h total sleep deprivation (TSD) in 16 healthy young men. MethodsThe subjects were evaluated before (Baseline, BAS) and during TSD, and the day after a night of recovery sleep (Recovery, REC). ResultsExercise training significantly decreased errors and increased speed assessed by the psychomotor vigilance task (PVT) during TSD and REC while no difference was found in executive inhibition (Go–noGo task) and working memory (2-Back task) performances. The multiple sleep latency test results were higher during BAS and REC at Post-exercise training, and no difference occurred in subjective sleepiness and daytime microsleeps over the 40-h TSD. The PVT speed was positively correlated with maximal oxygen consumption and maximal aerobic power measured before entry in the in-laboratory TSD protocol, and stage 3 sleep duration measured during the first night in the in-laboratory TSD protocol (N-1). Exercise training effects on sleep were found during the night recovery with lower stage-3 sleep and higher rapid eye movement (REM) sleep durations. An exercise training effect was also found on free insulin-like growth factor I levels with lower levels during TSD at Post-exercise training. ConclusionsIn healthy young men, exercise training reduced sleep pressure at baseline and protected against sustained attention deficits induced by TSD with persistent effect after one night of recovery sleep. Nevertheless, exercise training was not effective in reducing deficits in executive inhibition and working memory induced by TSD.

Sleep cardiac dysautonomia and EEG oscillations in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease due to loss of motor neurons. However, the autonomic nervous system (ANS) can also be involved. The aim of this research was to assess the sleep macro- and microstructure, the cardiac ANS during sleep, and the relationships between sleep, autonomic features, and clinical parameters in a cohort of ALS patients. Forty-two consecutive ALS patients underwent clinical evaluation and full-night video-polysomnography. Only 31 patients met inclusion criteria (absence of comorbidities, intake of cardioactive drugs, or recording artifacts) and were selected for assessment of sleep parameters, including cyclic alternating pattern (CAP) and heart rate variability (HRV). Subjective sleep quality and daytime vigilance were also assessed using specific questionnaires. Although sleep was subjectively perceived as satisfactory, compared with age- and sex-matched healthy controls, ALS patients showed significant sleep alteration: decreased total sleep time and sleep efficiency, increased nocturnal awakenings, inverted stage 1 (N1)/stage 3 (N3) ratio, reduced REM sleep, and decreased CAP rate, the latter supported by lower amounts of A phases with an inverted A1/A3 ratio. Moreover, a significant reduction in HRV parameters was observed during all sleep stages, indicative of impaired autonomic oscillations. Our results indicate that sleep is significantly disrupted in ALS patients despite its subjective perception. Moreover, electroencephalogram activity and autonomic functions are less reactive, as shown by a decreased CAP rate and a reduction in HRV features, reflecting an unbalanced autonomic modulation.

Quality of sleep in caregiving relatives of people with dementia: investigation of the prevalence and possible predictors

Caregiving relatives of people with dementia (PwD) are exposed to exhausting tasks all day long. The results of acurrent study suggest that personality traits, sociodemographic and caregiving variables could be associated with poor sleep quality of caregivers of PwD. Nevertheless, the detailed impact of these variables on sleep quality of caregivers is still unknown. This study is based on secondary data from the Tele.TAnDem project. First, descriptive data of 322 caregivers were analyzed regarding prevalence rates of poor sleep quality and high rates of daytime sleepiness in comparison to non-caregivers. Second, hierarchical regression analyses were conducted to calculate the predictive effect of interpersonal and caregiving related variables on subjective sleep quality and daytime sleepiness. With respect to the prevalence, descriptive data indicate a poorer subjective sleep quality and higher rates of daytime sleepiness of caregivers of PwD compared to non-caregivers. Regression analyses revealed significant effects for gender, disturbed day-night rhythm, burden of caregiving, stress coping strategies and depressive symptoms regarding subjective sleep quality. The number of disturbed behavior patterns, the burden of caregiving and depressive symptoms were significantly associated with higher rates of daytime sleepiness. Caregiving of PwD affects subjective sleep quality as well as daytime sleepiness of caregiving relatives. Both dimensions of sleep quality were associated with several personal and caregiving related variables. Chronic poor sleep quality is ahigh-risk factor for psychological and physical health problems and should be considered in further research and development of interventions for caregiving relatives of PwD.

Clinical Features and Contributing Factors of Excessive Daytime Sleepiness in Chinese Obstructive Sleep Apnea Patients: The Role of Comorbid Symptoms and Polysomnographic Variables.

Background The occurrence and severity of excessive daytime sleepiness (EDS) vary considerably among obstructive sleep apnea (OSA) patients. This study was designed to investigate the characteristics of EDS and identify its contributing factors in OSA patients. Methods This was a cross-sectional study from a tertiary medical center in China. A total of 874 consecutive patients with newly diagnosed OSA were included. Subjective daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). The subjects were assigned to the non-EDS group (582 patients), mild to moderate EDS group (227 patients), and severe EDS group (65 patients) according to the ESS scores. The clinical features and polysomnographic parameters were acquired and analyzed to identify the differences between groups and the determinants of EDS. Results The age of patients with severe EDS (49.5 ± 11.3) was slightly greater than that of patients with mild to moderate EDS (44.5 ± 10.2) (p < 0.05) and non-EDS patients (45.2 ± 12.0) (p < 0.05). Body mass index (BMI) was highest in the severe EDS group (29.1 ± 3.6 kg/m2) (p < 0.0001), intermediate in the mild to moderate EDS group (27.9 ± 3.3 kg/m2), and lower in the non-EDS group (26.8 ± 3.3 kg/m2). Logistic regression analysis showed waist circumference, memory loss, work/commute disturbances, and sleep efficiency were independently associated with mild to moderate EDS, and the microarousal index, apnea-hypopnea index (AHI), and saturation impair time below 90% were independent contributing factors of mild to moderate EDS. Meanwhile, age, neck circumference, gasping/choking, memory loss, work/commute disturbances, and sleep latency were independently associated with severe EDS, and the AHI and mean SpO2 were independent contributing factors of severe EDS. Conclusions OSA patients with various severities of EDS are more obese and have more comorbid symptoms compared to patients without EDS. Sleep fragmentation, respiratory events, and nocturnal hypoxia may be predictors of EDS. Comprehensive consideration of demographic, clinical, and polysomnographic factors is required when evaluating OSA patients.

Association of serum 25-hydroxyvitamin D concentrations with sleep phenotypes in a German community sample.

BackgroundSleep disorders and vitamin D deficiency are among the most common health problems. Few studies investigated the effect of vitamin D on objectively recorded sleep with sound methodological quality and reasonable temporal proximity.ObjectiveTo investigate the relationship between serum 25-hydroxyvitamin D (25(OH)D) concentrations and objective sleep parameters assessed within close temporal proximity in a population-based sample. It is expected that higher serum 25(OH)D concentrations are associated with 1) better objective sleep outcomes (longer sleep duration, higher sleep efficiency, earlier mid-sleep time) and 2) more positive subjective sleep evaluations.MethodsA subset of participants (n = 1045) from the LIFE-Adult-Study was analysed. Measurement of serum 25(OH)D vitamin was performed using an electrochemiluminescence immunoassay. Actigraphic assessments were performed using SenseWear Pro 3 devices. The following objective sleep parameters were calculated: total sleep duration, night sleep duration, night sleep efficiency, midsleep time and wake after sleep onset (WASO). Subjective sleep evaluations were assessed via questionnaire (sleep quality (PSQI), daytime sleepiness (ESS)). Data were analysed applying a multiple linear regression model with a stepwise approach.ResultsThe regression models revealed significant associations of serum 25(OH)D concentration with night sleep duration and midsleep time. No association was found for total sleep duration and night sleep efficiency. Higher serum 25(OH)D concentration was further associated with shorter WASO in males but longer WASO in females. Moreover, serum 25(OH)D concentration did not show any significant association with subjective sleep quality and daytime sleepiness.ConclusionThe results indicate that a higher concentration of serum 25(OH)D is associated with longer and earlier night sleep. Although the present study was able to demonstrate an association between serum 25(OH)D concentration and objective sleep parameters, no conclusion about underlying mechanisms or causal inferences can be drawn.

Clinical and Polysomnographic Correlates of Subjective Sleepiness in Mild Obstructive Sleep Apnea.

The decision to treat mild obstructive sleep apnea (OSA) often hinges on the presence of subjective daytime sleepiness. This study was done to identify clinical and polysomnographic features which correlate with subjective sleepiness in mild OSA. Utilizing data from the Apnea Positive Pressure Long-term Efficacy Study, 199 participants with mild OSA were identified. Participants were grouped as "sleepy" or "non-sleepy" based on their responses to a question regarding excessive daytime sleepiness, and Epworth Sleepiness Scores. We compared demographic, clinical and baseline polysomnographic data between the groups. The prevalence of subjective sleepiness was 74.4%. The sleepy group was younger (46.1 ± 12.6 vs. 53.3 ± 13.1 years, p=0.001), reported lower quality of life (4.5 ± 0.69 vs. 4.9 ± 0.61, p=0.0002), had higher depression scores (5.4 ± 4.7 vs. 3.1 ± 3.5, p=0.003) and reported more naps per week (2.6 ± 2.9 vs. 1.3 ± 1.9, p=0.01). Total sleep time and sleep efficiency were notably higher in the sleepy (254.2 ± 106 vs. 220.4 ± 114 min, p=0.08) and (80.2 ± 12.6 vs. 75.7 ± 14.9 %, p=0.06), approaching statistical significance. The non-sleepy group had slightly higher apnea hypopnea index (AHI: 12.2 ± 1.5 vs. 11.2 ± 2.4 events/hour, p=0.01) and worse desaturation indices. Subjective sleepiness in mild OSA is associated with younger age, worsened mood and quality of life. This study suggests that evidence of increased sleep drive on polysomnography may correlate with subjective sleepiness in mild OSA.

The acute effects of aerobic exercise on sleep in patients with depression: study protocol for a randomized controlled trial

BackgroundUnipolar depression is one of the most important mental disorders. Insomnia is a symptom of cardinal importance in depression. It increases the risk to develop depression, negatively affects disease trajectory, is the most common symptom after remission, increases the risk of relapse, and is associated with higher suicide rates. Existing therapies for insomnia in depression have limitations. Further adjuvant therapies are therefore needed. Acute aerobic exercise has been shown to have beneficial effects on sleep in healthy individuals and patients with insomnia. We therefore hypothesize that a single session of aerobic exercise has a positive impact on sleep in patients with unipolar depression. This trial aims to investigate the effects of a single bout of aerobic exercise on the subsequent night’s sleep in patients with depression.Methods/designThis is a two-arm parallel group, randomized, outcome assessor blinded, controlled, superiority trial. Patients between 18 and 65 years of age with a primary diagnosis of unipolar depression (without a psychotic episode) are included. Exclusion criteria are regular use of hypnotic agents, opioids, and certain beta-blockers, as well as the presence of factors precluding exercise, history of epilepsy, restless legs syndrome, moderate obstructive sleep apnea, and a BMI > 40. The intervention is a single bout of aerobic exercise, performed for 30 min on a bicycle ergometer at 80% individual anaerobic threshold. The control group sits and reads for 30 min. The primary outcome is sleep efficiency measured by polysomnography. Secondary outcomes include further polysomnographic variables, subjective pre-sleep arousal, nocturnal cardiovascular autonomic modulation, subjective sleep quality, daytime sleepiness, and adverse events. According to the sample size calculation, a total of 92 patients will be randomized using minimization.DiscussionThis trial will add new information to the body of knowledge concerning the treatment of insomnia in patients with depression. Thereby, the results will inform decision makers on the utility of acute aerobic exercise.Trial registrationClinicaltrials.gov, NCT03673397. Protocol version 1 registered on 17 September 2018.

Psychosocial Predictors of Sleep Quality in Residents of Nursing Homes

Abstract. This article examines the cross-sectional and long-term prediction of sleep quality (SQ) of 167 older nursing-home residents (80% females, 69–100 years), who participated in the study in 2008 and 2016. SQ was assessed in 2016 by the Pittsburgh Sleep Quality Index (PSQI); Total PSQI was found to be greater than 5 in 71% of participants. The domains of Subjective SQ and Daytime Functioning were relatively good, while Sleep Efficiency was most impaired. The observed set of predictors significantly explained 7–13% of PSQI variance cross-sectionally and 12–18% in the long-term effects analyses. The structure of predictors differed across SQ domains, in both the cross-sectional and the long-term effects analyses, and between the two, indicating the important impact of changes in psychophysiological functioning for current SQ of older adults.