Subjective Sleep Reports Research Articles

Associations of informant-based sleep reports with Alzheimer's disease pathologies.

PurposeRecent studies have found associations of increased brain amyloid beta (Aβ) accumulation and several abnormal sleep-wake patterns, including shorter latency and increased fragmentation in preclinical Alzheimer’s disease (AD). There is little known about the relationship between sleep and tau. The objective of this study was to understand the associations of both tau and Aβ with early signs of sleep and night-time behavior changes in clinically normal elderly adults. Specifically, we have addressed the question of how informant-based subjective sleep reports are linked to regional [18F]flortaucipir and [18F]florbetapir uptake.MethodsImaging and behavioral data from 35 subjects were obtained from the Alzheimer’s Disease Neuroimaging Initiative. The Neuropsychiatric Inventory Sleep (NPI-sleep) Questionnaire was used to assess the sleep and night-time behavior changes. Regional tau-positron emission tomography (PET) (entorhinal, brainstem) and Aβ-PET (posterior cingulate, precuneus, medial orbitofrontal) uptake values were calculated. A series of linear regression analyses were used to determine the combination of sleep symptoms that built the best models to predict each pathology.ResultsInformant-based reports of abnormal night-time behavior (NPI questions k3, k5, and k8) were significantly associated with increased entorhinal tau and Aβ (all regions) accumulation. Interestingly, informant-based reports of sleep deficiencies without abnormal nigh-time activity (NPI questions k1, k2, and k6) were negatively associated with entorhinal tau burden.ConclusionDetection of abnormal night-time behaviors (wandering, pacing, other inappropriate activities) by family members indicates early signs of both AD pathologies and may encourage the affected individuals to seek help by health care providers for detailed cognitive/neurobehavioral assessments.

Sleep and Glycemia in Adolescents with Type 1 Diabetes

Nearly 70% of adolescents have chronic sleep problems (quality, quantity, and/or altered circadian rhythm). Adolescents with type 1 diabetes (T1D) are subject to nocturnal blood glucose fluctuations that may result in restless sleep and require self-care that disrupts sleep. Deficient sleep may also contribute to insulin resistance. Few studies of sleep characteristics and their association with glycemic control have been conducted. Our aim was to describe sleep characteristics in adolescents with T1D and its relationship with glycemic control. Adolescents with T1D (ages 10-16) were recruited from the Yale Program. For 7 days, participants wore a wrist actigraph, which was used to calculate sleep/wake cycles using 30-second epochs, and a continuous glucose monitor (CGM). The Pittsburgh Sleep Quality Index (PSQI) was used to assess subjective sleep reports. The sample included 30 participants age 13.4+1.9, 67.9% female, 29.2% minority, BMI percentile 75+25%, diabetes duration 7.4+ 4.5 years, and 97% on insulin pumps. Hemoglobin A1c (A1c) levels (8.29+1.38%) and CGM (46.3+14.9% time in hyperglycemia) indicated poor glycemic control. Actigraphy showed inadequate total sleep time (7.33+19 hours), but good sleep efficiency (80.0+20.3%). Higher MESOR (rhythm adjusted mean) (r=0.25) and lower circadian quotient (r=-0.31) were associated with higher A1c. Greater circadian quotient was associated with more glucose variability (r=0.41). Greater WASO (wake after sleep onset) was associated with higher glucose (r=0.26), HBGI (high blood glucose index) (r=0.27), and more hyperglycemia (r=0.25). Higher MESOR was associated with lower LBGI (low blood glucose index) (r=-0.39) and less hypoglycemia (r=-0.42). Higher amplitude was associated with lower LBGI (-0.35) and less hypoglycemia (r=-0.39). These results suggest that insufficient sleep is common among adolescents with T1D and is associated with poorer glycemic control. Further research is required to determine if improving sleep will improve glycemic control. Disclosure M. Grey: None. K. Rechenberg: None.

Subjective but Not Objective Sleep is Associated with Subsyndromal Anxiety and Depression in Community-Dwelling Older Adults

To examine the relationship between subclinical anxiety and depressive symptoms and objective sleep architecture measures and subjective sleep reports in older adults. Community-dwelling older adults (N = 167) self-rated their current severity of anxiety symptoms, depressive symptoms, daytime sleepiness, and global sleep quality. Participants received overnight ambulatory polysomnography to assess sleep architecture. Multivariate linear regression models examined associations between anxiety and depressive symptoms and objective and subjective sleep measures. Significant findings emerged for subjective sleep, with higher depression and anxiety scores associated with worse global sleep quality and greater anxiety scores associated with greater daytime sleepiness. No significant associations were observed between subclinical levels of anxiety or depressive symptoms with sleep architecture. Subclinical levels of late-life anxiety and depression have distinct associations with subjective sleep disturbance. Findings implicate subjective measures of sleep quality and daytime sleepiness as stronger trait markers for subthreshold psychiatric symptoms than objective sleep biomarkers.

Sleep in ambulatory patients with stable cirrhosis of the liver

BackgroundQuestionnaires indicate that patients with liver disease have disturbed sleep. However, polysomnographic studies to quantify sleep architecture and sleep disorders in this population are lacking. The current study compared polysomnographic findings of two groups of patients with clinically stable but severe end-stage pathology of the liver and heart. MethodsThis was a prospective study of consecutive patients with end-stage liver disease or severe heart failure (HF). Measurements and resultsPatients underwent full-night, attended polysomnography along with a number of laboratory tests. Polysomnograms were scored blindly. Compared to HF patients, patients with cirrhosis suffered from severe periodic limb movements during sleep (PLMS), with an index of 39/hour associated with excessive arousals. In patients with cirrhosis, serum iron and ferritin levels were either at the upper normal limit or elevated. There were significant correlations between severity of PLMS versus blood levels of bilirubin (r = 0.73, p = 0.004) and ammonia (r = 0.74, p = 0.017). ConclusionsThis was the first polysomnographic study of patients with stable cirrhosis demonstrating severely disturbed sleep infrastructure and presence of excessive PLMS with arousals. The pathobiochemical mechanisms of these findings remain to be established. Independent of the mechanisms, these polysomnographic findings confirmed the subjective reports of poor sleep by patients with cirrhosis. Further, a subset of patients with cirrhosis acquired a syndrome similar to idiopathic Parkinson's disease, which per se was frequently associated with PLMS; the current results were consistent with this notion. Future studies are needed to determine if PLMS of cirrhosis is an early indication of incident Parkinsonian syndrome.

Preparing Safety Cases for Operating Outside Prescriptive Fatigue Risk Management Regulations.

Transport operators seeking to operate outside prescriptive fatigue management regulations are typically required to present a safety case justifying how they will manage the associated risk. This paper details a method for constructing a successful safety case. The method includes four elements: 1) scope (prescriptive rules and operations affected); 2) risk assessment; 3) risk mitigation strategies; and 4) monitoring ongoing risk. A successful safety case illustrates this method. It enables landing pilots in 3-pilot crews to choose the second or third in-flight rest break, rather than the regulatory requirement to take the third break. Scope was defined using a month of scheduled flights that would be covered (N = 4151). These were analyzed in the risk assessment using existing literature on factors affecting fatigue to estimate the maximum time awake at top of descent and sleep opportunities in each break. Additionally, limited data collected before the new regulations showed that pilots flying at landing chose the third break on only 6% of flights. A prospective survey comparing subjective reports (N = 280) of sleep in the second vs. third break and fatigue and sleepiness ratings at top of descent confirmed that the third break is not consistently superior. The safety case also summarized established systems for fatigue monitoring, risk assessment and hazard identification, and multiple fatigue mitigation strategies that are in place. Other successful safety cases have used this method. The evidence required depends on the expected level of risk and should evolve as experience with fatigue risk management systems builds.Gander P, Mangie J, Wu L, van den Berg M, Signal L, Phillips A. Preparing safety cases for operating outside prescriptive fatigue risk management regulations. Aerosp Med Hum Perform. 2017; 88(7):688-696.

Night-time sleep in Parkinson's disease - the potential use of Parkinson's KinetiGraph: a prospective comparative study.

Night-time sleep disturbances are important non-motor symptoms and key determinants of health-related quality of life (HRQoL) in patients with Parkinson's disease (PD). The Parkinson's KinetiGraph (PKG) can be used as an objective measure of different motor states and periods of immobility may reflect episodes of sleep. Our aim was to evaluate whether PKG can be used as an objective marker of disturbed night-time sleep in PD. In this prospective comparative study, data from PKG recordings over six consecutive 24 h periods are compared with Hauser diaries and scales focusing on motor state, sleep and HRQoL in PD patients. Thirty-three 'non-sleepy' PD patients (PD-NS) were compared with 30 PD patients presenting with excessive daytime sleepiness (PD-EDS). The groups were matched for age, gender and Hoehn and Yahr state. In the PD-EDS group subjective sleep reports correlated with the PKG's parameters for quantity and quality night-time sleep, but not in the PD-NS group. There were no significant correlations of the night-time sleep quantity parameters of the Hauser diary with subjective sleep perception, neither in the PD-EDS nor in the PD-NS group. This first PKG based study of night-time sleep in PD suggests that PKG could be used to provide an easy to use and rough evaluation of aspects of night-time sleep and one that could flag patients where polysomnography may be required. In sleepy PD patients for instance, quantity and quality PKG parameters correlate with different aspects of sleep such as insomnia, parasomnia and restless legs syndrome.

Trauma-Related Context Increases Sleep Disturbances in People with Acute Stress Disorder Symptoms.

In this study, we addressed how sleep is related to acute stress disorder (ASD) symptoms, and how the presence of a trauma related-context moderates this relationship. This study (N = 140) was carried out during the 2014 Israel-Gaza conflict, during which 70% of Israelis were exposed to missile attacks. Findings show that participants with clinical ASD symptom levels reported more sleep disturbances than participants without clinical ASD symptom levels. More critically, this effect was only evident among respondents who had a reinforced security room in their houses. While reinforced security rooms offer protection against indirect missile damage, their relevance is salient in negative traumatic situations, which individuals with a clinical level of ASD are more sensitive to. Conversely, in houses without a reinforced security room, there was no difference in subjective sleep reports between individuals with or without clinical levels of ASD symptoms. Results are discussed in reference to trauma being activated by context and the ensuing effects on sleep. Theoretical and clinical implications are discussed. Copyright © 2016 John Wiley & Sons, Ltd.

Cancer-related insomnia: Evaluation by mobile technology.

107 Background: Insomnia is difficulty with sleep onset, maintenance, early morning wakening or non-restorative sleep. Cancer prevalence is 30-75%. Daytime consequences include fatigue. It is under-reported and impairs quality of life. Measurement previously required sleep laboratories. Technology advances help real-time measurement in the natural environment. This study investigated the feasibility and acceptability of a wireless device to evaluate sleep in cancer. Methods: Prospective observational study: Stage A: 10 consecutive in-patient hospice admissions; Stage B: 20 consecutive community patients Sleep quality was rated by Insomnia Severity Index (ISI). Participants used a wireless non-contact bedside monitor (SleepMinder) for 3 nights. Acceptability questionnaires were completed by participant and nurse (Stage A) or family (Stage B).Descriptive statistics were generated by Microsoft Excel. Results: 30 participants with metastatic cancer were recruited. Median age: 63 years (47-84). Median Eastern Cooperative Oncology Group (ECOG) performance score: 2 (0-3). In-patient (n=10): In 50%, sleep onset was delayed >30 minutes. Median duration: 8 hours. Median awakenings per night: 1 (0-8). Median sleep efficiency (proportion of time in bed spent asleep): 89% (74-100%). ISI score correlated with sleep duration in 70%. Participants and nurses reported 100% device acceptability. Community (n=20): Sleep onset was delayed >30 minutes in 25%. Median duration: 8 hours. Median awakenings per night: 3 (0-10). Median sleep efficiency: 91% (46-100). ISI score correlated with sleep duration in 90%. Participants and family reported 100% device acceptability. Conclusions: (1)A wireless monitor effectively measures sleep in cancer in both inpatient and community settings, (2) High acceptability supports clinical use, (3) Subjective sleep quality reports correlate with device, and (4) Further research: evaluate sleep improvement interventions with device.

Effect of caregiving status on the sleep of older New Zealanders.

To investigate relationships between caregiving and subjective sleep reports among older New Zealanders. Participants were 434 carers (177 home-based) and 1747 non-carers (aged 55-72 years) who completed the 2008 Health Work and Retirement survey. Sleep outcomes (feeling worn out, tired, or dissatisfied with sleep or having a diagnosed sleep disorder) were explored by caregiving status. Logistic regression was used to investigate caregiving as an independent predictor of poor sleep health after controlling for other demographic variables. Home-based carers were more likely to report feeling tired some/all of the time than non-carers (odds ratio 1.6, 95% confidence interval 1.1-2.2). Being Māori, a woman, younger or more socioeconomically deprived (New Zealand Deprivation Index 2006) were also significant independent predictors of poor sleep outcomes. Carers are at increased risk of feeling tired in the daytime. Early recognition and management of underlying sleep problems are particularly important for older people providing care at home.

Vascular Endothelial Function and Self-reported Sleep

BackgroundThe authors investigated the relationship between self-reported sleep characteristics and brachial artery flow-mediated dilation (FMD) in a community-based population. Previous studies document that sleep apnea may be related to endothelial dysfunction but disagree whether subjective reports of sleep may also reflect such associations. MethodsIn 684 subjects (32% male) aged between 37 and 60 years enrolled in the Emory-Georgia Tech Predictive Health Institute study, the authors measured reported sleep characteristics using the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index (PSQI) along with cardiovascular risk factors. Endothelial function was assessed using brachial artery FMD. Multivariate analysis of covariance was used to adjust for various cardiovascular risk factors including age, race, gender, smoking, hypertension, diabetes and body mass index. ResultsLower brachial artery FMD values were correlated with higher Epworth Sleepiness Scale scores (P = 0.0275), even after adjustment for risk factors (P = 0.03). Total PSQI score was unrelated to brachial artery FMD. However, lower sleep quality (PSQI component 1) was associated with lower brachial artery FMD (multivariate P = 0.038), and participants who coughed or snored during sleep also had lower brachial artery FMD (6.24% ± 3.42%) compared with those who did not (6.92% ± 4.30%) (P = 0.056). This difference remained significant after adjustment for risk factors (P = 0.03). ConclusionsIn a community-based population, our analysis indicates a significant association between sleepiness and snoring assessed by questionnaires and endothelial function. Simple subjective reports about individuals’ sleep may be highly revealing indicators of endothelial function impairment and thus important indicators of cardiovascular disease risk.

Comparison between subjective and objective estimations of infants sleep

Validation studies between subjective reports of sleep and objective actigraphy parameters in infants are limited (Sadeh et al., 2011). The aim of this study is to investigate the agreement between mothers’ subjective reports of infants sleeping problems and objective sleep parameters obtained with actigraphy. Mothers filled out a questionnaire about infants sleep and strapped on their infant’s ankle an actigraph for a period of 7 days. Data were obtained for 29 infants (57.1% girls) twice, i.e., when babies were 3 and 6 months old. 3-month-old infants described by their mothers has having sleeping problems, who gave bad nights and who had difficulties falling asleep (items added as a Sleep factor) showed less sleep efficiency ( r = −.379; p = .021), less actual sleep time percentage ( r = −.418, p = .012), more actual wake time percentage asleep ( r = .426, p = .011), less immobile percentage asleep ( r = -.329; p = .041) and more moving time percentage asleep ( r = .342; p = .035). These infants also revealed higher total activity score ( r = .448; p = .007), mean activity score ( r = .462, p = .006) and mean score in active asleep ( r = .451; p = .007) as measured by actigraphy. These consistent associations were not observed in 6-month-old babies. The vast majority of 6-month-old infants slept in parents room (own crib; n = 14; 51.9%) or own room ( n = 11; 40.7%) while nearly all 3-month-old infants slept in parents room (own crib; n = 26, 89.7%). Agreement between subjective and objective estimations of sleep was particularly observed in 3-month-old babies. A possible explanation for this result is that mothers are more aware of their infants sleeping problems when their babies sleep in parents room. AstraZeneca Foundation for financial support. The collaboration of Mothers and Health Staff is deeply acknowledged.

Discrepancy Between Subjective and Objective Sleep Disturbances in Early- and Moderate-Stage Alzheimer Disease

Sleep disturbances such as nocturnal awakenings frequently occur in demented elderly persons and can contribute to depression, cognitive impairment, and caregiver burden. Recognizing sleep disturbances at an early stage of the disease progress is a first prerequisite of intervention and monitoring of progress. This study aimed to investigate the reliability of subjective sleep reports in early- and moderate-stage Alzheimer dementia (AD), by investigating whether they differ from matched healthy normal comparison groups with respect to the discrepancy of subjective and objective sleep estimates. Subjective sleep was assessed using the Pittsburgh Sleep Quality Index, the Sleep Disorders Questionnaire, and the Athens Insomnia Scale. Objective sleep was estimated using actigraphy. As compared with the normal comparison group (N = 26), AD patients (N = 55) complained less of insomnia, while their objective sleep estimates indicated, in fact, more disturbed sleep, including a longer sleep onset latency and a lower sleep efficiency. Regression analyses aimed at predicting actigraphic sleep parameter estimates from their subjective counterparts showed significant predictive value of only very few subjective sleep parameters. Subjective reports of both patients and the normal comparison group had significant value in predicting actigraphic indices of total sleep time and bedtime. In addition, subjective reports of the normal comparison group, but not of patients, were of value to predict actigraphic indices of sleep onset latency, average sleep bout duration, and sleep efficiency. The results show that the value of sleep questionnaires is limited in early- and moderate-stage AD. Actigraphy may be essential to ensure that sleep problems do not go undetected and untreated.

Sleep Loss Exacerbates Fatigue, Depression, and Pain in Rheumatoid Arthritis

Disturbances of sleep are hypothesized to contribute to pain. However, experimental data are limited to healthy pain-free individuals. This study evaluated the effect of sleep loss during part of the night on daytime mood symptoms and pain perceptions in patients with rheumatoid arthritis in comparison with control subjects. A between-groups laboratory study with assessment of mood symptoms and pain perception before and after partial night sleep deprivation (PSD; awake 23:00 hr to 03:00 hr). General clinical research center. Patients with rheumatoid arthritis (n = 27) and volunteer comparison control subjects (n = 27). Subjective reports of sleep, mood symptoms and pain, polysomnographic assessment of sleep continuity, and subjective and objective assessment of rheumatoid arthritis-specific joint pain. PSD induced differential increases in self-reported fatigue (P < 0.09), depression (P < 0.04), anxiety (P < 0.04), and pain (P < 0.01) in patients with rheumatoid arthritis compared with responses in control subjects, in whom differential increases of self-reported pain were independent of changes in mood symptoms, subjective sleep quality, and objective measures of sleep fragmentation. In the patients with rheumatoid arthritis, PSD also induced increases in disease-specific activity as indexed by self-reported pain severity (P < 0.01) and number of painful joints (P < 0.02) as well as clinician-rated joint counts (P < 0.03). This study provides the first evidence of an exaggerated increase in symptoms of mood and pain in patients with rheumatoid arthritis after sleep loss, along with an activation of rheumatoid arthritis-related joint pain. Given the reciprocal relationship between sleep disturbances and pain, clinical management of pain in patients with rheumatoid arthritis should include an increased focus on the prevention and treatment of sleep disturbance in this clinical population.

The Longitudinal Relationship between Fatigue and Sleep in Breast Cancer Patients Undergoing Chemotherapy

Fatigue and sleep disturbances are two of the most common and distressing symptoms of cancer patients. A relationship between the two symptoms was reported in symptom cluster studies; however, only subjective measurements of sleep were examined and most studies were cross-sectional. In this study of women with breast cancer undergoing chemotherapy, we explored the longitudinal relationship between fatigue and sleep measured both subjectively and objectively. Prospective study. Data were collected at 7 time points: before (baseline) and during the 3 weeks of cycle 1 and cycle 4 chemotherapy. Ninety-seven women with newly diagnosed stage I-III breast cancer who were scheduled to receive at least four 3-week cycles of chemotherapy. Objective sleep parameters were measured with an Actillume actigraph (Ambulatory Monitoring Inc.). Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). Fatigue was assessed with the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). Fatigue became worse during both cycles of chemotherapy (P-values < 0.01). Subjective sleep quality was poor at baseline and remained unchanged throughout treatment. Objective nighttime and daytime total sleep time increased compared to baseline during the treatment administration week of both cycles; daytime total wake time decreased during the treatment week of both cycles and during the last 2 week of cycle 4. Mixed model results revealed that fatigue was positively associated with total PSQI scores and with objective measures of total nap time, and negatively associated with total wake time during the day (all P-values < 0.01). Fatigue was significantly associated with subjective reports of poor sleep and objective measures of daytime sleepiness, but not with nocturnal sleep as measured with actigraphy. This relationship between fatigue and sleep warrants further studies to explore their possible common underlying etiology.

Infant Feeding Methods and Maternal Sleep and Daytime Functioning

Objective: Our purpose was to explore maternal actigraphically measured sleep, subjective sleep reports, and daytime functioning on the basis of current feeding method status during postpartum weeks 2 through 12. Methods: Objectively measured total sleep time, sleep efficiency, and fragmentation, subjectively reported numbers of nocturnal awakenings, total nocturnal wake time, and sleep quality, and sleepiness/fatigue measured by using the fatigue visual analog scale, the Stanford Sleepiness Scale, or the Epworth Sleepiness Scale were assessed. Results: We did not find differences between women who were exclusively breastfeeding, exclusively formula feeding, or using a combination of the 2 methods, with respect to the assessed parameters. Conclusions: Efforts to encourage women to breastfeed should include information about sleep. Specifically, women should be told that choosing to formula feed does not equate with improved sleep. The risks of not breastfeeding should be weighed against the cumulative lack of evidence indicating any benefit of formula feeding on maternal sleep. Language: en

Infant Feeding Methods and Maternal Sleep and Daytime Functioning

Our purpose was to explore maternal actigraphically measured sleep, subjective sleep reports, and daytime functioning on the basis of current feeding method status during postpartum weeks 2 through 12. Objectively measured total sleep time, sleep efficiency, and fragmentation, subjectively reported numbers of nocturnal awakenings, total nocturnal wake time, and sleep quality, and sleepiness/fatigue measured by using the fatigue visual analog scale, the Stanford Sleepiness Scale, or the Epworth Sleepiness Scale were assessed. We did not find differences between women who were exclusively breastfeeding, exclusively formula feeding, or using a combination of the 2 methods, with respect to the assessed parameters. Efforts to encourage women to breastfeed should include information about sleep. Specifically, women should be told that choosing to formula feed does not equate with improved sleep. The risks of not breastfeeding should be weighed against the cumulative lack of evidence indicating any benefit of formula feeding on maternal sleep.

Sleep habits in middle-aged, non-hospitalized men and women with schizophrenia: A comparison with healthy controls

Patients with schizophrenia may have sleep disorders even when clinically stable under antipsychotic treatments. To better understand this issue, we measured sleep characteristics between 1999 and 2003 in 150 outpatients diagnosed with Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) schizophrenia or schizoaffective disorder and 80 healthy controls using a sleep habits questionnaire. Comparisons between both groups were performed and multiple comparisons were Bonferroni corrected. Compared to healthy controls, patients with schizophrenia reported significantly increased sleep latency, time in bed, total sleep time and frequency of naps during weekdays and weekends along with normal sleep efficiency, sleep satisfaction, and feeling of restfulness in the morning. In conclusion, sleep-onset insomnia is a major, enduring disorder in middle-aged, non-hospitalized patients with schizophrenia that are otherwise clinically stable under antipsychotic and adjuvant medications. Noteworthy, these patients do not complain of sleep-maintenance insomnia but report increased sleep propensity and normal sleep satisfaction. These results may reflect circadian disturbances in schizophrenia, but objective laboratory investigations are needed to confirm subjective sleep reports.

Power Spectral Analysis of the Sleep Electroencephalogram in Heartburn Patients With or Without Gastroesophageal Reflux Disease

Determine the feasibility of using power spectrum of the sleep electroencephalogram (EEG) as a more sensitive tool than sleep architecture to evaluate the relationship between gastroesophageal reflux disease (GERD) and sleep. GERD has been shown to adversely affect subjective sleep reports but not necessarily objective sleep parameters. Data were prospectively collected from symptomatic patients with heartburn. All symptomatic patients underwent upper endoscopy. Patients without erosive esophagitis underwent pH testing. Sleep was polygraphically recorded in the laboratory. Spectral analysis was performed to determine the power spectrum in 4 bandwidths: delta (0.8 to 4.0 Hz), theta (4.1 to 8.0 Hz), alpha (8.1 to 13.0 Hz), and beta (13.1 to 20.0 Hz). Eleven heartburn patients were included in the GERD group (erosive esophagitis) and 6 heartburn patients in the functional heartburn group (negative endoscopy, pH test, response to proton pump inhibitors). The GERD patients had evidence of lower average delta-power than functional heartburn patients. Patients with GERD had greater overall alpha-power in the latter half of the night (3 hours after sleep onset) than functional heartburn patients. No significant differences were noted in conventional sleep stage summaries between the 2 groups. Among heartburn patients with GERD, EEG spectral power during sleep is shifted towards higher frequencies compared with heartburn patients without GERD despite similar sleep architecture. This feasibility study demonstrated that EEG spectral power during sleep might be the preferred tool to provide an objective analysis about the effect of GERD on sleep.

Sleep dysfunction and psychosocial adaptation among women undergoing treatment for non‐metastatic breast cancer

The current study aimed to determine the frequency of sleep disturbances in women prior to adjuvant therapy for breast cancer (BCa), and whether greater sleep dysfunction uniquely predicts poorer functional outcomes. We assessed subjective sleep reports and associated them with multiple indicators of psychosocial adaptation in 240 women with Stage I-III BCa before they had begun adjuvant treatment. The average global score on the Pittsburgh Sleep Quality Index (PSQI) was 8.49 (SD=4.16); 54% scoring above the suggested adjusted cutoff for cancer populations of 8.0. Controlling for various medical, sociodemographic, and psychosocial covariates, multiple regression analyses revealed that higher global PSQI score was significantly associated with poorer functional well-being, greater fatigue intensity, greater disruptions in social interactions, and lower positive states of mind. Specifically, a poorer 'sleep efficiency' PSQI component was associated with poorer functional quality of life and the SIP-Social Interactions subscale, while a poorer 'sleep quality' (SQ) PSQI component was associated with all of the outcomes except for the SIP-Recreations and Pastimes subscale. Results indicate consistent associations between a clinical indicator of sleep dysfunction, particularly those subscales of the PSQI comprising the 'SQ' component, and multiple indicators of psychosocial adaptation among women treated for BCa, independent of anxiety and depression, and suggest the value of comprehensive psychosocial interventions that consider sleep problems.

Self-Reported and Measured Sleep Duration

Recent epidemiologic studies have found that self-reported duration of sleep is associated with obesity, diabetes, hypertension, and mortality. The extent to which self reports of sleep duration are similar to objective measures and whether individual characteristics influence the degree of similarity are not known. Eligible participants at the Chicago site of the Coronary Artery Risk Development in Young Adults Study were invited to participate in a 2003-2005 ancillary sleep study; 82% (n = 669) agreed. Sleep measurements collected in 2 waves included 3 days each of wrist actigraphy, a sleep log, and questions about usual sleep duration. We estimate the average difference and correlation between subjectively and objectively measured sleep by using errors-in-variables regression models. Average measured sleep was 6 hours, whereas the average from subjective reports was 6.8 hours. Subjective reports increased on average by 34 minutes for each additional hour of measured sleep. Overall, the correlation between reported and measured sleep duration was 0.47. Our model suggests that persons sleeping 5 hours over-reported their sleep duration by 1.2 hours, and those sleeping 7 hours over-reported by 0.4 hours. The correlations and average differences between self-reports and measured sleep varied by health, sociodemographic, and sleep characteristics. In a population-based sample of middle-aged adults, subjective reports of habitual sleep are moderately correlated with actigraph-measured sleep, but are biased by systematic over-reporting. The true associations between sleep duration and health may differ from previously reported associations between self-reported sleep and health.