scholarly journals Insomnia subtypes characterised by objective sleep duration and NREM spectral power and the effect of acute sleep restriction: an exploratory analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chien-Hui Kao ◽  
Angela L. D’Rozario ◽  
Nicole Lovato ◽  
Rick Wassing ◽  
Delwyn Bartlett ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Spectral Power ◽  
Power Spectral Analysis ◽  
Asymmetry Index ◽  
Sleep Restriction ◽  
Healthy Controls ◽  
Sleep State ◽  
Subjective Sleep Quality ◽  
Delta Power ◽  
Normal Sleep

AbstractInsomnia disorder (ID) is a heterogeneous disorder with proposed subtypes based on objective sleep duration. We speculated that insomnia subtyping with additional power spectral analysis and measurement of response to acute sleep restriction may be informative in overall assessment of ID. To explore alternative classifications of ID subtypes, insomnia patients (n = 99) underwent two consecutive overnight sleep studies: (i) habitual sleep opportunity (polysomnography, PSG) and, (ii) two hours less sleep opportunity (electroencephalography, EEG), with the first night compared to healthy controls (n = 25). ID subtypes were derived from data-driven classification of PSG, EEG spectral power and interhemispheric EEG asymmetry index. Three insomnia subtypes with different sleep duration and NREM spectral power were identified. One subtype (n = 26) had shorter sleep duration and lower NREM delta power than healthy controls (short-sleep delta-deficient; SSDD), the second subtype (n = 51) had normal sleep duration but lower NREM delta power than healthy controls (normal-sleep delta-deficient; NSDD) and a third subtype showed (n = 22) no difference in sleep duration or delta power from healthy controls (normal neurophysiological sleep; NNS). Acute sleep restriction improved multiple objective sleep measures across all insomnia subtypes including increased delta power in SSDD and NSDD, and improvements in subjective sleep quality for SSDD (p = 0.03), with a trend observed for NSDD (p = 0.057). These exploratory results suggest evidence of novel neurophysiological insomnia subtypes that may inform sleep state misperception in ID and with further research, may provide pathways for personalised care.

Insomnia subtypes characterised by objective sleep duration and NREM spectral power and the effect of acute sleep restriction: an exploratory analysis

2021 ◽  
Author(s):  
Chien-Hui Kao ◽  
Angela L. D'Rozario ◽  
Nicole Lovato ◽  
Rick Wassing ◽  
Delwyn Bartlett ◽  
...  
Keyword(s):  
Sleep Duration ◽  
Spectral Power ◽  
Power Spectral Analysis ◽  
Asymmetry Index ◽  
Sleep Restriction ◽  
Healthy Controls ◽  
Sleep State ◽  
Subjective Sleep Quality ◽  
Delta Power ◽  
Normal Sleep

Abstract Insomnia disorder (ID) is a heterogeneous disorder with proposed subtypes based on objective sleep duration. We speculated that insomnia subtyping with additional power spectral analysis and measurement of response to acute sleep restriction may be informative in overall assessment of ID. To explore alternative classifications of ID subtypes, insomnia patients (n = 99) underwent two consecutive overnight sleep studies: (i) habitual sleep opportunity (polysomnography, PSG) and, (ii) two hours less sleep opportunity (electroencephalography, EEG), with the first night compared to healthy controls (n = 25). ID subtypes were derived from data-driven classification of PSG, EEG spectral power and interhemispheric EEG asymmetry index. Three insomnia subtypes with different sleep duration and NREM spectral power were identified. One subtype (n = 26) had shorter sleep duration and lower NREM delta power than healthy controls (short-sleep delta-deficient; SSDD), the second subtype (n = 51) had normal sleep duration but lower NREM delta power than healthy controls (normal-sleep delta-deficient; NSDD) and a third subtype showed (n = 22) no difference in sleep duration or delta power from healthy controls (normal neurophysiological sleep; NNS). Acute sleep restriction improved multiple objective sleep measures across all insomnia subtypes including increased delta power in SSDD and NSDD, and improvements in subjective sleep quality for SSDD (p = 0.03), with a trend observed for NSDD (p = 0.057). These exploratory results suggest evidence of novel neurophysiological insomnia subtypes that may inform sleep state misperception in ID and with further research, may provide pathways for personalised care.

Insomnia and sleep state misperception: Clinical features, diagnosis, management and implications

2017 ◽  
Vol 41 (S1) ◽  
pp. s853-s853
Author(s):  
J. Isaac ◽  
C. Santos ◽  
A. Matos Pires
Keyword(s):  
Sleep Duration ◽  
Clinical Features ◽  
Mental Disease ◽  
Sleep Time ◽  
Sleep State ◽  
Short Sleep Duration ◽  
Short Sleep ◽  
Psychological Therapies ◽  
Normal Sleep ◽  
Competing Interest

BackgroundInsomnia is a highly prevalent complaint, largely associated with mental disease. Clinical evidence classifies insomnia in 2 subtypes: with sleep misperception (WSM) and without sleep misperception (wSM). That presents distinctive pathophysiologic pathways and different public health implications.ObjectivesDescribe the main differences between primary insomnia WSM and wSM regarding:– clinical features;– diagnosis;– management;– implications.MethodsWe conducted a systematic review. PubMed, Embase and PsycInfo were searched from 2000–2016. The reference lists of systematic reviews, narrative synthesis and some important articles were included. Following the inclusion criteria, we selected 25 studies from 59 articles.ResultsThe prevalence of sleep-state misperception in primary insomniacs (total sleep time > 6.5 h and sleep efficiency > 85%) is around 26%. Insomniacs with normal sleep duration showed a profile of high depression and anxiety and low ego strength, whereas insomniacs with short sleep duration showed a profile of a medical disorder.Cortical hyperarousal is higher in insomniacs and could be related to an alteration in sleep protection mechanisms. The sleep architecture was relatively normal for the WSM comparing with the group wSM. Risk of cardiometabolic, neurocognitive morbidity and mortality, and responses to treatment are different between these two insomnia phenotypes. Patients with short sleep duration may respond better to biological treatments, whereas insomnia with normal sleep duration may respond primarily to psychological therapies.ConclusionsThe clinical characteristics of patients with sleep-state misperception differed from those without this condition. Available research related to these conditions is expanding rapidly, but many questions remain unanswered.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals 0280 Change in Sleep Depth Across the Night as a Measure of Sleep Adequacy

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A106-A106
Author(s):  
P K Schweitzer ◽  
K Griffin ◽  
M Younes ◽  
J K Walsh
Keyword(s):  
Spectral Power ◽  
Secondary Analysis ◽  
Nrem Sleep ◽  
Sleep Time ◽  
Sleep Restriction ◽  
Continuous Measure ◽  
Delta Power ◽  
Sleep Depth ◽  
Sleep Adequacy ◽  
The Individual

Abstract Introduction It is well known that sleep becomes lighter towards the end of the night reflecting the reduction in homeostatic sleep pressure. We hypothesized that more adequate nocturnal sleep (i.e. sufficient quantity and quality for the individual) would result in a greater reduction in sleep depth across the night and would be reflected in decreased next-day sleep tendency. Methods In a secondary analysis of data from a study in which sleep depth was altered by sleep restriction combined with either placebo or gaboxadol (a delta-promoting drug) we correlated change across the night in two measures of sleep depth with next-day Multiple Sleep Latency Test (MSLT) latencies. Forty-one healthy subjects underwent 8 consecutive sleep studies; two baseline, four sleep restriction (5 hours) and two recovery nights. MSLT was performed following each baseline night and the last two restriction nights. Sleep depth in the first and last hours of NREM sleep was determined by two methods 1) Log delta spectral power; 2) The odds-ratio-product (ORP), a recently introduced continuous measure of sleep depth. The difference between initial and final values was calculated (ΔDelta, ΔORP). Post-restriction MSLT latency was correlated with baseline MSLT latency, ΔDelta, ΔORP, log delta power and ORP in the last hour, lost total sleep time and lost REM time. Results ΔDelta was -0.27 ±0.13 and ΔORP was 0.17 ±0.13, both changes reflecting lightening of sleep across the night. In both univariate and multivariate analysis only baseline MSLT latency (p &lt 0.001) and ΔORP (p &lt 0.01) were significantly and positively correlated with post-restriction MSLT latency. Conclusion The reduction in sleep depth across the night as measured by ORP, but not by delta power, is significantly correlated with reduced objective sleepiness following sleep restriction. ΔORP may be a useful index that reflects sleep adequacy during the night. Support None

scholarly journals Comparing two measures of sleep depth/intensity

SLEEP ◽  
2020 ◽  
Vol 43 (12) ◽  
Author(s):  
Magdy Younes ◽  
Paula K Schweitzer ◽  
Kara S Griffin ◽  
Robert Balshaw ◽  
James K Walsh
Keyword(s):  
Spectral Power ◽  
Secondary Analysis ◽  
Sleep Restriction ◽  
Sleep Stages ◽  
Characteristic Analysis ◽  
Experimental Conditions ◽  
Delta Power ◽  
Sleep Depth ◽  
Two Measures ◽  
Degree Of Association

Abstract Study Objectives To compare delta spectral power (delta) and odds ratio product (ORP) as measures of sleep depth during sleep restriction with placebo or a drug that increases delta. Methods This is a secondary analysis of data from a study of 41 healthy participants randomized to receive placebo or gaboxadol 15 mg during sleep restriction. Participants underwent in-laboratory sleep studies on two baseline, four sleep restriction (5-h), and two recovery nights. Relation between delta or ORP and sleep depth was operationally defined as the degree of association of each metric to the probability of arousal or awakening occurring during the next 30 s (arousability). Results ORP values in wake, N1, N2, N3, and REM were significantly different. Delta differed between both N2 and N3 and other sleep stages but not between wake and N1 or N1 and REM. Epoch-by-epoch and individual correlations between ORP and delta power were modest or insignificant. The relation between ORP and arousability was linear across the entire ORP range. Delta also changed with arousability but only when delta values were less than 300 μV2. Receiver-operating-characteristic analysis found the ability to predict imminent arousal to be significantly greater with ORP than with log delta power for all experimental conditions. Changes in ORP, but not log delta, across the night correlated with next-day physiologic sleep tendency. Conclusions Compared to delta power, ORP is more discriminating among sleep stages, more sensitive to sleep restriction, and more closely associated with arousability. This evidence supports ORP as a measure of sleep depth/intensity.

332 Non-REM EEG Spectral Power at Baseline and After Total Sleep Deprivation in Individuals with Sleep-Onset Insomnia

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A133-A133
Author(s):  
Myles Finlay ◽  
Devon Hansen ◽  
Lillian Skeiky ◽  
Hans Van Dongen
Keyword(s):  
Sleep Deprivation ◽  
Rem Sleep ◽  
Spectral Power ◽  
Sleep Onset ◽  
Sleep Eeg ◽  
Alpha Power ◽  
Healthy Controls ◽  
Total Sleep Deprivation ◽  
Delta Power ◽  
Sleep Homeostasis

Abstract Introduction The baseline non-REM sleep EEG of individuals with insomnia has been found to display increased spectral power at frequencies >14Hz, which may reflect hyperarousal. There is some evidence in this population of reduced slow wave activity after total sleep deprivation (TSD), potentially indicating altered sleep homeostasis. We investigated non-REM sleep EEG spectra at baseline and after TSD in individuals with sleep-onset insomnia. Methods 10 individuals with sleep-onset insomnia and 5 healthy controls (ages 22-40y, 11 females) completed a 5-day laboratory study with an adaptation night, baseline night, assignment to 38h TSD (n=5 insomnia, n=5 control) or equivalent non-TSD control (n=5 insomnia), and recovery night. Sleep periods were 10h (22:00-08:00) with digital polysomnography (250Hz; Nihon Kohden). Following artifact rejection, 5s subepochs of the non-REM (stages N2, N3) sleep EEG (C3-M2 derivation) in baseline and recovery nights were subjected to spectral analysis. Spectra (0.2Hz bins) were averaged over subepochs in 30s epochs. Repeated-measures ANOVA compared baseline spectra between insomnia and controls, and baseline-recovery difference spectra between TSD insomnia, non-TSD insomnia, and TSD controls. Results Average non-REM sleep amount was 5.9 at baseline, increasing by 1.1h after TSD, with no differences between groups (p≥0.20). At baseline, the insomnia group showed increased power in theta/alpha (~4–12Hz), reaching significance in the lower spindle range, compared to controls (p<0.05). As anticipated, no differences emerged between baseline and recovery nights in the non-TSD insomnia group. However, the TSD insomnia group showed increased delta (~1–3Hz) and theta/alpha (~6–10Hz) power (p<0.05) during recovery. Healthy controls showed expected power increases in delta and lower spindle range, and decreases in upper spindle range (~14–15Hz), after TSD (p<0.05). Conclusion Compared to healthy controls, individuals with sleep-onset insomnia showed increased non-REM sleep EEG power in the theta/alpha bands and low spindle frequency range, with further significant increases in theta/alpha in addition to delta power following TSD, despite small sample size. The increase in delta power following TSD was equivalent to that in healthy controls, suggesting no sleep homeostasis abnormality. Whether the elevated theta/alpha power may be related to hyperarousal is unclear. Support (if any) ONR grant N00014-13-C-0063

scholarly journals 0150 Comparing Two Measures of Sleep Depth/ Intensity

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A59-A59
Author(s):  
M Younes ◽  
P K Schweitzer ◽  
K Griffin ◽  
J K Walsh ◽  
R Balshaw
Keyword(s):  
Spectral Power ◽  
Secondary Analysis ◽  
Sleep Restriction ◽  
Sleep Stages ◽  
Continuous Measure ◽  
Characteristic Analysis ◽  
Experimental Conditions ◽  
Delta Power ◽  
Sleep Depth ◽  
Two Measures

Abstract Introduction There is currently no well-validated method for evaluating objective sleep depth/intensity. Delta power is thought to reflect sleep depth based upon limited evidence. Odds-ratio-product (ORP) is a recently introduced continuous measure of sleep depth. We compared delta spectral power (delta) and ORP as measures of sleep depth/intensity during manipulations that altered sleep depth (sleep restriction with placebo or with a delta-promoting drug). We hypothesized that ORP will provide a more robust measure of sleep depth. Methods This is a secondary analysis of data from a study in which forty-one healthy subjects were sleep restricted and randomized to receive placebo or gaboxadol 15mg. Participants underwent consecutive in-laboratory sleep studies on two baseline, four sleep restriction (5 hours) and two recovery nights. The relation between delta or ORP during any given 30s epoch and sleep depth, operationally defined as the probability of arousal / awakening occurring during the next 30 seconds (arousability), was assessed. Results Mean ORP values differed significantly among the four sleep / wake stages, but delta power did not differentiate wake, N1 and N2. The relation between ORP and arousability was linear across the entire range of ORP whereas delta power detected differences in arousability only with delta values &lt 300 μV2. Correlations with arousability in individual subjects were stronger with ORP (p &lt 0.0001). Receiver operating characteristic analysis found the ability to predict imminent arousal to be significantly greater with ORP than with delta power for all experimental conditions (p &lt 0.0001). The increase in sleep depth with restriction alone was detected on the second day of restriction by ORP (p &lt 0.01) but not by delta. Conclusion As compared to delta power, ORP is more discriminating among sleep stages, more sensitive to sleep restriction, and more closely associated with arousability. These observations indicate ORP better reflects sleep depth/intensity. Support None

scholarly journals Preoperative Heart Rate Variability During Sleep Predicts Vagus Nerve Stimulation Outcome Better in Patients With Drug-Resistant Epilepsy

2021 ◽  
Vol 12 ◽  
Author(s):  
Xi Fang ◽  
Hong-Yun Liu ◽  
Zhi-Yan Wang ◽  
Zhao Yang ◽  
Tung-Yang Cheng ◽  
...  
Keyword(s):  
Machine Learning ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Outcome Prediction ◽  
Healthy Controls ◽  
Drug Resistant ◽  
Sleep State ◽  
Drug Resistant Epilepsy

Objective: Vagus nerve stimulation (VNS) is an adjunctive and well-established treatment for patients with drug-resistant epilepsy (DRE). However, it is still difficult to identify patients who may benefit from VNS surgery. Our study aims to propose a VNS outcome prediction model based on machine learning with multidimensional preoperative heart rate variability (HRV) indices.Methods: The preoperative electrocardiography (ECG) of 59 patients with DRE and of 50 healthy controls were analyzed. Responders were defined as having at least 50% average monthly seizure frequency reduction at 1-year follow-up. Time domain, frequency domain, and non-linear indices of HRV were compared between 30 responders and 29 non-responders in awake and sleep states, respectively. For feature selection, univariate filter and recursive feature elimination (RFE) algorithms were performed to assess the importance of different HRV indices to VNS outcome prediction and improve the classification performance. Random forest (RF) was used to train the classifier, and leave-one-out (LOO) cross-validation was performed to evaluate the prediction model.Results: Among 52 HRV indices, 49 showed significant differences between DRE patients and healthy controls. In sleep state, 35 HRV indices of responders were significantly higher than those of non-responders, while 16 of them showed the same differences in awake state. Low-frequency power (LF) ranked first in the importance ranking results by univariate filter and RFE methods, respectively. With HRV indices in sleep state, our model achieved 74.6% accuracy, 80% precision, 70.6% recall, and 75% F1 for VNS outcome prediction, which was better than the optimal performance in awake state (65.3% accuracy, 66.4% precision, 70.5% recall, and 68.4% F1).Significance: With the ECG during sleep state and machine learning techniques, the statistical model based on preoperative HRV could achieve a better performance of VNS outcome prediction and, therefore, help patients who are not suitable for VNS to avoid the high cost of surgery and possible risks of long-term stimulation.

Women with abuse-related PTSD sleep more fitfully but just as long as healthy controls: an actigraphic study

SLEEP ◽  
2021 ◽  
Author(s):  
Franziska Friedmann ◽  
Holger Hill ◽  
Philip Santangelo ◽  
Ulrich Ebner-Priemer ◽  
Andreas B Neubauer ◽  
...  
Keyword(s):  
Childhood Abuse ◽  
Sleep Duration ◽  
Stress Disorder ◽  
Healthy Controls ◽  
Healthy Women ◽  
Healthy Control ◽  
History Of ◽  
Group A ◽  
Subjective Reports ◽  
Ptsd Group

Abstract Study Objectives Subjective reports of sleep impairments are common in individuals with posttraumatic stress disorder (PTSD), but objective assessments of sleep have yielded mixed results. Methods We investigated sleep via actigraphy and e-diary on 6 consecutive nights in a group of 117 women with PTSD after childhood abuse (CA; PTSD group), a group of 31 mentally healthy women with a history of CA (healthy trauma controls, HTC group) and a group of 36 non-traumatized mentally healthy women (healthy controls, HC group). Results The PTSD group reported lower sleep quality, more nights with nightmares, and shorter sleep duration than both HTC and HC. Actigraphic measures showed more and longer sleep interruptions in the PTSD group compared to HTC and HC, but no difference in sleep duration. While the PTSD group underestimated their sleep duration, both HTC and HC overestimated their sleep duration. HTC did not differ from HC regarding sleep impairments. Conclusions Sleep in women with PTSD after CA seems to be more fragmented but not shorter compared to sleep patterns of mentally healthy control subjects. The results suggest a stronger effect of PTSD psychopathology on sleep compared to the effect of trauma per se.

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