Wake Time After Sleep Onset Research Articles

Comparing sleep measures in cancer survivors: self-reported sleep diary versus objective wearable sleep tracker.

Cancer survivors are increasingly using wearable fitness trackers, but it is unclear if they match traditional self-reported sleep diaries. We aimed to compare sleep data from Fitbit and the Consensus Sleep Diary (CSD) in this group. We analyzed data from two randomized clinical trials, using both CSD and Fitbit to collect sleep outcomes: total sleep time (TST), wake time after sleep onset (WASO), number of awakenings (NWAK), time in bed (TIB), and sleep efficiency (SE). Insomnia severity was measured by Insomnia Severity Index (ISI). We used the Wilcoxon signed rank test, Spearman's rank correlation coefficients, and the Mann-Whitney test to compare sleep outcomes and assess their ability to distinguish insomnia severity levels between CSD and Fitbit data. Among 62 participants, compared to CSD, Fitbit recorded longer TST by an average of 14.6 (SD = 84.9) minutes, longer WASO by an average of 28.7 (SD = 40.5) minutes, more NWAK by an average of 16.7 (SD = 6.6) times per night, and higher SE by an average of 7.1% (SD = 14.4); but shorter TIB by an average of 24.4 (SD = 71.5) minutes. All the differences were statistically significant (all p < 0.05), except for TST (p = 0.38). Moderate correlations were found for TST (r = 0.41, p = 0.001) and TIB (r = 0.44, p < 0.001). Compared to no/mild insomnia group, participants with clinical insomnia reported more NWAK (p = 0.009) and lower SE (p = 0.029) as measured by CSD, but there were no differences measured byFitbit. TST was the only similar outcome between Fitbit and CSD. Our study highlights the advantages, disadvantages, and clinical utilization of sleep trackers in oncology.

Efficacy of Chinese Medicine Treatment Based on Syndrome Differentiation for Primary Insomnia: A Randomized Placebo Controlled Triple-Blinded Trial.

To assess efficacy of Chinese medicine (CM) on insomnia considering characteristics of treatment based on syndrome differentiation. A total of 116 participants aged 18 to 65 years with moderate and severe primary insomnia were randomized to the placebo (n=20) or the CM group (n=96) for a 4-week treatment and a 4-week follow-up. Three CM clinicians independently prescribed treatments for each patient based on syndromes differentiation. The primary outcome was change in total sleep time (TST) from baseline. Secondary endpoints included sleep onset latency (SOL), wake time after sleep onset (WASO), sleep efficiency, Pittsburgh Sleep Quality Index (PSQI) and CM symptoms. The CM group had an average 0.6 h more (95% confidence interval (CI): 0.3-0.9, P<0.001) TST and 34.1% (10.3%-58.0%, P=0.005) more patients beyond 0.5 h TST increment than that of the placebo group. PSQI was changed -3.3 (-3.8 to -2.7) in the CM group, a -2.0 (-3.2 to -0.8, P<0.001) difference from the placebo group. The CM symptom score in the CM group decreased -2.0 (-3.3 to -0.7, P=0.003) more than the placebo group. SOL and WASO changes were not significantly different between groups. The analysis of prescriptions by these clinicians revealed blood deficiency and Liver stagnation as the most common syndromes. Prescriptions for these clinicians displayed relative stability, while the herbs varied. All adverse events were mild and were not related to study treatment. CM treatment based on syndrome differentiation can increase TST and improve sleep quality of primary insomnia. It is effective and safe for primary insomnia. In future studies, the long-term efficacy validation and the exploratory of eutherapeutic clinicians' fixed herb formulas should be addressed (Registration No. NCT01613183).

Clinical effectiveness of internet-based cognitive behavioral therapy for insomnia in routine secondary care: results of a randomized controlled trial.

Delivering cognitive behavioral therapy for insomnia over the internet bears the advantage of accessibility and uptake to many patients suffering from chronic insomnia. In the current study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy for insomnia (iCBT-I) in routine care. We conducted a two-arm non-blinded randomized controlled trial with care as usual (CAU) as a control condition. Participants were recruited in a specialized outpatient sleep medicine department. Both arms had access to other healthcare resources, and the intervention group had access to the iCBT-I program for 2 months. The primary outcome was insomnia severity, measured by the Insomnia Severity Index (ISI). Secondary outcomes were fatigue severity, daytime sleepiness, affective symptoms, dysfunctional beliefs and attitudes about sleep, sleep locus of control, sleep hygiene, sleep efficiency (SE), sleep onset latency, wake time after sleep onset (WASO), and total sleep time (TST). Linear mixed models for repeated measures were used to analyze the longitudinal data at baseline, post-treatment, and after 3 months of follow-up. The trial was registered at www.clinicaltrials.gov (NCT04300218 21.04.2020). The results showed a significant time*group interaction effect (p = 0.001) at post-treatment with between-group effect size (d = 0.51), indicating that the ISI decreased by a score of 3.8-fold in the iCBT-I group than in the CAU group. There was no significant difference in ISI between groups at follow-up. Regarding secondary outcomes, dysfunctional beliefs about sleep, SE, and WASO decreased significantly during treatment in the intervention group with between-group effect sizes d = 0.35, d = -0.51, and d = 0.47, respectively. At the follow-up, between-group effects on DBAS and SE remained significant: d = 0.36 and d = -0.63, respectively. For TST, we observed a significant time*group effect of d = -0.38 only after follow-up. Our findings suggest that iCBT-I has a significant effect on insomnia severity at post-treatment compared to CAU. iCBT-I further improved dysfunctional beliefs about sleep and improved subjective sleep characteristics, such as SE, WASO, and TST during 3 months after treatment. www.clinicaltrials.gov, identifier (NCT04300218).

Efficacy and Safety of Cannabidiol Oil on Chronic Insomnia: The First Randomized, Double-Blind, Placebo-Controlled, Crossover, Pilot Study in Thailand

Objective: Cannabidiol (CBD) is a non-intoxicating extract from Cannabis sativa. The advantages of CBD on sleep-wake cycle and insomnia remain sparse. The present study investigated the impact of a continuous four-week sublingual CBD intake on sleep indicators. Materials and Methods: The present study was a randomized, double-blind, placebo-controlled, crossover pilot study involving 45 chronic insomnia patients. The participants were administered medium-chain triglycerides oil soluble cannabidiol (MCT-CBD) using 1 mg/kg/dose, sublingually for four weeks, then two weeks of washout period, and a subsequent four-week placebo phase. Sleep architecture with N1, N2, N3, and rapid eye movement (REM), sleep quality (PSQI), daytime sleepiness (ESS), and quality of life were investigated. Results: Polysomnography (PSG) revealed that the total sleep time (TST), sleep onset latency (SOL), wake time after sleep onset (WASO), and arousal index were significantly improved compared to the patients who were taking placebo, while sleep structure remained unaltered. Additionally, actigraphy showed a substantial improvement in TST, sleep efficiency (SE), and SOL. The results of PSQI, ESS, and EQ-5D-5L were statistically significant and better than placebo (p&lt;0.05). Conclusion: Continuously sublingual CBD treatment could improve sleep duration, sleep maintenance, sleep induction, quality of life, and daytime sleepiness without altering the sleep architecture in patients with chronic insomnia. No evidence of serious side-effects was found. Keywords: Hemp; CBD; Cannabidiol; Cannabis; Insomnia; Sleep

ASSOCIATIONS OF NIGHT AND DAY SLEEP WITH COGNITIVE PERFORMANCE IN SHIFT WORKERS: PRELIMINARY RESULTS

Abstract Emerging evidence suggests that night shift workers are at higher risk of severe cognitive impairment, mainly because of the repeated disruption of the sleep–wake schedule and the resulting poor sleep (e.g., less deep sleep or shorter sleep time). However, questions remain about how daytime and nighttime sleep characteristics correlate with cognitive performance in shift workers. The purpose of this study is to examine the association of objective sleep quality, measured on workdays and days off, with cognitive performance, determined by the psychomotor vigilance task (PVT), in shift workers compared to day workers. We included eight night shift and ten day shift workers from an ongoing pilot study in this analysis. Participants undergo multiple home sleep studies with electroencephalograms on their workdays or days off. Sleep quality measures include total sleep time (TST), percentage of deep sleep stage in TST, and wake time after sleep onset (WASO). Night shift workers showed longer TST and shorter WASO during their nighttime sleep on days off compared to day shift workers. In night shift workers, longer deep sleep on days off was significantly correlated with faster mean reaction time to a visual stimulus (better cognitive performance) on the PVT (r = -.944, p = .016), after controlling for age. However, longer deep sleep during their daytime sleep was associated with slower reaction time (r = .756, p = .049). Further studies are necessary to elucidate differential impacts of daytime and nighttime sleep on the risk of future cognitive impairment in night shift workers.

Sleep and electroencephalography biomarkers in preclinical Alzheimer’s Disease

AbstractBackgroundAccumulating evidence supports a bi‐directional relationship between sleep and Alzheimer’s Disease, including sleep disruptions in preclinical Alzheimer’s Disease (pAD), prior to onset of overt cognitive symptoms. Subsequently, sleep phenotypic variables and electroencephalography (EEG) features are attractive noninvasive biomarkers for pAD. The Biomarkers of Alzheimer’s Disease in Sleep and EEG (BASE) study seeks to develop such sleep‐EEG biomarkers for pAD.MethodCommunity‐dwelling participants (n = 52, mean age: 70.8 ± 4.5 years) underwent cognitive testing including Montreal Cognitive Assessment (MOCA, general cognition), Craft Story 21 (CS21, memory), and Trails A and B (visuospatial, executive); performance was z‐scored by age, sex, and education. Objective measures of sleep quality were obtained using actigraphy over 4‐14 (mean 9.1) days at home: wake time after sleep onset (WASO), number of awakenings (NoA), and sleep efficiency. In‐lab overnight polysomnography was performed, and EEG features were extracted during NREM sleep from F3, F4, C3, and C4 channels: relative slow and fast delta power (RSDP, RFDP), spindle density, and slow wave density. The following morning (9‐10AM), CSF was obtained by fasted lumbar puncture, and assessed for amyloid‐b‐42 and tau; pAD was determined by tau/amyloid‐b‐42 ratio. Correlations between cognitive performance and EEG /sleep variables were performed using linear models, adjusted for age, sex, education, and sleep apnea status. Interaction between pAD status and correlations were assessed.ResultThere were 36 biomarker‐negative healthy controls (HC) and 16 with pAD; groups did not significantly differ demographically. RSDP and WASO were negatively associated with CS21 (RSDP: p = 0.040; WASO: p = 0.034). RFDP and NoA interacted with pAD status for MOCA (RFDP: p = 0.010; NoA: p = 0.026), and RFDP interacted with pAD status for CS21 (p = 0.017).ConclusionWe assessed objective sleep quality and sleep‐EEG features against cognitive performance, and any interaction with pAD status. Worse sleep quality was associated with worse memory performance. Among the EEG features assessed, RFDP was strongly negatively correlated with memory performance in those with pAD, suggesting neurophysiological aberrations of NREM sleep in this cohort.

Preliminary investigation of the interactive role of physiological arousal and insomnia complaints in gray matter volume alterations in chronic widespread pain.

Brain regions involved in insomnia and chronic pain are overlapping and diffuse. The interactive role of physiological arousal in associations between insomnia symptoms and neural regions is unknown. This preliminary study examined whether arousal interacted with sleep in associations with gray matter volume of frontal (dorsolateral prefrontal cortex, anterior cingulate cortex) and temporal (right/left hippocampus) regions in adults with chronic widespread pain and insomnia complaints. Forty-seven adults with chronic widespread pain and insomnia (mean age = 46.00, standard deviation = 13.88, 89% women) completed 14 daily diaries measuring sleep onset latency (SOL), wake time after sleep onset, and total sleep time (TST), as well as Holter monitor assessments of heart rate variability (measuring physiological arousal), and magnetic resonance imaging. Multiple regressions examined whether average SOL, wake time after sleep onset, or TST were independently or interactively (with arousal/heart rate variability) associated with dorsolateral prefrontal cortex, anterior cingulate cortex, and left/right hippocampus gray matter volumes. Shorter TST was associated with lower right hippocampus volume. TST also interacted with arousal in its association with right hippocampal volume, Specifically, shorter TST was associated with lower volume at highest and average arousal levels. SOL interacted with arousal in its association with anterior cingulate cortex volume, such that, among individuals with lowest arousal, longer SOL was associated with lower volume. Preliminary findings highlight the interactive roles of physiological arousal and insomnia symptoms in associations with neural structure in chronic widespread pain and insomnia. Individuals with the highest physiological arousal may be particularly vulnerable to the impact of shorter TST on hippocampal volume loss. Reducing SOL may only impact anterior cingulate cortex volume in those with lower physiological arousal. Curtis AF, Nair N, Hayse B, etal. Preliminary investigation of the interactive role of physiological arousal and insomnia complaints in gray matter volume alterations in chronic widespread pain. J Clin Sleep Med. 2024;20(2):293-302.

THU341 Associations Of Longitudinal Nighttime Sleep Characteristics With Nighttime/Daytime Glucose Values As Assessed By Continuous Glucose Monitoring In Type 2 Diabetes

Abstract Disclosure: Y. Li: None. K.K. Danielson: None. J.C. Park: None. J. McAnany: None. F.Y. Chau: None. B. Prasad: None. E.C. Hanlon: None. S. Reutrakul: None. Background: Sleep disturbances have been shown to be associated with incident diabetes and poor glycemic control. Recently, evidence emerged that nightly sleep may affect glucose levels both during that night and the following day. In this study, we explored the association of serial measures of nightly sleep parameters with night/day glucose levels in patients with type 2 diabetes (T2D). Methods: Baseline data of 28 T2D patients participating in an ongoing study exploring the relationship between diabetes retinopathy (DR) and sleep (NCT 04547439) were included. Sleep was objectively recorded using 14-days actigraphy. Sleep parameters nightly included sleep duration, sleep efficiency, wake time after sleep onset (WASO), and mid-sleep time (MST, time between sleep time and waketime). Glucose was recorded using blinded continuous glucose monitors (CGM). CGM data were divided into nighttime and daytime glucose values, utilizing the sleep time from actigraphy. CGM parameters included mean glucose, percent time spent in range (TIR%; glucose values 70-180 mg/dL), percent time above range (&amp;gt;180 mg/dL), and percent time below range (&amp;lt;70 mg/dL). Glucose variability indices included percent coefficient of variation (%CV) and Continuous Overall Net Glycemic Action (CONGA). Longitudinal mixed linear regression models, adjusting for age, sex, insulin use and DR status, were used to determine the associations between sleep parameters and nighttime/subsequent daytime CGM values. Associations were considered statistically significant at p&amp;lt;0.01 due to the multiple comparisons. Results: Mean (SD) age was 55.0 (6.5) years, A1C was 7.8 (1.5)%, 57% of the participants were female and 60.1% had DR. Average sleep duration was 6.1 (1.0) hours, sleep efficiency was 79.8 (9.6)%, WASO was 49.0 (27.1) minutes and MST was 3:25 (1:23) AM. There were a total of 281 nights and 254 days of CGM recordings. For nighttime CGM analyses, sleep duration (mins) was significantly longer in %TIR of ≥70% vs. &amp;lt;70% (β=57, SE=13, p=0.0005), but there were no associations of duration with other CGM parameters. WASO (log) was positively associated with CONGA (β=2.3, SE=0.9, p=0.008). Earlier MST was associated with greater glucose variability including higher CONGA (β=−1.6, SE=0.4, p&amp;lt;0.0001), and %CV (β=−1.6, SE=0.4, p&amp;lt;0.0001). For the following day CGM analyses, only the association between earlier MST and greater time spent below range (β=−0.7, SE=0.2, p=0.006) was significant. Conclusion: Longer nightly sleep duration was associated with higher nighttime %TIR, while poor sleep continuity was associated with higher nighttime glucose variability. In contrast to previous findings, earlier sleep timing was associated with unfavorable glucose profiles both during nighttime and daytime. These pilot data highlighted the associations between nighttime sleep and metabolic control, and should be explored in a larger cohort. Presentation: Thursday, June 15, 2023

0281 An Assessment of the Agreement Between Sleep Diary and Actigraphy in Firefighters

Abstract Introduction Sleep disruption is a common complaint for firefighters, largely thought to emanate from work and personal demands that prohibit recovery sleep. These disruptions increase the risk of sleep disorders, cardiovascular disease, cancer, and other disorders. Given the significance of sleep on health and the high frequency of sleep disruption in the fire service, we sought to examine the concordance between actigraphic and daily diary sleep assessments. The purpose of this analysis was to contribute information on the use of actigraphy and sleep diaries in shift workers individuals prone to insufficient sleep. Methods The sleep of 60 firefighters (n = 329 observations) working 24-hour shifts was assessed on a 6-day recovery period. Objective sleep was assessed via the Actiwatch-2, a research-grade, wrist-worn actigraph that measures motor activity in 30 sec intervals. Subjective sleep was assessed via the research consensus daily sleep diary, a self-reported measure collected upon awakening. Major sleep indices compared were: sleep onset latency (SOL), total sleep time (TST), sleep efficiency (SE), and wake time after sleep onset (WASO). Results Repeated effects Bland-Altman analysis using a mixed effects technique (measurement = fixed effect; participant = random effect) found that firefighters underestimated WASO (M = 32 min) and overestimated SE (M = 10%) at a level greater than the a priori clinical significance thresholds set by the American Academy of Sleep Medicine for insomnia. The limits of agreement for all sleep indices were very broad. For instance, 95% of the differences between self-report and actigraphic TST fell within a 4.7h range. The majority of the variability could be attributed to within-subject sources of variability versus between-subject sources of variability. Conclusion In firefighters, actigraphy and sleep diaries showed substantial disagreement in major sleep indices, with a systematic underestimation of WASO and overestimation of SE. The wide range of differences suggest that daily assessments of SOL, WASO, SE, or TST in on-call shift workers should be compared against a feasible gold-standard. Further research is needed to understand within-subject factors (e.g., daily differences) that predict a discrepancy between actigraphic and self-reported sleep in different working populations. Support (if any) #1R01HL117995-01A1

0398 Efficacy of Suvorexant for Insomnia Disorder in Patients with Poorly-Controlled Type 2 Diabetes

Abstract Introduction Sleep disturbance is a common and underappreciated feature of diabetes and sleep may contribute to glycemic control in patients with type two diabetes (T2D). We conducted a randomized placebo-controlled 3-month trial to examine the efficacy of suvorexant in improving sleep and other aspects of health in patients with suboptimally-controlled type 2 diabetes and insomnia. Methods This double-blind, randomized placebo-controlled 3-month trial was conducted using the sequential parallel comparison design (SPCD). Sixty-nine poorly-controlled T2D patients (HbA1c≥6.5) were randomized to placebo and/or suvorexant (10-20 mg). The primary outcome was subjective total sleep time (STST), and secondary outcomes were Insomnia Severity Index (ISI) score and wake time after sleep onset (WASO). Exploratory outcomes included sleep efficiency, hemoglobin A1c (HbA1c), and C-reactive protein (CRP). Exploratory analyses were conducted on relationships of sleep and diabetes outcomes. Results There were no significant improvements in STST, ISI, or WASO among patients taking suvorexant compared to those taking placebo. There were also no significant changes in any of the exploratory endpoints. Improvements in sleep were associated with improvements in both objective (i.e. HbA1c) and subjective (i.e. Diabetes Distress Scale) measures of diabetes, across treatment assignments. Conclusion Our negative findings for suvorexant efficacy for insomnia in poorly-controlled T2D may be related to inadequate sample size or due to the complex and multiple contributions to insomnia in this patient population. The associations of improved sleep with improvements in diabetes-related metrics across groups highlights the importance of identifying and treating sleeping difficulties in this population. Support (if any) This research was funded by an investigator-initiated grant from Merck Pharmaceuticals.

0079 Subjective-Objective Sleep Discrepancy in Older Adults: Does Cognitive Functioning Matter?

Abstract Introduction Differences between subjective and objective sleep [subjective-objective sleep discrepancy (SOSD)] is prevalent in insomnia and older adults. Despite associations between cognition and sleep parameters, the impact of cognitive functioning on SOSD is unclear. We examined associations between various cognitive domains and SOSD in older adults and whether insomnia status moderates these associations. Methods Older adults with (N=47, Mage=68.85, 66% women) and without (N=32, Mage=67.41, 78% women) insomnia [met DSM-5 criteria plus reported &amp;gt;30 mins sleep onset latency (SOL) and/or wake time after sleep onset (WASO) on 3+nights/7] completed measures of subjective sleep (7-days of sleep diaries), objective sleep (one-night polysomnography, PSG), and objective cognitive tasks: Dimensional Change Card Sort (executive functioning, EF), List Sorting (working memory, WM), Auditory Verbal Learning Test (episodic memory), Flanker (inhibitory control), Pattern Comparison (processing speed). SOSD direction (average sleep diary variable – PSG variable) was computed. Moderated regressions determined independent and interactive (with insomnia status) associations between cognitive performance and SOSD for SOL, WASO, total sleep time (TST) and sleep efficiency, controlling for age, sex, apnea-hypopnea index, and sleep medication usage. Results For insomnia, longer self-reported than PSG TST was associated with better WM (b=27.90, SE=9.05, p=.003, episodic memory (b=12.83, SE=2.77, p=.01), processing speed (b=9.50, SE=2.00, p&amp;lt;.01), and inhibitory control (b=118.40, SE=54.09, p=.03). Similarly for insomnia, better self-reported than PSG sleep efficiency was associated with better WM (b=5.58, SE=2.12, p=.01), episodic memory (b=2.66, SE=1.08, p=.02), and processing speed (b=2.11, SE=0.47, p&amp;lt;.01). For non-insomnia, reports of SOSD were not associated with cognitive functioning (ps&amp;gt;.05). Conclusion Better diffuse cognitive functioning may be a contributing SOSD mechanism in older adults with insomnia. We speculate that better cognitive functioning may suppress cognitive arousal symptoms that are prevalent in insomnia patients, leading to better self-reported sleep relative to what is objectively measured. Prospective studies examining independent and interactive associations between cognition functioning and arousal, and insomnia on SOSD may inform underlying mechanisms of poor sleep health and the temporal impact on cognition. Support (if any) This research project was made possible by awards (PI: Curtis) from the American Academy of Sleep Medicine Foundation, a foundation of the American Academy of Sleep Medicine.

Dual orexin receptor antagonists for the treatment of insomnia: systematic review and network meta-analysis.

Several randomized clinical trials (RCTs) have shown that dual orexin receptor antagonists (DORAs) are effective in the treatment of chronic insomnia. However, the superiority of one particular DORA over the others remains unclear. To perform a network meta-analysis to evaluate the efficacy of different DORAs in patients with chronic insomnia. The Medline, Embase, and Cochrane Central databases were searched for RCTs that compared DORA with placebo in patients ≥ 18 years of age with a diagnosis of insomnia disorder. We pooled outcomes for wake time after sleep onset (WASO), latency to persistent sleep (LPS), total sleep time (TST), and adverse events (AEs). We included 10 RCTs with 7,806 patients, 4,849 of whom received DORAs as the intervention. Overall, we found that DORAs were associated with the improvement of all analyzed efficacy outcomes. Concerning TST, an apparent dose-dependent pattern was noticed, with higher doses relating to a longer TST. Lemborexant 10mg provided the largest reduction in WASO (at month 1) in minutes (standardized mean difference [SMD] = -25.40; 95% confidence interval [95%CI] = -40.02--10.78), followed by suvorexant 20/15mg (SMD = -25.29; 95%CI = -36.42--14.15), which also appeared to provide the largest decrease in long-term WASO (SMD = -23.70; 95%CI = -35.89--11.51). The most frequent AEs were somnolence, nasopharyngitis, and headache, with rates of up to 14.8%. Our results suggest that DORAs are associated with greater efficacy when compared with placebo in the treatment of insomnia, a complex 24-hour sleep disorder. Additionally, dosing might play an important role in the management of chronic insomnia.

Brain-derived neurotrophic factor (BDNF) variants and promoter I methylation are associated with prolonged nocturnal awakenings in older adults.

Brain-derived neurotrophic factor (BDNF) is important for sleep physiology. This study investigates whether BDNF variants and promoter I methylation may be implicated in sleep disturbances in older adults. Genotyping was performed for seven BDNF single nucleotide polymorphisms (SNPs) in 355 community-dwelling older adults (aged ≥65 years) and BDNF exon 1 promoter methylation was measured in blood samples at baseline (n=153). Self-reported daytime sleepiness and insomnia, ambulatory polysomnography measures of sleep continuity and architecture, and psychotropic drug intake were assayed during follow-up. Logistic regression adjusted for age, sex, comorbidities, body mass index, and psychotropic drug intake. Associations were found specifically between wake time after sleep onset (WASO) and four SNPs in the participants not taking psychotropic drugs, whereas in those taking drugs, the associations were either not significant (rs6265 and rs7103411) or in the reverse direction (rs11030101 and rs28722151). Higher BDNF methylation levels were found at most CpG units in those with long WASO and this varied according to psychotropic drug use. The reference group with short WASO not taking drugs showed the lowest methylation levels and the group with long WASO taking treatment, the highest levels. Some SNPs also modified the associations, the participants carrying the low-risk genotype having the lower methylation levels. This genetic and epigenetic study demonstrated blood BDNF promoter methylation to be a potential biomarker of prolonged nocturnal awakenings in older people. Our results suggest the modifying effect of psychotropic drugs and BDNF genetic variants in the associations between methylation and WASO.

Characteristics of sleep structure in Parkinson's disease patients with hallucinations based on polysomnography.

Hallucination is a common non-motor symptom in patients with Parkinson's disease (PD). Additionally, sleep disorders are associated with an increased risk of hallucinations in PD patients. This study aimed to examine the association between hallucination and objective sleep parameters in PD patients. We retrospectively recruited 278 PD patients who underwent polysomnography and clinical assessments and classified them into non-hallucination and hallucination groups. Hallucinations were observed in 77 older PD patients who had more severe motor symptoms and higher scores on the Non-Motor Symptoms Questionnaire (NMSQ), Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) but lower scores on the Montreal Cognitive Assessment (MOCA) and PD Sleep Scale (PDSS) than PD patients without hallucinations. Analysis of the polysomnographic variables in patients with hallucinations showed that they exhibited a decrease in total sleep time, sleep efficiency (SE), rapid eye movement (REM) sleep time and slow wave sleep (SWS, N3) time and percentage but a significant increase in wake time after sleep onset (WASO), periodic limb movement index (PLMI) scores, and stage 2 NREM (N2)percentage. Logistic regression analysis revealed that higher NMSQ scores, lower MOCA scores, lower SE, and a lower percentage of N3 sleep were associated with hallucinations in PD patients. Our results suggested that PD patients with hallucinations had worse sleep quality and differences in sleep architecture (measured by polysomnography).

The impact of marine engine noise exposure on seafarer fatigue: A China case

Previous relevant studies have revealed that noise and poor sleep quality are two important risk factors causing seafarer fatigue. However, the relationship between marine engine noise and objective sleep parameters has rarely been studied. Using primary data collected from a 28-day on-board experiment and 1 questionnaire survey during both voyage and berthing periods, this study takes a pioneering step to address this crucial relationship. Energy indicators related to the engine noise for 28 days were estimated and 6 objective sleep parameters were used to measure the degree of seafarer fatigue. The findings reveal that as seafarers want to sleep longer to relieve their anxiety and irritability caused by the increased engine noise, the time in bed (TB) and the total sleep time (TST) increased when the engine noise level increased. Meanwhile, with the growing engine noise levels and the higher number of engine noise events, the total wake time after sleep onset (WASO) and the time for sleep onset latency (SOL) increased, and the sleep efficiency (SE) decreased. Energy indicators were significantly associated with objective sleep parameters. Finally, strengthening the content of psychological adjustment in the seafarer training link and cultivating the seafarers' character strength to improve the ability to face harsh environments are recommended. In maritime management, managers should play the role of social work intervention to adjust seafarers’ sleep quality and ease fatigue. In the construction of ships, builders should emphatically consider the use of sound insulation materials to reduce noise effect on living areas.

Efficacy of a Smartphone-Based Virtual Companion to Treat Insomniac Complaints in the General Population: Sleep Diary Monitoring Versus an Internet Autonomous Intervention.

(1) Background: Insomnia is the most prevalent sleep disorder worldwide and cognitive behavioral therapy is the front-line treatment. Digital health technologies have a role to play in screening and delivering interventions remotely and without the need for human intervention. The KANOPEE app, which provides a screening and behavioral intervention for insomnia symptoms through an interaction with a virtual agent, showed encouraging results in previous studies during and after the COVID-19 lockdown, but has not yet been evaluated in a controlled study. This study aims at comparing the benefits of KANOPEE, a smartphone application dealing with insomnia complaints, with another application proposing an electronic sleep diary named “My Sleep Diary”. The acceptance and potential benefits of these digital solutions are tested in real-life settings (i.e., without soliciting human medical resources) and in the general population. (2) Methods: Subjects were included if they downloaded one of the apps between December 2020 and October 2021, and were of legal age. Both apps were available on downloading platforms in France. Primary outcome was Insomnia Severity Index (ISI), and secondary outcomes were total sleep time (TST), sleep efficiency (SE) and wake time after sleep onset (WASO). (3) Results: A total of 535 users completed the intervention with KANOPEE and 489 users completed My Sleep Diary, both for 17 days. KANOPEE users improved their ISI score significantly more than sleep diary users (interaction Time*Group: F(2,2002) = 17.3, p < 0.001). Similar results were found for nocturnal sleep parameters (TST) (KANOPEE users gained 48 min of sleep after intervention, while My Sleep Diary users gained only 16 min of sleep), and particularly in the population with moderate to severe initial sleep complaints (F(4,1980) = 8.9, p < 0.001). Other sleep markers (SE and WASO) were significantly improved in the KANOPEE users compared to the sleep diary ones (p < 0.001). (4) Conclusions: KANOPEE provides significantly greater benefits than an electronic sleep diary regarding reduction of insomnia complaints and estimated nocturnal sleep characteristics in a self-selected sample of the general population. Population with the most severe initial ISI score (≥15) benefited the most from the KANOPEE App compared to filling up a simple sleep diary.

Effectiveness of Cognitive Behavioral Therapy for Sleep Disorder: An overview of Systematic Review

Objectives: The purpose of this overview was to summarize the evidence regarding the effectiveness of Cognitive Behavioral Therapy (CBT) for sleep disorders through systematic reviews (SRs) and meta-analyses (MAs).Methods: An overview of systematic review was conducted according to the study protocol (reviewregistry1320). A comprehensive literature search was performed using three databases (Pubmed, Cochrane Central Register of Controlled Trials, and Web of Science) and three Korean databases (KoreaMed, KMbase, and ScienceON). Final studies were selected by three authors according to inclusion and exclusion criteria, and data needed for analysis were extracted by a pre-planned extraction framework. Methodological quality of systematic review was assessed using the ‘Assessment of multiple systematic reviews 2 (AMSTAR2)’.Results: Fourteen SRs and MAs were included, of which eleven SRs were performed MAs. Twelve studies studied insomnia among sleep disorders, and the rest are nightmares and sleep disturbances with PTSD. Ten studies reported the effect of CBT on sleep disorders measured by insomnia severity index (ISI) and sleep onset latency (SOL), and all reported a significant improvement effect. Eight studies reported the effect of CBT on sleep disorders measured by wake time after sleep onset (WASO), and seven studies reported a significant improvement effect. The methodological quality of the studies evaluated with AMSTAR 2 was mainly low or very low because of omission of protocol registration and excluded study list.Conclusions: Practical guidelines and studies show that CBT is effective for sleep disorders, but access to CBT needs to be improved.

Methamphetamine-Induced Sleep Impairments and Subsequent Slow-Wave and Rapid Eye Movement Sleep Rebound in Male Rhesus Monkeys.

Use of amphetamine-type stimulants is associated with numerous adverse health outcomes, with disturbed sleep being one of the most prominent consequences of methamphetamine use. However, the extent to which methamphetamine alters sleep architecture, and whether methamphetamine-induced sleep impairment is associated with next-day sleep rebound effects, has received relatively little investigation. In the present study, we investigated the effects of acute morning methamphetamine administration on sleep parameters in adult male rhesus monkeys (N = 4) using a fully-implantable telemetry system. Monkeys were prepared with telemetry devices that continuously monitored electroencephalography (EEG), electromyography (EMG) and electrooculography (EOG) throughout the night. We investigated the effects of morning (10h00) administration of methamphetamine (0.01–0.3 mg/kg, i.m.) on sleep during the night of the injection. In addition, we investigated sleep during the subsequent night in order to assess the possible emergence of sleep rebound effects. Methamphetamine administration dose-dependently increased sleep latency and wake time after sleep onset (WASO). Methamphetamine also decreased total sleep time, which was reflected by a decrease in total time spent in N2, slow-wave (N3) and REM sleep stages, while increasing the percentage of total sleep time spent in sleep stage N1. Importantly, methamphetamine decreased time spent in N3 and REM sleep even at doses that did not significantly decrease total sleep time. Sleep rebound effects were observed on the second night after methamphetamine administration, with increased total sleep time reflected by a selective increase in time spent in sleep stages N3 and REM, as well as a decrease in REM sleep latency. Our findings show that methamphetamine administered 8 h prior to the inactive (dark) phase induces marked changes in sleep architecture in rhesus monkeys, even at doses that do not change sleep duration, and that sleep rebound effects are observed the following day for both N3 and REM sleep stages.

Effects of TS-142, a novel dual orexin receptor antagonist, on sleep in patients with insomnia: a randomized, double-blind, placebo-controlled phase 2 study

RationaleNovel compound with potent antagonistic activity against orexin receptors may be new treatment option for patients with insomnia.ObjectiveThe aim was to investigate the efficacy and safety of single oral doses of the dual orexin receptor antagonist TS-142 in patients with insomnia.MethodsThis multicenter, double-blind, crossover randomized clinical trial included non-elderly patients with insomnia. Patients were randomized to receive single doses of placebo and TS-142 at doses of 5, 10, and 30 mg in one of four different sequences, with a 7-day washout period between treatments. Primary efficacy endpoints were latency to persistent sleep (LPS) and wake time after sleep onset (WASO) measured by polysomnography.ResultsTwenty-four patients were included (mean age 50.3 ± 10.5 years; mean duration of insomnia 5.71 ± 8.68 years). Least-squares mean differences (95% confidence interval) from placebo in LPS with 5, 10, and 30 mg TS-142 were − 42.38 (− 60.13, − 24.63), − 42.10 (− 60.02, − 24.17), and − 44.68 (− 62.41, − 26.95) minutes, respectively (all p < 0.001). Least-squares mean differences (95% confidence interval) from placebo in WASO with 5, 10, and 30 mg TS-142 were − 27.52 (− 46.90, − 8.14), − 35.44 (− 55.02, − 15.87), and − 54.69 (− 74.16, − 35.23) minutes, respectively (all p < 0.01). Self-reported aspects of sleep initiation and sleep quality, determined using the Leeds Sleep Evaluation Questionnaire (LSEQ), were also improved with TS-142 administration versus placebo. TS-142 was well tolerated; all adverse events were mild or moderate and none were serious.ConclusionSingle-dose TS-142 was well tolerated and had clinically relevant effects on objective and subjective sleep parameters in patients with insomnia.Clinical Trial registrationJapicCTI173570 (www.clinicaltrials.jp); NCT04573725 (www.clinicaltrials.gov).

Relationship between sleep quality, mood state, and performance of elite air-rifle shooters

BackgroundTo evaluate the impact of pre-competition sleep quality on the mood and performance of elite air-rifle shooters.MethodsElite shooters who participated in an air-rifle shooting-competition from April 2019 to October 2019 were evaluated using actigraphy, including Total Sleep Time (TST), Sleep Efficiency (SE), Sleep Latency (SL), Wake-time after Sleep Onset (WASO). Sleep quality was assessed by Pittsburgh sleep quality index (PSQI) and Profile of Mood State (POMS). Mood state was assessed by Competitive State Anxiety Inventory-2.ResultsStudy included 23 shooters, of them 13 male and 10 female with the mean age 23.11 ± 4.82 years. The average time to fall asleep was 20.6 ± 14.9 min, TST was 7.0 ± 0.8 h and SE was 85.9 ± 5.3%. Average sleep quality was 5.2 ± 2.2 and tended to decrease as the competition progressed. Pre-competition sleep time in female athletes was significantly higher compared to the competition day (P = 0.05). Pre-competition SL was significantly longer in women than in men (P = 0.021). During training and pre-competition, the tension, fatigue, depression, and emotional disturbance were significantly lower in athletes with good sleep quality. Athletes with good sleep quality had significantly more energy. The PSQI total score positively correlated with cognitive anxiety (r = 0.471, P < 0.01), and somatic anxiety (r = 0.585, P < 0.01), and negatively correlated with energy (− 0.504, P < 0.01) and self-confidence scores (r = − 0.523, P < 0.01).ConclusionPoor sleep quality negatively impacted the mood of athletes; however, sleep indices and competition performance of athletes during competitions were not significantly correlated.