Wake After Sleep Onset Research Articles

Objective underpinnings of self-reported sleep quality in middle-aged and older adults: The importance of N2 and wakefulness

Study objectivesThe measurable aspects of brain function (polysomnography, PSG) that are correlated with sleep satisfaction are poorly understood. Using recent developments in automated sleep scoring, which remove the within- and between-rater error associated with human scoring, we examine whether PSG measures are associated with sleep satisfaction. Design and settingA single night of PSG data was compared to contemporaneously collected measures of sleep satisfaction with Random Forest regressions. Whole and partial night PSG data were scored using a novel machine learning algorithm. ParticipantsCommunity-dwelling adults (N = 3165) who participated in the Sleep Heart Health Study. InterventionsNone. Measurements and resultsModels explained 30% of sleep depth and 27% of sleep restfulness, with a similar top four predictors: minutes of N2 sleep, sleep efficiency, age, and minutes of wake after sleep onset (WASO). With increasing self-reported sleep quality, there was a progressive increase in N2 and decrease in WASO of similar magnitude, without systematic changes in N1, N3 or REM sleep. In comparing those with the best and worst self-reported sleep satisfaction, there was a range of approximately 30 min more N2, 30 min less WASO, an improvement of sleep efficiency of 7–8%, and an age span of 3–5 years. Examination of sleep most proximal to morning awakening revealed no greater explanatory power than the whole-night data set. ConclusionsHigher N2 and concomitant lower wake is associated with improved sleep satisfaction. Interventions that specifically target these may be suitable for improving the self-reported sleep experience.

Examining First Night Effect on Sleep Parameters with hd-EEG in Healthy Individuals.

Difficulty sleeping in a novel environment is a common phenomenon that is often described as the first night effect (FNE). Previous works have found FNE on sleep architecture and sleep power spectra parameters, especially during non-rapid eye movement (NREM) sleep. However, the impact of FNE on sleep parameters, including local differences in electroencephalographic (EEG) activity across nights, has not been systematically assessed. Here, we performed high-density EEG sleep recordings on 27 healthy individuals on two nights and examined differences in sleep architecture, NREM (stages 2 and 3) EEG power spectra, and NREM power topography across nights. We found higher wakefulness after sleep onset (WASO), reduced sleep efficiency, and less deep NREM sleep (stage 3), along with increased high-frequency NREM EEG power during the first night of sleep, corresponding to small to medium effect sizes (Cohen’s d ≤ 0.5). Furthermore, study individuals showed significantly lower slow-wave activity in right frontal/prefrontal regions as well as higher sigma and beta activities in medial and left frontal/prefrontal areas, yielding medium to large effect sizes (Cohen’s d ≥ 0.5). Altogether, these findings suggest the FNE is characterized by less efficient, more fragmented, shallower sleep that tends to affect especially certain brain regions. The magnitude and specificity of these effects should be considered when designing sleep studies aiming to compare across night effects.

Abstract WP60: Better Sleep Is Associated With Improvement In Functional Mobility During Inpatient Rehabilitation After Stroke

Introduction/Purpose: Sleep is critical for health and plays a role in motor learning, which is an important component of post stroke rehabilitation. There is limited research on the impact of sleep on functional outcomes during the early stages of rehabilitation after stroke. The purpose of this study was to explore the associations between sleep parameters and functional recovery during inpatient rehabilitation in people with stroke. Methods: 13 participants undergoing inpatient rehabilitation after stroke were recruited to participate. Function was measured at admission and discharge using GG Self Care and Mobility scales. Sleep parameters; sleep efficiency and wake after sleep onset (WASO); were determined from an ActiGraph wGT3X-BT activity monitor (AGAM), which participants wore for 5 days continuously upon admission. Associations between sleep parameters and function were determined using Pearson correlation coefficients. Results: Mean time since stroke was 15.5 (9.0) days, mean National Institutes of Stroke Scale score was 6.2 (4.1), mean age was 65.1 (12.1) years old, and 54% were women. There was a moderate association between sleep efficiency and change in GG mobility score; r=0.67 (p=0.012); and a moderate inverse association between WASO and change in GG mobility scores: r=-0.66 (p=0.013). There was not a significant association between change in GG self-care score and sleep parameters (p>=0.05). Discussion: Quality of sleep is associated with improvement in functional mobility during inpatient rehabilitation after stroke. Participants with better sleep efficiency and less time awake during the night after falling asleep during the first 5 days of their inpatient rehabilitation stay had greater improvement in functional mobility at discharge. Further research is needed to examine the complex relationships between sleep and recovery after stroke and to investigate possible interventions to promote better sleep during inpatient rehabilitation after stroke.

Examining the trajectory and predictors of post-concussion sleep quality in children and adolescents

ABSTRACT Objectives This study aimed to 1) determine if post-concussion sleep quality of children and adolescents differed from healthy sleep estimates; 2) describe the trajectory of parameters of sleep quality; 3) determine factors that predict sleep quality outcomes; and 4) compare sleep parameter outcomes between asymptomatic and symptomatic participants at 4 weeks post-concussion. Methods Nightly actigraphy estimates of sleep in 79 children and adolescents were measured throughout 4 weeks post-concussion. Total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), number of arousals (NOA), and average arousal length (AAL) were measured. Results Child and adolescent participants experienced significantly poorer SE and longer WASO duration throughout 4 weeks of recovery and adolescents experienced significantly longer TST. SE significantly improved with time post-injury (p = .047). Older age was associated with longer TST (p = .003) and female sex was associated with longer WASO (p = .025) and AAL duration (p = .044). Week 4 sleep parameter outcomes were not significantly different between asymptomatic and symptomatic participants. Conclusions The sleep quality of youth is adversely affected by concussion, particularly in females. Sleep quality appears to improve with time but may require more than 4 weeks to return to normal.

The relationship between the HDRS insomnia items and polysomnographic (PSG) measures in individuals with treatment-resistant depression

The Hamilton Depression Rating Scale (HDRS), which includes several insomnia-related items, is potentially valuable in evaluating both depressive and sleep symptoms. However, the HDRS insomnia items have not been fully assessed by objective measures. This study compared the three HDRS insomnia items (Early, Middle, and Late) with the corresponding objective polysomnography (PSG) measures of Sleep Latency (SL), middle wakefulness, and late wakefulness. The study used HDRS and PSG data from 130 baseline nights, drawn from 80 participants enrolled in clinical trials for treatment-resistant depression (TRD). Mixed models evaluated the relationship between the HDRS and PSG, and primary analyses examined the Early, Middle, and Late Insomnia HDRS items and the PSG variables SL and Waking After Sleep Onset (WASO). To approximate the Middle and Late HDRS Insomnia items more closely, WASO was divided into WASO before 4:00 a.m. (waking between Sleep Onset and 0400 h) and WASO after 4:00 a.m. (waking between 0400 h and 0700 h). Secondary analyses included summed HDRS Global Insomnia score. HDRS Early and Late Insomnia items predicted objective PSG measures of early and late wakefulness. For Early Insomnia, each additional point in severity was associated with 61% [95%CI: 35%, 93%] longer SL. For Late Insomnia, each additional point was associated with a 35% [95% CI: 13%, 63%] increase in WASO after 4:00 a.m. Middle Insomnia was marginally related to WASO before 4:00 a.m. HDRS Early and Late Insomnia items may thus provide an index of wakefulness in TRD and help monitor treatment response when objective measures such as PSG are not feasible. Clinical trials identifierwww.clinicaltrials.gov (NCT01204918, NCT00054704, NCT00088699).

A double-blind, randomized, placebo-controlled trial of suvorexant for the treatment of vasomotor symptom-associated insomnia disorder in midlife women.

The neuropeptide orexin promotes wakefulness, modulates thermoregulation, increases after menopause, and is normalized in women receiving estrogen therapy, suggesting a role for orexin antagonism as a treatment for the vasomotor symptom (VMS)-associated insomnia disorder. We tested the efficacy of the dual orexin receptor antagonist suvorexant for chronic insomnia related to nighttime VMS. In a double-blind, placebo-controlled trial, 56 women with chronic insomnia associated with nighttime VMS, Insomnia Severity Index (ISI) scores ≥15, and >30 min of diary-rated wake after sleep-onset (WASO) were randomized to receive oral suvorexant 10-20 mg (n = 27) or placebo (n = 29) nightly for 4 weeks. Analysis of within-person change in ISI was adjusted for baseline ISI and race. Mean baseline ISI scores were 18.1 (95% CI, 16.8 to 19.4) and 18.3 (95% CI, 17.2 to 19.5) in the suvorexant and placebo groups, respectively (p = .81). The average 4-week ISI within-person decrease from baseline was greater on suvorexant (-8.1 [95% CI, -10.2 to -6.0]) compared to placebo (-5.6 [95% CI, -7.4 to -3.9], p = .04). Compared to placebo, nighttime diary-rated VMS frequency was significantly reduced with suvorexant (p < .01). While diary-rated WASO and total sleep time trended toward improvement on suvorexant, findings were not significant after adjustment for multiple comparisons. Daytime VMS and other sleep-related outcomes did not differ between groups. Suvorexant was well tolerated. These results suggest that suvorexant is likely a well-tolerated and efficacious treatment for VMS-associated insomnia disorder and reduces nighttime VMS. Antagonism of orexin receptors could provide a novel therapeutic option for midlife women with VMS-associated chronic insomnia. Efficacy of Suvorexant in the Treatment of Hot Flash-associated Insomnia, https://clinicaltrials.gov/ct2/show/NCT03034018, ClinicalTrials.gov Identifier: NCT03034018.

The Clinical Effect of Blue Light Therapy on Patients with Delayed Sleep-Wake Phase Disorder

ObjectiveTo investigate the feasibility and patient acceptance of applying blue light glasses to treat delayed sleep-wake phase disorder (DSWPD).MethodsFifteen patients with DSWPD were collected as the observation group and 15 healthy people as the control group. The patients wore blue light glasses with a continuous radiation wavelength of about 470 nm for 1h to 2h during the period from 06:30 to 09:00 in the morning after waking up, respectively. Assessment of Hamilton Anxiety Scale 14 items (HAMA14), Hamilton Depression Rating Scale 24 items (HAMD24), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), Morningness–Eveningness Questionnaire (MEQ), and Insomnia Severity Index (ISI) scores before and after 1 week of treatment. Pearson correlation was used to analyze the correlation between the efficacy of patients with sleep-wake phase delay disorder and HAMA14, HAMD24, PSQI, ISI, ESS, MEQ, SL (sleep time), TST (total sleep time), TTiB (total time in bed), SQ (sleep quality), TOA (total arousal time), WASO (wake after sleep onset), AAT (average arousal time), and SE (sleep efficiency percent). Multi-factor logistic regression analysis of factors influencing the efficacy of patients with sleep-wake phase delay disorder.ResultsAfter treatment, PSQI-G scores, number of nighttime awakenings and time of awakening recorded in the sleep diary decreased significantly in the observation group (P < 0.05), and subjective sleep quality and MEQ scores increased (P < 0.05). MEQ score shifted from “moderate night type” to “intermediate type”, sleep-wake phase tended to shift forward. The total PSQI score and Pittsburgh Sleep Quality Index Global (PSQI-G) score were significantly lower in the control group after treatment (P < 0.05). By Pearson correlation analysis, the efficacy of patients with sleep-wake phase delay disorder was significantly correlated with HAMA14, HAMD24, PSQI, ISI, ESS, MEQ, SL, TST, TTiB, SQ, TOA, WASO, AAT, and SE. Multifactorial logistic regression analysis revealed that the factors influencing the efficacy of patients with sleep-wake phase delay disorder were PSQI, ISI, ESS, MEQ, SL, TST, TTiB, SQ, TOA, WASO, AAT, and SE.ConclusionBlue light therapy has a positive effect on improving subjective sleep quality, reducing the number of nocturnal awakenings and the duration of nocturnal awakenings, improving daytime function, and shifting the sleep phase forward in patients with DSWPD. Blue light therapy improves subjective sleep quality and daytime function the following day in normal individuals.

Comparing polysomnography, actigraphy, and sleep diary in the home environment: The Study of Women's Health Across the Nation (SWAN) Sleep Study.

Study ObjectivesPolysomnography (PSG) is considered the “gold standard” for assessing sleep, but cost and burden limit its use. Although wrist actigraphy and self-report diaries are feasible alternatives to PSG, few studies have compared all three modalities concurrently across multiple nights in the home to assess their relative validity across multiple sleep outcomes. This study compared sleep duration and continuity measured by PSG, actigraphy, and sleep diaries and examined moderation by race/ethnicity.MethodsParticipants from the Study of Women’s Health Across the Nation (SWAN) Sleep Study included 323 White (n = 147), African American (n = 120), and Chinese (n = 56) middle-aged community-dwelling women (mean age: 51 years, range: 48–57). PSG, wrist actigraphy (AW-64; Philips Respironics, McMurray, PA), and sleep diaries were collected concurrently in participants’ homes over three consecutive nights. Multivariable repeated-measures linear models compared time in bed (TIB), total sleep time (TST), sleep efficiency (SE), sleep latency (SL), and wake after sleep onset (WASO) across modalities.ResultsActigraphy and PSG produced similar estimates of sleep duration and efficiency. Diaries yielded higher estimates of TIB, TST, and SE versus PSG and actigraphy, and lower estimates of SL and WASO versus PSG. Diary SL was shorter than PSG SL only among White women, and diary WASO was lower than PSG and actigraphy WASO among African American versus White women.ConclusionsGiven concordance with PSG, actigraphy may be preferred as an alternative to PSG for measuring sleep in the home. Future research should consider racial/ethnic differences in diary-reported sleep continuity.

Sleep Architecture in Progressive Supranuclear Palsy: A Video-Polysomnography Study.

Sleep disturbances have been reported to occur in progressive supranuclear palsy (PSP). The anatomical regions affected in PSP and those regulating sleep and wake cycle like dorsal raphe nucleus, locus coeruleus (LC), and pedunculopontine nucleus (PPN) overlap. There is a paucity of polysomnographic studies in PSP and they have shown altered sleep architecture. To study the sleep architecture in patients with PSP using video-polysomnography (vPSG) and correlate it with the disease severity and duration. This was a prospective, cross-sectional, case-control, single-center study. A total of 22 patients with PSP and 15 age and gender-matched controls were recruited. The cases and controls underwent clinical assessment, face-to-face interviews with sleep questionnaires, anxiety and depression scales, and one overnight vPSG. The sleep architecture was analyzed in detail. The sleep architecture was altered as compared to the controls. The total sleep time, stage N2 duration, stage N3 duration, rapid-eye-movement (REM) sleep duration, sleep efficiency %, and N2%, N3%, and REM% were significantly lesser in PSP patients. The wake duration, wake after sleep onset (WASO) duration, wake%, WASO%, stage N1 duration was significantly greater in PSP patients. The stage N2 and N3 latencies were significantly prolonged in patients. REM sleep without atonia was noted in four patients and no patients had vPSG proven REM sleep behavior disorder. Sleep architecture is altered in PSP even during the early stages of the disease. There is reduced total sleep including both non-REM and REM sleep, sleep efficiency, prolonged sleep latencies, and increased wake duration. This correlates with the neurodegenerative processes affecting the anatomical region regulating the sleep/wake cycle like dorsal raphe nucleus, locus coeruleus (LC), pedunculopontine nucleus (PPN).

Influence of sleep fragmentation and fatigue on turnover of female nurses working rotating shifts.

To investigate whether the sleep quality and fatigue of female nurses working rotating shifts could be used to predict future turnover status. Female nurses working rotating shifts often suffer from sleep problems and fatigue, and the turnover rates of nurses are generally higher than those of other hospital personnel. A prospective study. We recruited a total of 198 female nurses working rotating shifts from December 2017 to March 2019. The nurses completed the Checklist Individual Strength (CIS) scale and wore an actigraph for seven consecutive days in order to collect their sleep parameters. Their turnover status was tracked until 31 May 2021 at which time 55 participants (27.8%) had resigned. The Cox proportional hazard model was used to analyse the factors influencing turnover. In addition, the study adhered to the STROBE checklist. The results revealed significant differences between the nurses in the still-working group and the resigned group in terms of the sleep quality parameters sleep efficiency (SE) and wake after sleep onset (WASO) as well as CIS scores. WASO was significantly correlated with intensity of fatigue, and fatigue was common among all of the nurses working rotating shifts. As time progressed, the sleep quality parameter WASO and CIS scores could be used to predict turnover status after 2.4years. The results of this study indicated more sleep fragmentation and poor sleep efficiency in the resigned group. Sleep fragmentation was highly correlated with fatigue, and sleep fragmentation and fatigue could be used to predict turnover status. We suggest that relevant hospital management pay more attention to the sleep conditions and fatigue of female nurses working rotating shifts when arranging personnel and schedules and offer them more understanding.

Associations of adverse childhood experiences (ACEs) with sleep duration and quality: the BCOPS study

BackgroundAdverse Childhood Experiences (ACEs) are associated with numerous adverse health outcomes in adulthood. Our objective was to investigate associations between ACEs and sleep measures among 206 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress study. MethodsACEs (independent variable) was assessed using the ACE questionnaire. Sleep measures were assessed using the Pittsburgh Sleep Quality Index and actigraphy. ANOVA/ANCOVA were used to investigate associations between ACEs and sleep measures. ResultsThe mean self-reported sleep duration was significantly lower among participants who reported ≥1 ACEs compared to those who reported no ACEs (6.0 ± 0.11 vs. 6.4 ± 0.14 h; multivariate-adjusted p = 0.035). Sleep efficiency was significantly lower among participants who reported ≥1 ACEs compared to those who reported none (mean = 88.7%, 95% CI = 87.7–89.6 vs. 90.2%, 89.2–91.2; unadjusted p = 0.031) but was slightly attenuated and lost statistical significance after multivariate-adjustment (88.8%, 87.8–89.7 vs. 90.1%, 88.9–91.1; p = 0.094). Compared to participants who reported no ACEs, those who reported ≥1 ACEs had a higher mean activity index score (36.9 ± 0.96 vs. 31.2 ± 1.25; multivariate-adjusted p = 0.001); a higher mean wake after sleep onset (WASO) (44.3 ± 2.24 vs. 35.3 ± 2.92 min; multivariate-adjusted p = 0.019); and a higher sleep fragmentation index (3.8 ± 1.65 vs. 3.3 ± 1.20 unadjusted p = 0.044 and 3.8 ± 0.13 vs. 3.3 ± 0.18; multivariate-adjusted p = 0.062). Among men (but not women) who reported ≥1 ACEs, self-reported sleep duration was significantly lower (5.9 ± 0.13 vs. 6.4 ± 0.15 h; multivariate-adjusted p = 0.025) and activity index was significantly higher (39.1 ± 1.3 vs. 33.2 ± 1.51; multivariate-adjusted p = 0.004) compared to those who reported no ACEs. ConclusionExposure to ≥1 ACE was associated with worse sleep measures.

Associations Between Actigraphy-Assessed Health Behaviors and Cognitive Performance in Older Adults

Lifestyle behaviors are important determinants of healthy brain aging. Research has not fully explored how sleep quality and physical activity may differentially influence specific domains of cognitive function. The present study aimed to estimate the relative influence of sleep quality and physical activity on cognitive performance in three domains in a sample of older adults. Older adults (ages 60-89, M = 74.74) without cognitive impairment (N= 160) wore an accelerometer for 7 days in a free-living environment. We used average vector magnitude counts per minute to measure total physical activity (TPA), and average wake after sleep onset (WASO) to measure sleep quality. We created cognitive composite scores (executive function, attention, and verbal memory) from neuropsychological data using confirmatory factor analysis. We regressed cognitive scores onto TPA and WASO with age and education entered as covariates. Higher amounts of physical activity and better sleep quality were associated with better executive function (R2 = 20.3%, F (4, 155) = 11.12, p < .001). Neither physical activity nor sleep quality was associated with verbal memory or attention. Results suggest that more physical activity and improved ability to stay asleep may benefit executive function, but not other cognitive domains. Future studies should clarify the interaction and mechanisms of action between health behaviors and cognitive performance in older adults.

The effect of vitamin B12-supplementation on actigraphy measured sleep pattern; a randomized control trial

Vitamin B12 deficiency is common worldwide and has been associated with poor sleep. The effect of vitamin B12 supplementation on sleep in infants is not known. To measure the effect of daily supplementation of vitamin B12 for one year on sleep in infants at risk of deficiency. This was an individually randomized double-blind placebo-controlled trial in 600 infants in low-to middle-income neighborhoods in Bhaktapur, Nepal of daily supplementation of vitamin B12 for one year. Infants were included if they were 6-11 month year-old and with a length-for-age less than one z-score. Sleep was a predefined, secondary outcome, and was measured by actigraphy including sleep duration at night and total sleep duration (day and night), sleep onset latency (SOL), and wake after sleep onset (WASO). The effect of vitamin B12 on sleep was additionally assessed in predefined subgroups defined by stunting, underweight, vitamin B12 status, low birthweight, anemia and exclusive breastfeeding for 3 months. There was no effect of vitamin B12 supplementation on sleep duration at night, total sleep duration, or WASO. There was a small significant negative effect for SOL. None of the included subgroup analyses revealed effect modification on any of the sleep outcomes. Overall, vitamin B12 supplementation did not have an effect on sleep in infants or for high-risk subgroups, with the exception of a small negative effect for SOL. The present study does not support vitamin B12 supplementation to improve sleep in infants. clinicaltrials.gov: NCT02272842. U1111-1161-5187.

Fragmented Sleep and the Prevalence of Hypertension in Middle-Aged and Older Individuals.

ObjectiveWe aimed to investigate the association between fragmented sleep and the prevalence of hypertension in middle-aged and older individuals.MethodsThis study included 5804 participants with an average age of 63.1±11.2 years from the Sleep Heart Health Study. Fragmented sleep parameters including arousal index in total sleep (ArI-Total), rapid eye movement sleep (ArI-REM), non-rapid eye movement sleep (ArI-NREM), fragmented sleep index (SFI), sleep efficiency (SE) and wake after sleep onset (WASO) were monitored using polysomnography. The information on hypertension, defined as systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg or under antihypertensive treatment, was collected at baseline. We conducted multivariable logistic regression to explore the cross-sectional association between fragmented sleep and the prevalence of hypertension.ResultsAfter adjusting for potential confounders, fragmented sleep parameters (per 5-unit change) including SE (odds ratio [OR] 0.904; 95% confidence interval [CI] 0.877–0.932; P < 0.001), WASO (OR 1.019; 95% CI 1.012–1.027; P < 0.001), ArI-Total (OR, 1.036; 95% CI, 1.005–1.068; P = 0.024), and ArI-NREM (OR 1.032; 95% CI 1.004–1.062; P = 0.027) were significantly associated with the prevalence of hypertension. In addition, ArI-Total, ArI-NREM, and ArI-REM were positively correlated with both systolic blood pressure and diastolic blood pressure.ConclusionWe found a high prevalence of hypertension among middle-aged and older individuals with fragmented sleep. The causal association between fragmented sleep and hypertension warrants further investigation.

Neuronal correlates of sleep in neurodegenerative diseases

Sleep plays a key role in the origination and progression of neurodegenerative diseases. We have recently shown that the key areas that regulate sleep and wakefulness in the subcortical nuclei are particularly vulnerable to tau-inclusion and neuronal loss even in the early stages in AD. Nevertheless, it remains uncertain whether the pathological lesion of specific nuclei directly contributes to the patient's clinical sleep impairment. Here, we correlate quantitative sleep measurements with post-mortem stereological neuronal analysis in neurodegenerative diseases.Twenty-two patients (50% female; mean age: 70.65 ± 1.54) completed overnight polysomnography and/or MEG at the Memory and Aging Center at UCSF. Of 22 patients, 12 were neuropathologically diagnosed with AD, and 10 were PSP (progressive supranuclear palsy)(Table 1). Locus coeruleus (LC), lateral hypothalamus (LHA), and tuberomammillary nuclei (TMN) were immunostained for their respective primary neurotransmitter (TH, orexin, or histamine) and tau inclusions, followed by stereological neuronal count and Spearman correlation analysis.The number of orexinergic and histaminergic neurons showed a significant correlation with the objective sleep measurements, including total sleep time (TST), wake-after sleep onset (WASO), sleep maintenance, NREM2 sleep, and REM sleep (Figure 1).Loss of neurons involved in the sleep-wake network may play a direct role in impairing sleep architecture and function in neurodegenerative disease. This is the first study to use a quantitative, systematic approach to correlate pathological lesions and sleep parameters in AD and PSP. Understanding the neuronal basis of sleep impairment in neurodegenerative diseases is crucial in designing the next generation of sleep medications and even slowing down the progress of neurodegenerative diseases through early inventions.

Sleep patterns and insomnia among adolescents receiving child welfare services: A population-based study

ObjectivesSleep problems are common in adolescence. We aimed to investigate sleep patterns and insomnia in Norwegian adolescents who have been in contact with child welfare services (CWS), both adolescents living in foster care (FC) and adolescents receiving in-home-services (IHS). Both groups were compared to youth who reported they were not receiving child welfare interventions. DesignCross-sectional. SettingThe population-based study youth@hordaland from 2012 in Hordaland, Norway. ParticipantsAbout 9421 adolescents (53.8% girls), age range 16-19 years, were divided into 3 groups; IHS group (n = 123), FC group (n = 132), and control group (n = 9166). MeasurementsSelf-reported information about demographics, detailed sleep patterns, sleep problems, and adverse life events. ResultsAdolescents receiving IHS (vs. controls) had significantly shorter sleep duration, lower sleep efficiency, longer sleep onset latency (SOL), wake after sleep onset (WASO), and higher prevalence of insomnia. They had increased odds of insomnia (adjusted odds ratio [AOR] = 1.77, 95% confidence interval [CI] = 1.19-2.62) and SOL ≥ 30 minutes (AOR = 1.95, CI = 1.32-2.87). Adolescents in FC (vs. controls) reported lower sleep efficiency and longer WASO. When adjusting for sex and age, the associations did not substantially change. When additionally adjusting for adverse life events, the associations were considerably attenuated for both groups, and were no longer significant for the FC group. ConclusionOur results indicate a higher rate of sleep problems among adolescents receiving interventions from CWS, particularly those receiving IHS. Adverse life events accounted for a substantial part of the increased risk of sleep problems.

A Latent Profile Analysis of Sleep, Anxiety, and Mood in Youth with Craniopharyngioma

ABSTRACT Craniopharyngioma is a histologically benign brain tumor that arises in the suprasellar region affecting critical neurovascular structures including the hypothalamic-pituitary-adrenal axis and optic pathways. Children with craniopharyngioma often experience excessive daytime sleepiness (EDS) which may be compounded by anxiety and depression. The current study investigated disparate sleep profiles to better understand psychological adjustment among children diagnosed with craniopharyngioma. Method: Actigraphs recorded nightly sleep data, including measures of sleep onset latency (SOL) and wake after sleep onset (WASO), in a cohort of 80 youth between the ages of 2 and 20 years (median age = 9). Parent reports of behavioral and emotional functioning were included in the analysis. A latent profile analysis examined disparate sleep profiles, and a multinomial logistic regression examined differences of anxiety and depression among the sleep profiles. Results: The latent profile analysis revealed three sleep profiles: “healthy sleepers” (68.8%), “night wakers” (21.3%), and “prolonged onset sleepers” (10.0%). Contrary to expectations, sleep profiles were not associated with daytime anxiety (β = 2.26–4.30, p > .05) or depression (β = −5.87–4.74, p > .05). Conclusions: Youth with craniopharyngioma demonstrate poor sleep and EDS. Those with delayed SOL and prolonged WASO are particularly vulnerable to disrupted nighttime sleep, which may significantly compound EDS. Disrupted sleep was not associated with anxiety or depression, which may be related to the overall poor sleep and daytime sleepiness or to timing, as patients were early in their treatment course. Further study should evaluate the factors underlying sleepiness and daytime function in patients with craniopharyngioma.

Prospective cohort study to evaluate the accuracy of sleep measurement by consumer-grade smart devices compared with polysomnography in a sleep disorders population

ObjectivesConsumer-grade smart devices are now commonly used by the public to measure waking activity and sleep. However, the ability of these devices to accurately measure sleep in clinical populations warrants...

Sleep in 21-Day Dry Immersion. Are Cardiovascular Adjustments Rapid Eye Movement Sleep-Dependent?

Introduction: A decrease in sleep quality and duration during space missions has repeatedly been reported. However, the exact causes that underlie this effect remain unclear. In space, sleep might be impacted by weightlessness and its influence on cardiovascular function. In this study, we aimed at exploring the changes of night sleep architecture during prolonged, 21-day Dry Immersion (DI) as one of the ground-based models for microgravity studies and comparing them with adaptive changes in the cardiovascular system.Methods: Ten healthy young men were exposed to DI for 21 days. The day before (baseline, B-1), on the 3rd (DI3), 10th (DI10), and 19th (DI19) day of DI, as well as in the recovery period, 1 day after the end of DI (R + 1), they were subjected to overnight polysomnography (PSG) and ambulatory blood pressure monitoring.Results: On DI3, when the most severe back pain occurred due to the effects of DI on the spine and back muscles, the PSG data showed dramatically disorganized sleep architecture. Sleep latency, the number of awakenings, and the duration of wake after sleep onset (WASO) were significantly increased compared with the B-1. Furthermore, the sleep efficiency, duration of rapid eye movement sleep (REM), and duration of non-rapid eye movement stage 2 decreased. On DI10, subjective pain ratings declined to 0 and sleep architecture returned to the baseline values. On DI19, the REM duration increased and continued to rise on R + 1. An increase in REM was accompanied by rising in a nighttime heart rate (HR), which also shows the most significant changes after the end of DI. On DI19 and R + 1, the REM duration showed opposite correlations with the BP parameters: on DI19 it was negatively associated with the systolic BP (SBP), and on R + 1 it was positively correlated with the diastolic BP (DBP).Conclusion: An increase in REM at the end of DI and in recovery might be associated with regulatory changes in the cardiovascular system, in particular, with the reorganization of the peripheral and central blood flow in response to environmental changes.

Longitudinal association of actigraphy-assessed sleep with physical growth in the first 6 months of life.

Suboptimal sleep is associated with obesity and its sequelae in children and adults. However, few studies have examined the association between sleep and physical growth in infants who experience rapid changes in sleep/wake patterns. We examined the longitudinal association of changes in objectively assessed sleep/wake patterns with changes in growth between ages 1 and 6 months. We studied 298 full-term infants in the longitudinal Rise & SHINE cohort study. Changes from 1 and 6 months in nighttime sleep duration, wake after sleep onset (WASO), and number of waking bouts ≥5 min were assessed using ankle actigraphy. Overweight was defined as age- and sex-specific weight for length ≥95th percentile. Generalized estimating equation analyses adjusted for infants' and mothers' characteristics. The mean (SD) birth weight was 3.4 (0.4) kg; 48.7% were boys. In multivariable adjusted models, each 1-h increase in nighttime sleep duration between months 1 and 6 was associated with a 26% decrease in the odds of overweight from 1 to 6 months (odds ratio [OR] = 0.74; 95% confidence interval [CI, 0.56, 0.98]). Each 1-unit decrease in number of waking bouts was associated with a 16% decrease in the odds of overweight (OR = 0.84; 95% CI [0.72, 0.98]). Changes in WASO were not associated with the odds of overweight. Greater increases in nighttime sleep duration and more consolidation of nighttime sleep were associated with lower odds of overweight from 1 to 6 months. Adverse sleep patterns as early as infancy may contribute to excess adiposity.